Are the measures of the variables valid and reliable?
Setting aside that the wrong method was selected by Illingworth and Timmons, an evaluation of the survey questions reveals additional weakness in the study. The question: “On average how often does a patient come from the theatre into the recovery room wearing Flowtron boots?” demonstrates ambiguity and subjectivity (See Appendix). Whatever the respondent selects, it is irrelevant as the question itself introduces variability by adding the On average statement at the beginning of the question. So if the respondent selects Never, that can be interpreted as the average is Never. If the average is never then there is a distribution with never being the average but it still happens sometimes. Now they have created a loop as Sometimes (on average) is also a selection. The point is, the question is invalid and therefore the results of the survey are invalid.
In the book How to Measure Survey Reliability and Validity by Litwin (1995) there are tests available for examining the reliability and validity of survey questions. Reliability looks at the stability of a response when a measurement is repeated. The most common reliability test is Test-retest where respondents answer the same survey at different points in time to evaluate consistency. This is then quantified with a correlation coefficient with the goal of r > 0.70.
Validity is described by Litwin (1995) as how well a survey measures what it sets out to measure. One example of a validity test that could have been used by Illingworth and Timmons is criterion validity where the survey would have been validated against another instrument or type of data collect such as a chart review. Comparing the survey results to...
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... the data collection method for both validity and reliability with a gage r&r test and a test re-test with the data collectors. If the audit demonstrated that the charting was not adequate for collecting the data needed to answer the research question, I would have done an observation by creating a checklist and actually observing cases and inspecting patients for the treatments. This would have established actual observed results that then can be compared to the expected results and compliance rates could be reported. Proper data collection would also provide specific categories, units, and providers that are not in compliance for focusing performance improvement activity and additional projects. More importantly, I would have intervened on any cases that were not meeting the standard and corrected the failure before the patient would be negatively affected.
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