Background: Previous research has identified four distinct developmental stages associated with organizational learning in high-performing hospital units: identity and ownership, team and respect, accountability and support, and reliability and sustainability. We designed a research instrument to measure these constructs. The purpose of this thesis was to establish the content and predictive validity of this instrument.Methods: The Organizational Learning Development Instrument (OLDI) consists of a total of 35 items in Likert-scale format. Item-level and instrument-level content validity were assessed using three cycles of cognitive interviewing with 28 nurses, and eight expert ratings. The OLDI was administered to nurses in Magnet® hospitals via a web-based survey. National Database of Nursing Quality Indicators (NDNQI) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) reports were used for comparison of hospital performance. Predictive validity was tested using multiple linear regression. Based on a power analysis for multiple linear regression, reaching 80% power, with a medium effect size of 0.15, an alpha of 0.05, and five predictor variables, the target sample size was 92 hospital units.Results: Results from 63 inpatient units in 11 Magnet® hospitals were used. The scale- level content validity for this instrument was 0.95 and item-level content validity index scores ranged from 0.86 to 1.0, suggesting excellent content validity. No significant relationships were found between OLDI results and NDNQI measures. Significant correlations (P<.05) were found between several OLDI constructs and HCAHPS composites.Discussion: Correlations with HCAHPS scores help validate the OLDI, as well as the theory underlying the instrument. The OLDI may not have predicted NDNQI measures due to a lack of instrument sensitivity or because NDNQI results are strongly influenced by other factors. Nurse managers can use the OLDI to predict unit performance related to patient satisfaction and to determine actions that may improve unit performance. Replicating this study with a larger sample size and more diverse hospital performance and more uniform unit type could further validate this instrument.



College and Department

Nursing; Nursing



Date Submitted


Document Type





Organizational Learning, Quality Improvement, Safety, Nurse Managers, Instrument Development, Leadership