Just how healthy is the practice environment for physicians and nurses at Cleveland Clinic? When researchers wanted to find out nearly a decade ago, they were surprised that no suitable tools existed.

“Not only did assessment instruments ask doctors and nurses different questions — which would be like comparing apples and oranges — they all focused on negative aspects of the hospital or health system work environment,” says Sandra Siedlecki, PhD, RN, CNS, Senior Nurse Scientist in Cleveland Clinic’s Office of Nursing Research and Innovation. “We wanted something that would measure positive aspects, not how much doctors and nurses thought poorly of each other.”

Over the next two years, Dr. Siedlecki and her team created their own tool, based on professional ideals such as mutual respect and effective communication. In 2011, the Professional Practice Environment Assessment Scale (PPEAS) (pronounced “peace”) was introduced in a psychometric study published in the Journal of Nursing Scholarship.

Measuring the positive

“PPEAS is unique because it asks the same 13 questions of both nurses and physicians, making comparison straightforward,” says Dr. Siedlecki. “It’s brief, which is good for busy medical professionals. But more importantly it’s positive. It asks participants to rate statements like, ‘Physicians demonstrate respect for nurses at my facility,’ rather than the converse, ‘Physicians don’t demonstrate respect.’”

The absence of abusive or rude behaviors doesn’t indicate the presence of helpful or respectful ones, she notes. That’s where other environmental assessment tools can be misleading. PPEAS is the only tool available that measures positive aspects of a hospital or health system’s work environment.

Quick test, thorough assessment

Questions evaluate four elements:

1. Positive physician characteristics
2. Positive nurse characteristics
3. Collaborative decision-making
4. Positive beliefs in the value of the nurse-physician relationship

On a scale of one to 10, participants rate how much they agree with each statement, such as “Physicians understand the role of nurses,” and “Physicians and nurses discuss patient care decisions.”

The higher the score, the more positive the environment. You can review scores by any of the four categories to pinpoint areas for improvement and better target interventions. You also can isolate nurses’ or physicians’ scores, although combining them reveals the most balanced result.

“PPEAS can be used for a one-time assessment or repeatedly, to monitor improvement strategies,” says Dr. Siedlecki. “It could also contribute to other organizational studies, such as on attrition rate or patient outcomes.”

PPEAS can be purchased here. Licenses are available for enterprises or student researchers.