Open Access Research article

Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare

Ann-Christine Andersson1239*, Mattias Elg4, Kent-Inge Perseius56 and Ewa Idvall78

Author affiliations

1 Division of Quality Technology and Management, Linköping University, Linköping, Sweden

2 Development Department, Kalmar County Council, Kalmar, Sweden

3 Faculty of Health and Society, Malmö University, Malmö, Sweden

4 Division of Quality Technology and Management and HELIX Vinn Excellence Centre, Linköping University, Linköping, Sweden

5 Nyckeln competence centre for pedagogy in health care, Kalmar County Council, Kalmar, Sweden

6 the Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden

7 Faculty of Health and Society, Malmö University, Malmö, Sweden

8 Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden

9 Box 601, SE-391 26, Kalmar, Sweden

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Citation and License

BMC Health Services Research 2013, 13:48  doi:10.1186/1472-6963-13-48

Published: 7 February 2013



Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare.


A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted.


The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach’s alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach’s alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work.


The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

Questionnaire development; Psychometric test; Improvement measurements; Improvement program; Questionnaire assessment; Healthcare setting