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Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). This research aims to provide a tool that engages HCWs in BSC implementation (BSC-HCW). Additionally, it seeks to translate the BSC-HCW to Arabic and validate it at Palestinian hospitals. A cross-sectional study, 454 questionnaires were retrieved from 14 hospitals. The composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. In both EFA and CFA, the scale demonstrated a good level of model fit. All the items had loadings greater than 0.50. All factors passed the discriminant validity. Although certain factors’ convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine factors and 28 items in CFA. The BSC-HCW is the first self-administered questionnaire to engage HCWs in assessing the BSC dimensions following all applicable rules and regulations. The findings revealed that this instrument’s psychometric characteristics were adequate. Therefore, the BSC-HCW can be utilized to evaluate BSC perspectives and dimensions. It will help managers highlight which BSC dimension predicts HCWs’ satisfaction and loyalty and examine differences depending on HCWs’ and hospital characteristics.

BackgroundImproving health care in Palestinian territories is a challenging task. Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). In the BSC implementations, some health care organizations (HCOs) assessed the satisfaction of health care workers (HCWs), but none considered their loyalty. Furthermore, none of them explored the causal links between BSC dimensions and HCWs’ satisfaction based on HCWs’ observations. This research aims to provide a tool to assess the performance of BSC dimensions and their impact on HCWs’ satisfaction and loyalty (BSC-HCWSL). Additionally, it seeks to translate the BSC-HCWSL to Arabic and validate it at Palestinian hospitals.MethodsThis is a cross-sectional study. Two expert committees performed the BSC-HCWSL item development. We performed forward and reverse translations from English to Arabic and vice versa. Pretesting was performed on 13 HCWs at one hospital. Then, between January and October 2021, 540 questionnaires were retrieved in the other 14 hospitals. To detect redundant and poorly correlated items, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity.ResultsIn both EFA and CFA, the scales demonstrated a good level of model fit. All the items had loadings greater than 0.50. All constructs passed the discriminant validity. Although certain constructs’ convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine constructs and 28 items in CFA.ConclusionThe BSC-HCWSL is the first self-administered HCW questionnaire designed to assess BSC perspectives and dimensions and their impact on HCWs’ satisfaction and loyalty. The questionnaire scale was completed following all applicable rules and regulations. The findings revealed that this instrument’s psychometric characteristics were adequate. Therefore, BSC-HCWSL can be utilized in future BSC implementations. It can also be used to assess the influence of BSC factors on HCWs’ satisfaction and loyalty and examine differences depending on HCWs and hospital characteristics.

Background The knee replacement (KR) surgery aims to restore the activity level and reduce the risk of experiencing disabilities. The outcomes of this surgery are evaluated mainly with subjective tools or low validity objective tools. However, the effect of the surgery on activity level using high validity objective accelerometer is still in question. Methods A systematic review and meta-analysis were conducted to evaluate the benefit of KR surgery alone to enhance physical activity recommendations based on high validity accelerometer. Two independent reviewers evaluated five electronic databases (Cochrane-Central-Register-of-Controlled Trials, EMBASE, PubMed, Web of Science, and Scopus) to find relative studies between January 2000 and October 2021. The quality assessments and risk of bias assessments were examined. Results Three articles were included with 202 participants (86 males, 116 females), with an average age of 64 years and an average 32 kg/m2 body mass index. The results found that the number of steps was significantly improved up to 36.35 and 45.5% after 6-months and 1-year of the surgery, respectively. However, these changes did not meet the recommended activity level guideline and could be related to the patients’ health status and their activity level before the surgery. No significant changes were seen in sedentary time, standing time, and upright time after 6-months and 1-year follow-ups. Heterogeneity among studies was low to moderate (0–63%). Conclusion Knee replacement surgery is an effective treatment for improving patients’ quality of life with severe knee injuries. However, various factors impact the success of surgical and achieving maximum benefit of the surgery. One factor, sedentary time, can be reduced by implementing pre-and post-surgery exercise or physical activity recommendations. Further studies are needed to understand the benefit of surgery with or without rehabilitation assessed using high validity monitors.

Background Improving the healthcare sector in Palestinian territories is challenging. Organizations frequently use the balanced scorecard (BSC) for performance evaluation (PE) worldwide. BSC includes an evaluation of five perspectives: financial, customer, internal process, knowledge and innovation, and environmental. Most HealthCare Organizations (HCO) evaluated patient satisfaction in BSC, but none considered engaging patients in the evaluation process. This paper aims to develop an instrument to engage patients in assessing BSC perspectives (BSC-PATIENT) and customize it for Palestinian hospitals. Methods This is a cross-sectional study. Two panels of experts participated in the item generation of BSC-PATIENT. Forward and backward translation processes from English to Arabic and vice versa were performed. Pretesting was performed for 30 patients at one hospital. Then, 1000 patients were recruited at 14 hospitals between January and October 2021. Construct validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Additionally, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were assessed to find redundant and low correlated items. Results The scales had high adequate model fit in EFA and CFA. All items included had loadings higher than 0.50. Although the convergent validity was less than 0.50 for some constructs, their discriminant validity, CR, IIC, and CITC showed satisfactory results except the services experience (SERV EXR) construct, which had a CR of 0.50. The final best fit model in CFA comprised ten constructs with 34 items. Conclusion BSC-PATIENT is the first self-administered questionnaire specially developed to engage patients in evaluating their experiences and attitudes based on the BSC perspectives. The questionnaire scales were carried out following relevant guidelines and regulations. The results showed adequacy in the psychometric properties of this instrument. Three-point Likert scales are recommended to assess patient experiences and attitudes since they have higher response rates. Future research can be conducted using this instrument to evaluate the impact of patient experience on attitudes toward BSC perspectives and compare the differences based on patient and hospital characteristics.