Items for the original HTVI were adapted from existing instruments on engagement, teamwork, work setting, and safety.
As part of Phase I of the study, the authors conducted cognitive interviews with a convenience sample of 18 providers (mostly registered nurses and ancillary staff). After taking the survey, providers were asked, "When you answered this question, what did you think you were being asked?" After reviewing the providers' answers and the fit between their answers with the item's intended construct, authors eliminated one and revised two items.
As part of Phase II of the study, the authors conducted exploratory factor analysis on the revised 19-item HTVI using a split sample of 464 health care providers. The results indicated a good fit for a four-factor model with 58% of scale variance explained by 10 items. Confirmatory factor analysis of the second half of the sample indicated good fit for a four-factor model, NNFI = 0.96, CFI = 0.98, RMSEA = 0.06.
Relation to Other Variables:
As part of Phase I of the study, the authors conducted a cross-sectional survey of 439 health care workers to examine the relationship between the 19 revised HTVI items and those from established instruments: (1) the Nursing Work Index-Revised (NWI-R), which focuses on job satisfaction, and (2) the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey of Patient Safety. Ten of the 19 items were correlated <.50 with either the NWI-R or the AHRQ instrument.