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Practical Information
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Instrument Name:
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Network Integration Survey (NIS)
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Instrument Description:
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The NIS assesses health system integration in the VA, such as coordination across medical centers, and also assesses employee satisfaction. The instrument is comprised of 13 subscales, each designed to measure a particular domain. Five of these subscales, intended for administration to all staff, measure the domains of leadership, staff cooperation, clinical coordination, service cooperation and alignment. Four subscales, intended for managers only, measure the domains of shared vision, quality improvement, manager alignment, and single standard of care. An additional four subscales measure the staff satisfaction domains of job satisfaction, level of integration, quality of medical care, and service line support.
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Price:
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Free (Available through Management Decision & Research Center)
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Administration Time:
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20 minutes or less.
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Publication Year:
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1999
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Item Readability:
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Flesch-Kincaid Grade Level of 11.4 for the items. Most items contain 15 to 20 words. Some terms may not be understandable to non-VA personnel.
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Scale Format:
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Closed-question format; 43 out of 68 items utilize a seven-point Likert scale.
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Administration Technique:
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Mail-delivered, paper-and-pencil self-administrated.
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Scoring and Interpretation:
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Scores are aggregated system-wide and interpreted at the system level only. Subscale mean scores are reported for the sample overall and are stratified by staff group, facility and service grouping. Higher mean scores suggest higher levels of system integration.
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Forms:
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No information found.
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Research Contacts
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Instrument Developers:
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VA HSR&D Management Decision & Research Center
Contacts: carol.vandeusenlukas@med.va.gov (Carol VanDeusen Lukas), Danielle.valley@med.va.gov (Danielle Valley)
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Instrument Development Location:
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VA Boston Healthcare System (152-M)
150 S. Huntington Avenue
Boston, MA 02130
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Instrument Developer Email:
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carol.vandeusenlukas@med.va.gov
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Instrument Developer Website:
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No information found.
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Annotated Bibliography
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1. Lukas CV, Meterko M, Lowcock S, Donaldson-Parlier R, Blakely M, Davies M, Petzel RA. Monitoring the progress of system integration. Qual Manag Health Care. 2002 Winter;10(2):1-11. [PMID: 11799825]
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Purpose: To construct and administer an instrument to measure system integration through a process of one VISN’s system integration. |
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Sample: N= 1042 individuals from the VA Upper Midwest Health Care Network. 73% of 1490 individuals responded. The sample was stratified by facility, service group, and position. |
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Methods: The survey was administered to 1490 individuals in 1999 and 1042 responded. The results were analyzed using factor analysis and multitrait analysis; as a result, 11 domains were reduced to 9 domains, which showed high reliability for group comparisons and stronger convergent/discriminant validity. |
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Implications: The Network Integration Survey, one of three components of Integrated System Scorecard, provided reliable data, and using the survey with the data from the other two components of the Scorecard, integration structures and system performance, would be more helpful to assess system integration. |
2. Lukas CV, Valley D, editors. Network Integration Survey. Management research tools/Instrument: Meeting on management research in VA; 2002 Feb 15; Washington, DC. Boston: Management Decision and Research Center; 2002.
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Purpose: To present the instrument briefly in a meeting. The instrument for VISN 2 was included. |
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top
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Factors and Norms
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Factor Analysis Work:
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Exploratory factor analysis of sample data (Ref: 1) suggests nine factors: Leadership, Staff Cooperation, Service Cooperation, Clinical Coordination, Facility-VISN Alignment, Shared Vision, Quality Improvement, Single Standard of Care, and Manager Alignment. The last four factors are specific to the manager’s version of the instrument. (Ref: 1)
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Normative Information Availability:
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Mean scores for each scale by Service grouping (n = 96 - 194) and Staff group (n = 303 - 390) were reported. (Ref: 1)
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Reliability Evidence
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Test-retest:
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No information found.
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Inter-rater:
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No information found.
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Internal Consistency:
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Range for Cronbach’s alpha is reported by subscale as follows (Ref: 2):
| Subscale
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Cronbach's alpha range
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| Leadership
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(0.82 – 0.92)
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| Staff Cooperation
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(0.78 – 0.86)
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| Clinical Coordination
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(0.77 – 0.85)
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| Alignment
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(0.70 – 0.76)
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| Service Cooperation
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(0.78 – 0.87)
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| Shared Vision
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(0.72 – 0.80)
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| Quality Improvement
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(0.72 – 0.87)
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| Manager Alignment
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(0.70 – 0.78)
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| Single Standard of Care
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(0.70 – 0.79)
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| Job Satisfaction
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(0.78 – 0.83)
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| Level of Integration
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(0.77 – 0.87)
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| Quality of Medical Care
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(0.87 – 0.90)
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| Service Line Support
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(0.70 – 0.87)
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Alternate Forms:
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No information found.
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Validity Evidence
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Construct/ Convergent/ Discriminant:
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95% of items in the “all-staff” subscales and 75% of items in the “manager-only” subscales are correlated more highly with other items in the subscale and with the subscale total score than with items or total scores of other subscales. (Ref: 1)
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Criterion-related/ Concurrent/ Predictive:
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No information found.
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Content:
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No information found.
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Responsiveness Evidence:
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No information found.
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Scale Application in VA Populations:
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Yes. (Ref: 1)
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Scale Application in non-VA Populations:
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No information found.
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Comments
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The NIS is a highly context-specific instrument, designed to measure a prespecified set of constructs of VA health system network integration.
Overall Usefulness for a Certain Population: The NIS is designed to be used by all VISNs within the VA system.
Advantages: The NIS was tailor-made for the purpose of measuring nine dimensions of VA health system network integration. There are no other publicly available instruments for this purpose.
Disadvantages: Verbatim transferability of the items to non-VA settings is probably limited, both because the terminology used in the items is context-specific to VA and because some of the constructs of VA health system network integration measured may not generalize to non-VA health systems.
Recommendation: For VISN integration within the VA system, this instrument appears ideal. Usefulness in other contexts is indeterminable; therefore, we suggest careful adaptation of the instrument, complete with local expert input throughout the adaptation process, before attempting to use the instrument with non-VA health systems.
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Updates
No information found.
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