Development and Validation of the CPO Scale, a New Instrument for Evaluation of Health Care Improvement Efforts.

Objective: To develop and validate an instrument for guidance and evaluation of quality and safety improvement efforts in health care. Context: The instrument is based on the Plan-Do-Study-Act cycle and the 3 fundamental improvement questions regarding aims, measurement, and change-making. Methods: An interdisciplinary team of improvement experts developed the Change Process and Outcome (CPO) scale. After studying the improvement literature, the scale was tested and refined on a sample of 5 projects. The CPO evaluation process and classification system was developed when evaluating 189 of the quality improvement projects of the Norwegian Medical Association by their final reports. The scale was validated by applying statistical testing to the evaluation results. Results: The final CPO scale consists of 13 process items and 7 outcome items. Interrater reliability ranged from 0.53 to 0.79, and test-retest reliability was 0.82. Factor analyses with Varimax rotation identified 2 significant process domains: Aims/change-making and Measurement/reporting, with Cronbach alpha values 0.88 and 0.95, respectively. The classification system produced 3 performance levels: successful, promising, and uncertain. Conclusion: The CPO scale shows good internal consistency, reliability, and validity for evaluating the success of quality improvement initiatives.