Today, in health care processes, there is evidence of the need for valid and reliable metrics for the implementation of organizational models in health sector companies that incorporate PCC as a guiding principle. Respect for human dignity and the strengthening of an organizational culture aimed at human beings and the protection of life in general are essential components of PCC.14 This humanized vision of the health worker is a contribution to the improvement of the quality and experience within the health system since it promotes excellence and innovation in organizations by contributing to the processes of patient care, satisfaction, the sense of membership and the promotion of well-being in the work environment.1
The psychometric validation analyzed and presented in this study sought to design and validate an instrument that would measure common aspects of person-centered care related to or affecting the experience of health care providers who work in different areas, such as hospital services and ambulatory and virtual care. The results of the validation from the exploratory factor analysis showed that the questionnaire has an underlying structure composed of a single factor solution, or by rotating the solution with the Varimax method, a two-factor solution. When evaluating the structure from the confirmatory factor analysis, the two-factor model has better goodness of fit, but it is not consistent with the conceptual understanding of the phenomenon and when comparing the single-factor model in an attempt to understand the experience, its goodness of fit is less than the five-factor structure extracted a priori from PCC theory. The reliability of the five-factor model is high, and its convergent validity with the NPS is moderate.
The descriptive results of the questionnaire showed that 82% of the subjects reported a positive overall experience. The most positive finding was in the domain "nutrition of being"; health care providers reported feeling happy that they were caring for patients’ health and that this was a corporate value they incorporated in their daily work. Providers had a less favorable perception of participation in the work environment. They reported a lack of recognition, integration in their work teams and initiatives to contribute to technical and scientific innovations in research or clinical practice. These aspects can be improved in institutions.
The evaluation of health care providers’ experiences contributes to a broader understanding of the quality of service and fosters dialog between workers and their organizations about what truly matters to health care teams. This is reflected in benefits for organizations dedicated to health care and society in multiple aspects, such as a better experience for health care providers and their well-being, good clinical results, safety and quality, a better experience for patients and the community, and a reduction in health care costs.
It is common to find that the level of satisfaction among health care providers is measured through direct measurements such as the NPS and indirect measures such as the work environment and the rotation of the health care provider, among others. Satisfaction is generally related to the operation of the health institution and its services and activities that may have a direct relationship with patient outcomes. Measurements that meet the country’s current guidelines are also used to evaluate compliance with the hiring process, benefits, communication and assigned headquarters. From time to time in high-risk areas, psychosocial risk has been assessed by evaluating healthy lifestyles, professional burnout, depression, satisfaction with personal and professional life, and religious or spiritual beliefs.
However, the purpose of measuring the experiences of health care providers is to identify their perceptions of physical, emotional and psychological interactions with any part of the institution, the health system, the patient, family and community. This assessment transcends the regulatory obligation, dignifies people, and fosters safe, transparent, legitimate and constructive organizations, with promises of value that reach all dimensions of the human being and their environment.
The adoption and implementation of this type of metric within health care organizations allows decision-makers from service leaders to discharge directors to stimulate the continuous and permanent creation of a culture of humanization toward the worker and to articulate it with guidelines, projects, programs, development plans and policies in which the PCC is oriented. Actions such as this one, at the local level in Colombia, have become one of the great challenges in the health sector, according to the Ministry of Health and Social Protection.1
Regarding the methodological limitations of this study, it is found that despite using a large and sufficient sample size for statistical calculations, the surveyed population could have low representation of some health professions and be biased in the evaluation of the experience when a respondent worked in more than one company at the same time. Additionally, it was found that the use of the NPS for the validity of convergent validity did not show results consistent with the theoretical hypothesis of the researchers. The correlation was lower than expected; so, future studies should include scales more commonly used in the workplace to measure job satisfaction and similar concepts.
It is important to indicate that, in construct validity, the model with the best goodness of fit was the two-factor model; however, this model does not have conceptual coherence according to PCC theory. For this reason, a comparison was made between a single-factor model to compare the scale as a single domain or a whole and a model with the five factors or domains established a priori in which the latter had better goodness of fit. However, the discriminant validity of the domains was not greater than the AVE, so these domains did not achieve statistical discrimination among themselves, although their distinction is important at a conceptual level.