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assessment of variation in the alberta context tool the contribution of unit level contextual factors and specialty in canadian pediatric acute care settings在阿尔伯塔省上下文工具评估变化的贡献单位级上下文因素和专业在加拿大儿科急性护理设置
Estabrooks et al. BMC Health Services Research 2011, 11:251
/1472-6963/11/251
RESEARCH ARTICLE Open Access
Assessment of variation in the alberta context
tool: the contribution of unit level contextual
factors and specialty in Canadian pediatric acute
care settings
1* 2 3 1 1
Carole A Estabrooks , Janet E Squires , Alison M Hutchinson , Shannon Scott , Greta G Cummings ,
Sung Hyun Kang1, William K Midodzi4 and Bonnie Stevens5
Abstract
Background: There are few validated measures of organizational context and none that we located are
parsimonious and address modifiable characteristics of context. The Alberta Context Tool (ACT) was developed to
meet this need. The instrument assesses 8 dimensions of context, which comprise 10 concepts. The purpose of
this paper is to report evidence to further the validity argument for ACT. The specific objectives of this paper are
to: (1) examine the extent to which the 10 ACT concepts discriminate between patient care units and (2) identify
variables that significantly contribute to between-unit variation for each of the 10 concepts.
Methods: 859 professional nurses (844 valid responses) working in medical, surgical and critical care units of 8
Canadian pediatric hospitals completed the ACT. A random intercept, fixed effects hierarchical linear modeling
(HLM) strategy was used to quantify and explain variance in the 10 ACT concepts to establish the ACT’s ability to
discriminate between units. We ran 40 models (a series of 4 models for each of the 10 concepts) in which we
systematically assessed the unique contribution (i.e., error variance reduction) of different variables to between-unit
variation. First, we constructed a null model in which we quantified the varian
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