Physicians' views on optimal use and payment system for telemedicine: a qualitative study.

BACKGROUND: Telemedicine is already in use in daily practice, but appropriate reimbursement and physician payment is falling behind in many countries. One reason is the limited availability of research on the matter. This research therefore examined physicians' views on the optimal use and payment modalities for telemedicine. METHODS: Sixty-one semi-structured interviews were conducted with physicians from 19 medical disciplines. Interviews were encoded using thematic analysis. RESULTS: Telephone and video televisits tend not to be used as a first patient contact, except for triage of patients in urgency situations. Several minimum required modalities for the payment system of televisits and telemonitoring were identified. For televisits these were: (i) remuneration of both telephone- and videovisits to increase healthcare equity, (ii) little or no differentiation between videovisit and in-person visit fee to make videovisits financially attractive and sustainable for physicians, (iii) differentiation of televisit fee per medical discipline, and (iv) quality requirements such as mandatory reporting in the patient's medical file. The identified minimum required modalities for telemonitoring were: (i) an alternative payment scheme than fee-for-service, (ii) remunerating not only physicians but also other involved health professionals, (iii) designating and remunerating a coordinator, and (iv) distinguishing sporadic vs. continuously follow-up. CONCLUSIONS: This research investigated the telemedicine usage behavior of physicians. Moreover, several minimum required modalities were identified for a physician-supported payment system of telemedicine, as these innovations necessitate challenging and innovation of the healthcare payment systems as well.

An organizational design perspective on the monthly self-scheduling process in nursing homes: A multiple case study.

AIMS: To describe the monthly self-scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization-related outcomes. DESIGN: A multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework. METHODS: Data collection was performed in four Belgian NH during Spring 2019 using semi-structured interviews (n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within-case and cross-case analysis was performed. The COREQ checklist was used for reporting the findings. RESULTS: One group (two NH) used self-scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self-scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes. CONCLUSION: Self-scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes. IMPACT: This study contributes to the rare literature on self-scheduling in NHs by focusing on the monthly self-scheduling process and by including an organizational design perspective. NH management can become informed of different self-scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes. PATIENT OR PUBLIC CONTRIBUTION: Three members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self-scheduling process.

Systematic review: What is the impact of self-scheduling on the patient, nurse and organization?

AIM: To systematically review and evaluate the literature on the impact of self-scheduling on patient, nurse and organization-related outcomes. DESIGN: A systematic review. DATA SOURCES: PubMed, Embase, Web of Science, Cinahl, Scopus, Google Scholar, ERIC and Cochrane Library were screened until October 2019 (week 40) for peer-reviewed, empirical articles, written in English, Dutch or French. REVIEW METHODS: Two reviewers screened title and abstract using predetermined eligibility criteria and one reviewer screened the full texts of relevant hits. Quality was assessed with the Mixed Methods Appraisal Tool. RESULTS: Studies (N = 23) were retained and classified into explanatory and descriptive studies. The articles reported on a range of outcomes: patient- and nurse-reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well-being, psychosocial factors, professional development, nurse manager's scheduling time, general working conditions, turnover, temporary employment agency use and absenteeism, recruitment and retention. CONCLUSION: The evidence base is limited. Several studies confirmed the positive impact of self-scheduling on the nurse and the organization. However, other studies found negative outcomes or no change. These outcomes should be interpreted in the light of contextual factors and the implementation process, which was often not without difficulties. Future research should use a multimethod longitudinal design, bear in mind the possibilities of quantitative research (e.g. for studying psychosocial factors) and employ a theoretical framework. IMPACT: This review informs about the inconsistent evidence on the association between self-scheduling and patient, nurse and organization-related outcomes and includes enablers and barriers to a successful implementation. These outcomes are influenced by the implementation process and the sustainability of the self-scheduling system, which are still major challenges for healthcare management. This demonstrates the urgent need for further research.

The relationship of nursing home price and quality of life.

BACKGROUND: Knowledge about the relationship between the residents' Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes. METHODS: The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question. RESULTS: The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P <  0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes. CONCLUSION: Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents' QOL.

The boundary-spanning behavior of nurses: The role of support and affective organizational commitment.

AIM: The aim of this study was to examine the relationship between organizational, supervisor, and coworker support, as perceived by registered nurses and their boundary-spanning behaviors. Furthermore, this article examines the mediating role of the affective organizational commitment of nurses in these relationships. BACKGROUND: Registered nurses play a key role in hospitals, as they have an important impact on the quality of the services delivered. For nurses to perform at their best, they need organizational, leader, and coworker support. To date, few studies have explored the link between nurses' perceived support, affective organizational commitment, and boundary-spanning behaviors. METHODS: This cross-sectional research used a questionnaire survey to explore the hypothesized relationships in a sample of 273 nurses from a hospital in Belgium. Structural equation modeling was used for statistical analysis of the mediation model. RESULTS: One hundred forty-seven (53.5%) nurses responded to the survey. Perceived support from the organization, supervisors, and coworkers positively influences nurses' boundary-spanning behaviors. Affective organizational commitment was found to mediate the positive relationship between perceived organization support, perceived coworker support, and boundary-spanning behaviors. Perceived supervisor support and boundary-spanning behaviors showed a direct relationship not mediated by affective organizational commitment. CONCLUSIONS: Perceived support has an important influence on the boundary-spanning behavior of nurses. This study emphasizes the importance on how support exerts an influence on boundary-spanning behavior and underscores the importance of affective organizational commitment. Health care organizations, supervisors, and coworkers are essential in fostering boundary-spanning behaviors of nurses, both directly and through the development of affective organizational commitment. These actors should therefore be aware of the way they behave and the implications their behavior may have.

Throughput efficiency and service quality after process redesign at a cancer day care unit: Two sides of the coin?

This study was designed to focus on the patient perspective in a reorganisation of care processes at a cancer day care unit (CDU). The effects of dose banding and of taking blood samples one day (or more) before the day care treatment (on Day -1) are investigated in terms of throughput efficiency and perceived service quality. Data were collected by mapping patient processes in detail and surveying patients in two CDUs at a university hospital (n = 308). A univariate model was used to investigate the effect of these factors on patient throughput time, and perceived service quality was examined with multiple linear regression. Taking blood samples on Day -1 decreases patient throughput time and increases the perceived service quality by improving the patient's perception of technical expertise and the outcome. This has a globally positive effect on patients' perceived service quality. Dose banding affected neither patient throughput time nor perceived service quality. Taking the pretreatment blood sample on Day -1 can be considered an important process design characteristic, as it increases both efficiency and service quality.

Systematic review: Association between the patient-nurse ratio and nurse outcomes in acute care hospitals.

AIMS: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes. BACKGROUND: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. EVALUATION: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. KEY ISSUE(S): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. CONCLUSION: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). IMPLICATIONS FOR NURSING MANAGEMENT: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines.

A 50% reduction in multiple live birth rate is associated with a 13% cost saving: a real-life retrospective cost analysis.

Belgian legislation limiting the number of embryos for transfer has been shown to result in a 50% reduction of the multiple live birth rate (MLBR) per cycle without having a negative impact on the cumulative delivery rate per patient within six cycles or 36 months. The objective of the current study was to evaluate the cost saving associated with a 50% reduction in MLBR. A retrospective cost analysis was performed of 213 couples, who became pregnant and had a live birth after one or more assisted reproductive technology treatment cycles, and their 254 children. The mean cost of a singleton (n = 172) and multiple (n = 41) birth was calculated based on individual hospital invoices. The cost analysis showed a significantly higher total cost (assisted reproductive technology treatment, pregnancy follow-up, delivery, child cost until the age of 2 years) for multiple births (both children: mean €43,397) than for singleton births (mean: €17,866) (Wilcoxon-Mann-Whitney P < 0.0001). A 50% reduction in MLBR resulted in a significant cost reduction related to hospital care of 13%.

Fulfillment of administrative and professional obligations of hospitals and mission motivation of physicians.

BACKGROUND: To be successful, hospitals must increasingly collaborate with their medical staff. One strategic tool that plays an important role is the mission statement of hospitals. The goal of this research was to study the relationship between the fulfillment of administrative and professional obligations of hospitals on physicians' motivation to contribute to the mission of the hospital. Furthermore the mediating role of the physicians' emotional attachment to the hospital and moderation effect of the exchange with the head physicians were considered. METHODS: Self-employed physicians of six hospitals participated in a survey. Descriptive analyses and linear regression were used to analyse the data. RESULTS: The results indicate that affective commitment mediated the relationship between psychological contract fulfillment and mission statement motivation. In addition, the quality of exchange with the Chief Medical Officer moderated the relationship between the fulfillment of administrative obligations and affective commitment positively. CONCLUSION: This study extends our understanding of social exchange processes and mission statement motivation of physicians. We showed that when physicians perceive a high level of fulfillment of their psychological contract they are more committed and more motivated to contribute to the mission statement. A high quality relationship between physician and Chief Medical Officer can enhance this reciprocity dynamic.

The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions.

BACKGROUND: Multiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies. METHOD: Systematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy. RESULTS: Thirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital's side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients. CONCLUSION: Our results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.

The impact of economic and noneconomic exchange on physicians' organizational attitudes: The moderating effects of the Chief Medical Officer.

BACKGROUND: Hospital-physician relationships are critical to hospitals' organizational success. A distinction can be drawn between economic and noneconomic physician-hospital exchange. Physician senior leadership could be an important component of managerial strategies aimed at optimizing hospital-physician relationships. PURPOSE: The purpose of this study was to investigate the moderating role of the quality of exchange with the Chief Medical Officer (CMO) in the relationship between economic and noneconomic exchange and physicians' key organizational attitudes. METHODOLOGY: Self-employed physicians practicing at six Belgian hospitals were surveyed. Economic exchange was conceptualized by the concepts of distributive and procedural justice, whereas noneconomic exchange was conceptualized by the concepts of administrative and professional psychological contract. Our outcomes comprise three key organizational attitudes identified in the literature (job satisfaction, affective organizational commitment, and intention to leave). The moderating role of leader-member exchange with the CMO in these relationships was assessed. FINDINGS: Our results showed a relationship between both psychological contract breach and organizational justice and physicians' organizational attitudes. The quality of exchange with the CMO buffered the negative effect of psychological contract breach and reinforced the positive effects of organizational justice with respect to physicians' organizational attitudes. PRACTICE IMPLICATIONS: Our results demonstrate that both economic and noneconomic aspects are important when considering physicians' key organizational attitudes. The reciprocity dynamic between physician and hospital can be enhanced by high-quality exchange with the CMO.

Determinants of using (non-)fluoroscopy-guided positioning for radiographs: a case study research.

This study examines the determinants of using (non-)fluoroscopy-guided positioning (FGP) for radiographs, in order to improve the use of non-FGP imaging techniques. We focused on knowledge and attitudes of radiographers and radiologists with respect to applying non-FGP in radiography and organizational factors. We analyzed data from an in-depth multiple case study that includes observations and field notes, interviews, documents and images collected from the radiology departments of four hospitals. The unified theory of acceptance and use of technology (UTAUT) was used to frame the findings. We found that inadequate skills and insufficient knowledge of positioning techniques and negative attitudes towards non-FGP were present. More precisely, staff expressed concerns with respect to the impact on the workload and workflow. Besides facilitating organizational conditions, the social influence of peers and the clinical leadership of RLs were found to be important. Adequate supervision, regular feedback and coaching were identified as important enabling factors for increasing the quality of the applied imaging techniques. In the conclusion we state that determinants of using non-FGP are quite complex. Therefore we argue that a holistic approach considering all these aspects is needed to improve imaging practices.

The Mediating Role of Psychological Contract Violation Between Psychological Contract Breach And Nurses' Organizational Attitudes.

This study draws on psychological contract theory, according to which organizational members reciprocate detrimental treatment they perceive with negative work-related attitudes and behaviors. Organizational attitudes were predicted by both breach and violation. This study demonstrates the importance of psychological contract breach and violation to nurses. Nursing administrators and leaders are advised to monitor and balance the expectations of nurses. They should recognize the importance of the interpretive process leading to feelings of betrayal and anger, thus providing the opportunity to manage perceptions of breach.

Fulfilment of administrative and professional organisational obligations and nurses' customer-oriented behaviours.

AIM: The aim of the study was to examine the relationship between the perceived quality of organisational exchange and nurses' customer-oriented behaviours. BACKGROUND: Hospitals face increasing competitive market conditions. Registered nurses interact closely with patients and therefore play an important front-office role towards patients. METHODS: A cross-sectional study was conducted. Registered nurses (n = 151) of a Belgian hospital received a questionnaire to assess the fulfilment of administrative and professional organisational obligations and their customer-oriented behaviours. RESULTS: We found a positive relationship between psychological contract fulfilment and nurses' customer-oriented behaviours. More precisely administrative and professional psychological contract fulfilment relates significantly to nurses' service delivery and external representation. In case of internal influence only administrative psychological contract fulfilment was significantly related. CONCLUSIONS: Nurses' perceptions of the fulfilment of administrative and professional obligations are important to their customer-oriented behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must be aware of the impact of fulfilling both administrative and professional obligations of registered nurses in order to optimise their customer-oriented behaviours.

The impact of professional and organizational identification on the relationship between hospital-physician exchange and customer-oriented behaviour of physicians.

BACKGROUND: Hospitals face increasingly competitive market conditions. In this challenging environment, hospitals have been struggling to build high-quality hospital-physician relationships. In the literature, two types of managerial strategies for optimizing relationships have been identified. The first focuses on optimizing the economic relationship; the second focuses on the noneconomic dimension and emphasizes the cooperative structure and collaborative nature of the hospital-physician relationship. We investigate potential spillover effects between the perceptions of physicians of organizational exchange and their customer-oriented behaviors. METHODS: A cross-sectional study was conducted on 130 self-employed physicians practicing at six Belgian hospitals. Economic exchange was measured using the concept of distributive justice (DJ); noneconomic exchange was measured by the concept of perceived organizational support (POS). Our outcomes consist of three types of customer-oriented behaviours: internal influence (II), external representation (ER), and service delivery (SD). RESULTS: Our results show a positive relationship between DJ and II (adjusted R(2) = 0.038, t = 2.35; p = 0.028) and ER (adjusted R(2) = 0.15, t = 4.59; p < 0.001) and a positive relationship between POS and II (adjusted R(2) = 0.032, t = 2.26; p = 0.026) and ER (adjusted R(2) = 0.22, t = 5.81; p < 0.001). No relationship was present between DJ (p = 0.54) or POS (p = 0.57) and SD. Organizational identification positively moderates the relationship between POS and ER (p = 0.045) and between DJ and ER (p = 0.056). The relationships between POS and II (p = 0.54) and between DJ and II (p = 0.99) were not moderated by OI. Professional identification did not moderate the studied relationships. CONCLUSION: Our results demonstrate that both perceptions of economic and noneconomic exchange are important to self-employed physicians' customer-oriented behaviours. Fostering organizational identification could enhance this reciprocity dynamic.

Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness.

BACKGROUND: Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. METHODS: Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. RESULTS: The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. CONCLUSIONS: This study shows that initiatives aimed at strengthening physicians' positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.

Job-related stress and sickness absence among belgian nurses: a prospective study.

PURPOSE: The purpose of this study was to investigate the influence of job stress on sickness absence of nurses and determine the predictive power of the Demand-Control-Support (DCS) model, the Effort-Reward Imbalance-Overcommitment (ERI-OC) model, and a combination of both. DESIGN: A survey was conducted to measure job stress in a sample of 527 Belgian nurses, followed by prospective data collection of sickness absence (long-term, short-term, and multiple episodes). FINDINGS: Perceptions of job strain and ERI increased the odds for long-term (adjusted odds ratio [OR] = 2.26; 99% confidence interval [CI; 1.27-4.04]) and multiple episodes of sickness absence (adjusted OR = 1.64; 95% CI [1.01-2.65]). Iso-strain and ERI-OC increased the odds for long-term (OR = 1.75; 95% CI [0.98-3.11]), multiple episode (adjusted OR = 1.93; 95% CI [1.14-3.26]), and short-term (adjusted OR = 1.69; 95% CI [1.03-2.76]) sickness absence. CONCLUSIONS: The combined model of DCS and ERI-OC predicts the odds for long-term and short-term sickness absence and multiple episodes. CLINICAL RELEVANCE: This study has implications for human resources management in nursing organizations. Nursing administrators are advised to monitor and balance nurses' job demands and efforts. They should recognize the importance of social support, job control, job rewards, and overcommitment in order to reduce the job stress of nurses.

The impact of organizational support and leader-member exchange on the work-related behaviour of nursing professionals: the moderating effect of professional and organizational identification.

AIM: The aim of this study was to examine the relations between perceived organizational support, the quality of leader-member exchange, in-role and extra-role behaviour, professional identification and organizational identification among registered nurses and nurse assistants. BACKGROUND: Theoretically, employees will reciprocate received beneficial treatment with positive attitudes and behaviour. Recently, it has been shown that this principle may be more complex than originally anticipated. DESIGN: A quantitative, cross-sectional survey design was used. The quality of social exchange and identification was scored by the involved registered nurses and nurse assistants; in-role and extra-role behaviour was rated by the head nurse. METHODS: The survey was administered to nurses and nurse assistants (n = 196) working in five Belgian nursing homes. Data were collected from February-March 2012. Pearson correlation analyses, t-test analyses and hierarchical regression were used to analyse the data. RESULTS: Our results showed no relationship between perceived organizational support and leader-member exchange and in-role behaviour. A positive relationship was found between perceived organizational support and extra-role behaviour and a trend towards significance between leader-member exchange and extra-role behaviour. Organizational and professional identification moderated the relationship between perceived organizational support and extra-role behaviour. CONCLUSIONS: Our study demonstrates the importance of social exchange to nurses and nurse assistants and therefore nursing administrators and leaders. When registered nurses and nurse assistants perceive high-quality social exchange, they are more likely to go the extra mile on behalf of the organization. Fostering social identification could enhance this.

The importance of social exchange to nurses and nurse assistants: impact on retention factors.

AIM: The purpose of this study was to test the norm of reciprocity by examining relationships between perceived organisational support (POS), the quality of leader-member exchange (LMX) and psychological contract breach (PCB) and important nurse retention factors identified in the literature. BACKGROUND: A major cause of turnover among nurses is related to unsatisfying workplaces. Previous research, mainly outside the nursing setting, found that social exchange affects employees' work-related attitudes. METHOD: A cross-sectional survey was conducted on 217 nurses and nursing assistants to test and refine a model linking POS, LMX, PCB with job satisfaction, trust and turnover intentions. RESULTS: Hierarchical multiple linear regression revealed that POS, PCB and LMX explained significant variance in all three retention factors: job satisfaction (adjusted R² = 0.502), trust (adjusted R² = 0.462) and turnover intentions (adjusted R² = 0.196). POS and PCB predicted most strongly job satisfaction (P < 0.001) and trust (P < 0.001 and P < 0.01, respectively). LMX predicted most strongly intention to leave (P < 0.01). CONCLUSION: In our study, POS, the quality of LMX and PCB were strongly related to job satisfaction, trust and turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers and leaders should recognize the importance of social exchange within their organisation to build trust, satisfy and retain scarce nurses and nursing assistants.

Validation of the Psychological Empowerment Scale and Client-Centered Care Questionnaire in budget holders with disabilities.

PURPOSE: Several high-income countries install Cash-for-Care Schemes (CCSs) by granting budgets to care users. However, little quantitative evidence exist on empowerment and client-centered care levels, due to a lack of validated scales. This research aimed to validate the Psychological Empowerment Scale (PE scale) and Client-Centered Care Questionnaire (CCCQ) in budget holders with disabilities. METHODS: A survey was developed based on a literature review and experts and budget holders input. Principal Axis Factoring with direct oblimin rotation, Cronbach's Alpha, and hypotheses testing with socio-demographic and budget characteristics as independent variables, and PE scale and CCCQ as dependent, were undertaken to assess both scales' internal consistency and validity. RESULTS: A convenience sample of 224 Flemish (proxy) budget holders completed the survey. Our analysis showed a two-factor solution for both scales; for the PE scale consisting of "meaning" and "competence," and "self-determination" and "impact," for CCCQ consisting of items 1-7 (conduct by caregiver) and items 8-15 (autonomy). Cronbach's Alpha of both scales was 0.94. The majority of our hypotheses were confirmed. CONCLUSIONS: The findings show that both scales are valid and internally consistent, meaning that they can be further tested in a respondent sample of people with disabilities and in other care contexts.

In light of the current trends in the (health)care sector to stimulate empowerment and client-centered care in care users, the monitoring of this experience is important.The Psychological Empowerment Scale (PE scale) measures empowerment by means of four cognitions (meaning, competence, impact, and self-determination), while the Client-Centered Care Questionnaire (CCCQ) measures the level of client-centered care.The PE scale and CCCQ are valid and internally consistent in our sample of (proxy) budget holders with disabilities.