Composite Indices

Composite scores or indices that are derived from the summation of disparate ordinal scales are commonly utilized in medical research. Doing so implicitly attributes equal significance to each component.

Scales and indexes are typical ordinal composite measures of variables: measurements based on more than one data item. A scale is constructed through the assignment of scores to patterns of responses, recognizing that some items reflect a relatively weak degree of the variable while others reflect something stronger. An index is constructed by simple addition of scores assigned to individual attributes. A scale takes advantage of an intensity structure that may exist among attributes, and generally conveys more information that index scores [9].

The satisfaction surveys used in this website were designed by the Taiwan Healthcare Executives Society, and consist of "attribute" questions grouped into separate sections (domains or dimensions) with a "composite" or "aggregate" index at the top. At the time of designing the questionnaire, the questions grouped together would have been highly correlated with each other, with a Cronbach's α of at least 0.90

The resultant composite indexes at the head of each section (with a green background) are calculated by unweighted addition of the results for each attribute in that section (then averaging to ensure that confidence intervals are calculated correctly). Regardless of how many "attribute" questions are in each section, the sections are then added (with equal weight of 1.0) to give the overall totals. In this way, equal importance is given to each dimension of the survey.

Dimension Index

Loyalty Index

A standard five-point Likert satisfaction scale (very dissatisfied, somewhat dissatisfied, neutral, somewhat satisfied, very satisfied) can produce very skewed results. A distribution like this makes it difficult to see what needs to be done for continuous improvement.

The prevailing methods for dealing with this common issue are the "customer satisfaction index". This index method is the top-box intercept of:

• overall satisfaction
• likelihood to remain in the job position (employee satisfaction) or to continue to revisit for medical care (patient satisfaction)
• likelihood to recommend friends come to this hospital to work (employee satisfaction) or to seek medical attention (patient satisfaction)

This method can be found in the literature as the "customer loyalty index", "customer delight index", "secured customer index", "customer satisfaction index", and many more.

Employee Engagement Index (EEI)

The concept of "employee engagement" was created by the Gallup Research group and in their hands shown to have a statistical relationship with employee retention and customer satisfaction. Similar relationships have not been shown for traditional constructs such as job satisfaction.

Engagement is the degree to which employees bring their personal identity and self into their work performance. This can vary from task to task and moment to moment. EEI assesses commitment to the mission, values of the hospital, attraction to the prospects that the job and policies hold, working towards achieving, level of enthusiasm and complete loyalty to the organization.

Press-Ganey use the following questions to assess EEI:

1. How satisfied are you with your place of employment as a place t work? (rate 1~5)
2. I know what is expected of me at work
3. I have the materials and equipment I need to do my work right
4. At work, I have the opportunity to do what I do best every day
5. In the last seven days, I have received recognition or praise for doing good work
6. My supervisor, or someone at work, seems to care about me as a person
7. There is someone at work who encourages my development
8. At work, my opinions seem to count
9. The mission or purpose of my organization makes me feel my job is important
10. My associates or fellow employees are commited to doing quality work
11. I have a best friend at work
12. In the last six months, someone at work has talked to me about my progress
13. This last year, I have had opportunities at work to learn and grow

However, the concept has been criticized as "faddish" and not academic since it mixes attitudes and behaviours in its definition and lacks validation.

Retention Index

Patient Retention: is reflected in continued attendance at the hospital over prolonged periods of time for healthcare for the patient and family members; it is also reflected in the willingness to return to the same hospital for problems that were not settled at earlier visits.

Employee Retention: is reflected by the intention to remain with one's current employer. By looking at employees' stated intention to continue working for the same organization a year from now, one can gauge - or predict - employee retention.