There were several limitations to this study. No
territories responded to the survey in 2007. Two
territories responded in 2010. The inclusion of the
2 territories does not explain the decrease in PM or
QI since 2007. Measurement of the QI construct needs
continued refinement. There were several issues regarding
the measurement of QI in this study. First,
the definition of QI provided in the 2010 survey was
slightly revised from the 2007 definition. Second, construct
validity may begin to be assessed with the inclusion
of additional QI related questions. Specifically,
these additional QI related questions on the 2010 survey
facilitate an understanding that the survey question regarding the presence of an agency QI process may be
unclear ormisinterpreted by respondents. For example,
6 respondents indicated they had no QI process at their
agency but implemented more than 1 formal project
to improve quality, 7 respondents indicated having QI
in job descriptions but no QI process, and 5 respondents
provided staff training in QI but reported no QI
process. When one state was contacted to clarify their
response, the respondent commented that the question
itself inquires about the “agency” having its own QI
process. Their initial response was “no” despite having
QI partially implemented for specific programs. As
referenced in the “Methods” section, the response options
to this question included whether QI was fully or
partially implemented either department-wide or for
specific programs. Perhaps rewording the question to
ask the level ofQI implementation may provide greater
clarity. Finally, verification of actual improvements in
quality and performance management did not occur.
Validity and reliability of the constructs continue to be
limitations.
There were several limitations to this study. Noterritories responded to the survey in 2007. Twoterritories responded in 2010. The inclusion of the2 territories does not explain the decrease in PM orQI since 2007. Measurement of the QI construct needscontinued refinement. There were several issues regardingthe measurement of QI in this study. First,the definition of QI provided in the 2010 survey wasslightly revised from the 2007 definition. Second, constructvalidity may begin to be assessed with the inclusionof additional QI related questions. Specifically,these additional QI related questions on the 2010 surveyfacilitate an understanding that the survey question regarding the presence of an agency QI process may beunclear ormisinterpreted by respondents. For example,6 respondents indicated they had no QI process at theiragency but implemented more than 1 formal projectto improve quality, 7 respondents indicated having QIin job descriptions but no QI process, and 5 respondentsprovided staff training in QI but reported no QIprocess. When one state was contacted to clarify theirresponse, the respondent commented that the questionitself inquires about the “agency” having its own QIprocess. Their initial response was “no” despite havingQI partially implemented for specific programs. Asreferenced in the “Methods” section, the response optionsto this question included whether QI was fully orpartially implemented either department-wide or forspecific programs. Perhaps rewording the question toask the level ofQI implementation may provide greaterclarity. Finally, verification of actual improvements inquality and performance management did not occur.Validity and reliability of the constructs continue to belimitations.
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