Construction And Application Of Evaluation Index System Of Lean Medical Incentive Level Based On AMO Theoretical Model

ObjectiveThis study takes the AMO theoretical model as the theoretical framework,aims at building a set of objective,simple and easy evaluation tool of domestic lean medical incentive level and testing its reliability and validity through empirical analysis,and analyzes the influencing factors for lean medical incentive level of hospitals,so as to provide reference and basis for improving the lean management level of hospitals.MethodsIn the first stage of the construction of the evaluation index of lean medical incentive level,this study constructs the evaluation index pool of lean medical incentive level by literature analysis method and semi-structured interview method;it scores the importance and rationality of each index in the evaluation index pool of lean medical incentive level with Delphi expert consultation method,puts forwards suggestions on increase,modification or deletion,and selects the answers to the three levels of indexes,so as to establish the evaluation index system of lean medical incentive level.In the second stage of project analysis,reliability and validity test,weight determination of all levels of indexes in terms of the evaluation index system of lean medical incentive level,this study issues online and offline questionnaire of "survey on the status quo of lean medical incentive level of hospitals" to the front-line employees(who are on the job in 2021 and have a certain understanding and contact with lean medical of their hospitals)of 6 hospitals in Guangdong Province that have carried out lean improvement through questionnaire and purpose sampling;it makes project analysis of questionnaire and tests its reliability and validity by statistical analysis method,and carries out descriptive statistical analysis of questionnaire data,project analysis,internal consistency and split half reliability test,exploratory factor analysis SPSS24.0 software and confirmatory factor analysis with AMOS24.0 software.According to the test results,the study improves the index system and determines the weight of each index by the standardized load by confirmatory factor analysis.In the third stage of analysis of the status quo of lean medical incentive level of hospitals and its influencing factors,this study mainly makes descriptive statistical analysis of the questionnaire data and comparative analysis of two or more groups of data with the statistical analysis method and SPSS24.0 software.If the measurement data conform to the normal distribution,this study makes the statistical description with(X±s).If not,it makes M(P35～P75)description.Two(more)groups of independent measurement data meeting the requirements of both normality and homogeneity of variance are tested with two independent samples t(one-way analysis of variance).This study compares two(more)groups of measurement data that do not conform to the normal distribution based on non parametric Mann Whitney U test(Kruskal-Wallis test).In this way,it further makes pairwise analysis by all paired and multiple comparisons of Kruskal-Wallis one-way ANOVA(k sample).The counting data are described by constituent ratio or percentage.P<0.05 was considered statistically significant.With Nvivo12.0 software,it fully matches lean incentive highlights and suggestions evaluated by the employees of 6 hospitals,and selects the first 50 phrases for the analysis of word frequency and formulation of word cloud map.ResultsIn the first stage of the construction of the evaluation index of lean medical incentive level,this study constructs the evaluation index pool of lean medical incentive level of hospitals by the early literature analysis and expert interviews,including three first-level indexes,nine second-level indexes and thirty-one third-level indexes.After three rounds of consulting Delphi experts,it forms the evaluation index system of lean medical incentive level of hospitals,including three first-level indexes,ten second-level indexes and thirty-four third-level indexes.In the second stage of project analysis,reliability and validity test,weight determination of all levels of indexes in terms of the evaluation index system of lean medical incentive level,1772 effective questionnaires are recovered,with the effective recovery rate of 88.70%.According to the results of project analysis,the absolute value of critical ratio is greater than 3(P<0.05).The overall Cronbach a coefficient of the questionnaire is 0.991,and the Cronbach a coefficient of each dimension was above 0.970;the Cronbach a coefficient,Pearson correlation coefficient,Spearman-Brown split half coefficient and Guttman split half reliability coefficient of the two sub questionnaires are above 0.900.The cumulative explanatory variance of the three common factors extracted from the exploratory factor analysis is 82.97%,and the three factors after rotation are completely consistent with the first-level index dimension design of this study.According to the results of first-order confirmatory factor analysis,the average variance extraction(AVE)are above 0.5 and combined reliability(C.R.)of potential variables are above 0.6;the correlation coefficients between potential variables are less than the corresponding AVE square root index;the correlation coefficients between potential variables in the same dimension are above 0.75,showing a moderate and high correlation and suggesting the high-order confirmatory factor analysis.According to the results of second-order confirmatory factor analysis,the AVE are above 0.5 and C.R.of potential variables are above 0.6;the correlation coefficients between potential variables are less than the corresponding AVE square root index.After the establishment of the residual correlation in the same dimension,the χ2/df of the modified second-order confirmatory factor was 6.421(>3),RMSEA 0.078(<0.08),NFI 0.937(>0.90),RFI 0.931(>0.90),IFI 0.946(>0.90),CFI 0.946(>0.90),RMR 0.025(<0.05),PNFI 0.855(>0.50),and PCFI 0.864(>0.50).In the third stage of analysis of the status quo of lean medical incentive level of hospitals and its influencing factors,For the hospitals involved,the overall score of lean medical incentive level is 3.9700(3.1195～4.4449),the practical ability is 4.0000(3.0104～4.4415),the practical motivation is 4.0000(3.0453～4.5645),and the practical opportunity dimension is 3.9998(2.9999～4.4931);Different hospital levels(secondary or tertiary),ages,education backgrounds,positions,technical qualifications,working years,positions,and whether they belong to lean green belt,have participated in or hosted lean medical projects,and served as tutor of lean project team affect the lean medical incentive level evaluation.The lean medical incentive highlights evaluated by the employees of the six hospitals participating in the survey mainly include leaders’full attention to and support for lean,lean medical assistance to service quality improvement,lean medical promotion of work efficiency,and others.And the employees involved also propose to strengthen training,link lean medical with departmental rating and target responsibility,enhance cooperation between departments,and increase the reward of lean medical.ConclusionThis study determines the final evaluation index system of lean medical incentive level,including three first-level indexes,ten second-level indexes and thirty-four third-level indexes.The test shows that the index system is with excellent internal consistency reliability and split half reliability,higher structural validity,convergence validity and discriminant validity,and is a good tool for hospitals in China to measure the lean incentive level.