Análisis de desempeño de los sistemas de control

Trust in Clinical Commissioning Group colleagues

Trust is an individual-level construct in this research and assesses the trust in other CCG colleagues who were involved in the commissioning process in question. We adopt the trust definition given by de Jong and Elfring,128_{that is, the‘psychological state of individuals involving confident, positive expectations about}

the actions of another’. Following previous scholars, trust, in this research, captures two main elements: ‘positive expectations’and‘suspension of uncertainty’.128,155,156_{Positive expectation is assessed by items 1,}

2, 5, 6 and 7, which are related to whose interest people take into account when making decisions. Suspension of uncertainty is assessed through items 3 and 4. We assess trust in CCG colleagues specifically here, as individuals working in the CCG might also work at another practice or health-care organisation, and the aim is to assess the ACAP of CCGs in particular.

The first four items in the construct of trust in CCG colleagues are adapted from de Jong and Elfring:128

‘they helped me if I had difficulties with my CCG-related job’,‘they took my interests into account’,‘they kept me informed’and‘they kept their word’. The last three items,‘they had the best interest of service users at heart’,‘they had the best interest of their own practice/organisation at heart’and‘they had the best interest of their professional group at heart’, have been developed based on the results of the qualitative study.

Trust between Clinical Commissioning Groups and their partners

Interorganisational trust is also assessed to capture the status quo of the relationships with partner organisations. We first ask respondents to list the partner that their CCG worked with most frequently, the partner that was the most crucial to the outcome and the partner that, in hindsight, they should have worked more closely with during the commissioning of Project X, and why they listed the three partners. Then, we use a three-item comparative scale to assess the trust between the CCG and their partners, comparing the partner that was most crucial to the outcome with the partner that the CCG should have worked with more closely. The rationale for comparison is that we predict variation in the trust between these two partners and the CCG. The three items are adapted from the five-item interorganisational trust scale developed by Poppoet al.:129_{‘the relationship with this partner was mutually trusting’,‘this partner}

kept their promises to our CCG’and‘our CCG was sure what this partner said was true’.

Trust in Clinical Commissioning Group managers

To assess trust in CCG managers, we adapt the trust scale from Mayer and Gavin,130_{which is developed to}

measure the trust between employees and managers specifically. Considering the CCG context, we use a short version of their 10-item scale, including‘I wish I had more influence over the manager’s decision’, ‘I share my opinion about sensitive issues with the manager even if my opinion may be unpopular’,‘if the CCG manager asks why a problem happened, I speak freely even if I am partly to blame’and‘my manager and I have mutual trust’.

Taking charge

Taking charge focuses on proactive improvement at one’s organisation or work unit in terms of work structures, policies and procedures134,157_{and, therefore, is likely to affect how the organisation acquires}

and shares information. We measure taking charge using four of the eight items developed by Morrison and Phelps:134_{‘I tried to bring about improved procedures’,‘I tried to correct a faulty procedure or}

practice’,‘I tried to eliminate redundant or unnecessary procedures’and‘I tried to change rules, procedures and policies that were non-productive or counterproductive’. The other four items were dropped as they do not fit the context.

Voice

Voice is‘making innovative suggestions for change and recommending modifications to standard procedures even when others disagree’, a concept indicating the degree to which individuals speak up with useful suggestions.135,157_{Previous scholars examine the possible link between voice and organisational}

outcome, and reveal that voice can improve employees’overall performance and organisational performance.135,157,158_{Based on the context, we use three items for voice based on the four-item scale}

developed by Grantet al.:157_{‘I spoke up with ideas for changes in work procedures of the CCG’,‘I}

communicated opinions about CCG-related work issues to others even if my opinions differed or others disagreed’and‘I developed and made recommendations on CCG-related work issues’.

Being heard

We also sought advice from a PPI group, involving participants in commenting and critiquing the tool. The notion of being heard was considered relevant during the PPI meeting, particularly for some partners of CCGs. Being heard is linked to voice and is a necessary prerequisite for having an impact on organisational performance, and what’s been voiced needs to be actively taken on board by managers to have an impact on organisational outcome.158_{A three-item scale was developed to capture the sentiment of being heard:}

‘my voice was heard by the CCG general manager’,‘my voice had influence over commissioning decision’ and‘my voice should have had more influence’.

Knowledge sharing

Knowledge sharing in this study refers to the exchange of both tacit and explicit knowledge related to the commissioning of Project X.126_{We assess knowledge sharing from both the individual and group level.}

Group knowledge sharing involves interaction and communication among team members regarding the commissioning process in questions.127

The four-item scale for individual knowledge sharing is adapted from van den Hooff and Huysman:126

‘I was kept informed of what my CCG colleagues knew about the Commissioning Project X’,‘When I needed certain information about Commissioning Project X, I asked my CCG colleagues’,‘I informed my CCG colleagues of what I was working on related to Commissioning Project X’and‘When I learnt something new related to Commissioning Project X, I made sure my CCG colleagues learnt about it too’. The three items for group knowledge sharing are adapted from the four-item scale developed by Faraj and Sproull:127_{‘CCG colleagues shared relevant information or knowledge with one another’,‘if a}

colleague in the CCG had some relevant information or knowledge, he or she was not likely to tell the others about it’and‘CCG colleagues provided each other with hard-to-find relevant information or knowledge’. The fourth item,‘there is virtually no exchange of information, knowledge, or sharing of skills among members’, is excluded, partly because we are constrained by time and space, and also because this item assesses the same aspect of knowledge sharing as item 1.

Team reflexivity

Team reflexivity assesses how frequently team members reflect on their work in relation to processes, structures and objectives and modify them accordingly.128,159_{Scholars find that team reflexivity affects intrateam trust and}

team performance, as team reflexivity helps to find problems in work processes, structures and objectives, and seeks improvement at the same time.136_{De Jong and Elfring}128_{also point out the potential positive}

relationship between trust and team performance. To measure team reflexivity, we use a five-item scale from de Jong and Elfring,128_{such as‘the CCG reviewed the feasibility of our objectives’,‘the CCG discussed the}

methods used to get the job done’and‘the CCG discussed whether we were working effectively together’.

APPENDIX 1

NIHR Journals Library www.journalslibrary.nihr.ac.uk

Organisational commitment

Organisational commitment describes‘the degree to which an individual feels attached to the

organisation’.131,160_{We focus on affective commitment, adopting a four-item scale from Conwayet al.}131

that has the following items:‘I do not feel a strong sense of belonging to my CCG’,‘I do not feel personally attached to my CCG’,‘working at my CCG has a great deal of personal meaning to me’and ‘I really feel that problems faced by my CCG are also my problems’.

Organisational identification

Organisational identification is defined as‘a perceived oneness with an organisation and the experience of the organisation’s success and failures as one’s own’.132_{Identification is measured with a four-item scale:}

‘when someone criticises the CCG, it feels like a personal insult’,‘I am very interested in what others think about my CCG’,‘when I talk about this CCG, I usually say“we”rather than“they”and‘when someone praises the CCG, it feels like a personal compliment’.132

Emotion

Emotional experiences in relation to the job are known to affect a range of relevant employee attitudes and behaviours, including decision-making, knowledge sharing and commitment.161_{We identify 12}

different types of emotional reactions to the commissioning process during the qualitative study: angry, frustrated, disappointed, anxious, fed up, let down, happy, surprised, excited, proud, satisfied and pleased. We aim to assess the frequency of each emotion during the commissioning process of Project X. Our emotion scale of six positive and six negative items is a short version of the job-related affective well-being scale developed by Von Katwyket al.,133_{which includes a 30-item scale assessing a wide range of positive}

and negative emotional responses with different levels of intensity.133,162

Group influence

We develop the group influence construct to assess the level of influence of different groups involved in the commissioning of Project X, including managers, doctors, nurses, local authority and PPI. The rationale to incorporate the construct, group influence, is the different roles that the aforementioned groups could play in the decision-making process. The health-care sector is known for multiple professionals working together, and there is distinction between the status of different actors such as doctors, nurses and managers.163,164_{For example, existing literatures show that nurses struggle to diffuse their knowledge}

upwards and outwards to doctors and managers.165_{Thus, different professionals in CCGs might have a}

different level of influence on the decision-making of the commissioning of Project X.