Relationship quality and patient-assessed quality of care in va primary care clinics: Development and validation of the work relationships scale

Erin P. Finley, Jacqueline A. Pugh, Holly Jordan Lanham, Luci K. Leykum, John Cornell, Poornachand Veerapaneni, Michael L. Parchman

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


PURPOSE Efforts to better understand the impact of clinic member relationships on care quality in primary care clinics have been limited by the absence of a validated instrument to assess these relationships. The purpose of this study was to develop and validate a scale assessing relationships within primary care clinics. METHODS The Work Relationships Scale (WRS) was developed and administered as part of a survey of learning and relationships among 17 Department of Veterans Affairs (VA) primary care clinics. A Rasch partial-credit model and principal components analysis were used to evaluate item performance, select the final items for inclusion, and establish unidimensionality for the WRS. The WRS was then validated against semi structured clinic member interviews and VA Survey of Healthcare Experiences of Patients (SHEP) data. RESULTS Four hundred fifty-seven clinicians and staff completed the clinic survey, and 247 participated in semi structured interviews. WRS scores were significantly associated with clinic-level reporting for 2 SHEP variables: overall rating of personal doctor/nurse (r2 = 0.43, P <.01) and overall rating of health care (r2 = 0.25, P <.05). Interview data describing relationship characteristics were consistent with variability in WRS scores across low-scoring and high-scoring clinics. CONCLUSIONS The WRS shows promising validity as a measure assessing the quality of relationships in primary care settings; moreover, primary care clinics with lower WRS scores received poorer patient quality ratings for both individual clinicians and overall health care. Relationships play an important role in shaping care delivery and should be assessed as part of efforts to improve patient care within primary care settings.

Original languageEnglish (US)
Pages (from-to)543-549
Number of pages7
JournalAnnals of family medicine
Issue number6
StatePublished - 2013


  • Patient satisfaction
  • Primary care
  • Quality of care
  • Relationships
  • Veteran's administration

ASJC Scopus subject areas

  • Family Practice


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