Culture, Organization, and Management in Intensive Care questionnaire

Abstract

The Culture, Organization, and Management in Intensive Care (COMIC) questionnaire is a multidimensional instrument developed to systematically assess the perceptions of healthcare workers regarding the organizational climate, management practices, and working relationships within Intensive Care Units (ICUs). The scale is structured into three principal sections focusing on the unit’s general functioning, specific organizational aspects (including communication, coordination, and learning capacity), and interpersonal working relationships, including those pertaining to psychological working conditions and job satisfaction. Initially validated in 2005, the COMIC questionnaire provides a crucial tool for researchers and hospital administrators to evaluate organizational culture and identify areas for improvement in critical care settings, ultimately aiming to enhance quality of care and staff well-being.

Keywords

Organizational culture, Intensive Care Unit, ICU, healthcare management, work climate, job satisfaction, burnout, coordination, communication, psychological working conditions

Authors

Minvielle, E., Dervaux, B., Retbi, A., Aegerter, P., Boumendil, A., Jars-Guincestre, M. C., & Guidet, B.

Purpose

The primary purpose of the Culture, Organization, and Management in Intensive Care questionnaire is to conduct a comprehensive assessment of the culture, organizational structure, and management efficiency within Intensive Care Units. By capturing the subjective opinions of working staff, the instrument facilitates a detailed evaluation of various operational domains critical to the functioning of high-stakes medical environments.

Specifically, the questionnaire aims to quantify staff perceptions across three major domains: the prevailing organizational culture and general unit functioning; the efficiency of organizational processes such as coordination, communication, and learning capacity; and the quality of interpersonal working relationships, including those with patients/families and the psychological impact on the staff.

Construct

The COMIC questionnaire is designed to measure the complex, multidimensional construct of the organizational culture and management environment within a critical care setting. This construct is operationalized through several core sub-dimensions, which collectively define the climate in which ICU professionals operate.

Key constructs assessed include shared values and expected behaviors (Organizational Culture), efficiency metrics (Coordination and Communication), adaptive capabilities (Organizational Learning and Change), conflict resolution mechanisms (Management of Disagreements), perceived outcomes (Effectiveness), and individual well-being (Psychological Working Conditions and Job Satisfaction). This holistic approach allows for the identification of specific organizational factors that may influence staff performance and patient outcomes in the demanding ICU environment.

Validity

The original validation study conducted by Minvielle et al. (2005) focused on establishing the construct validity of the questionnaire. The process involved rigorous development and testing to ensure that the instrument’s structure accurately reflected the theoretical domains of culture, organization, and management in critical care. Although specific details regarding different types of validity (e.g., content, criterion) are elaborated within the core reference, the foundational work aimed to confirm that the identified subscales reliably measured distinct, yet related, aspects of the ICU environment as perceived by the staff.

Reliability

Test reliability of the COMIC questionnaire was systematically reported in the foundational academic publication by Minvielle et al. (2005). Reliability assessment, typically involving measures such as internal consistency (e.g., Cronbach’s alpha coefficients) for the derived subscales, is crucial for ensuring that the instrument consistently measures the constructs over time and across different groups of respondents. High reliability indicates that the variance observed in the scores is due to true differences in the measured construct rather than measurement error.

Factor Analysis

While the original source content does not explicitly detail the outcomes of the factor analysis, the construction and validation of the questionnaire inherently relied on sophisticated psychometric methods, including factor analysis, to structure its multidimensional framework. The questionnaire’s division into three main conceptual parts—general functioning/culture, specific organizational aspects, and working relationships—suggests that exploratory or confirmatory factor analysis was utilized to delineate the specific latent factors (subscales) contributing to the overall measurement of culture, organization, and management.

The resulting factors likely correspond to the distinct sections found in the questionnaire, such as Organizational Culture, Relations and Communications, Coordination, Organizational Learning and Change, Management of Disagreements, Perceived Effectiveness, and Psychological Working Conditions. This psychometric step was fundamental to justifying the use of the scale as a tool for measuring these theoretically distinct components of the ICU environment.

Instrument

Test Type: Self-report questionnaire / Multidimensional Organizational Assessment Scale

Format: Likert-type scales utilizing various response formats (e.g., extent of agreement, frequency, likelihood), categorized into nine distinct sections.

Language Available: English and French

Population Group: Healthcare professionals (Physicians and Nursing Personnel)

Age Group: Adult working population, typically those employed in critical care settings.

Population Details: Staff working within Intensive Care Units (ICUs) and similar critical care environments, including full-time and part-time physicians, residents, and nursing staff (staff nurses and assistant nurses).

Test Methodology: The methodology involves staff members providing their subjective opinions on observable behaviors and organizational characteristics within their unit. Responses are confidential and are intended to assess the unit’s collective situation rather than individual performance. The questionnaire is divided into sections covering general culture (13 items), organizational aspects (covering relations, coordination, learning, and conflict management), perceived effectiveness, and psychological working conditions (22 items).

Keywords

ICU staff perceptions, organizational climate, critical care management, team dynamics, conflict resolution, staff burnout, quality of care, hospital administration, professional well-being

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: N/A (Information not provided in source material)

Permissions & Fee and Test Year

The questionnaire was constructed and validated, with primary results published in 2005. Information regarding current usage permissions, licensing fees, or specific distribution protocols beyond the initial publication is not provided in the source material. Interested users should refer to the corresponding authors (Minvielle et al.) for formal permission requests.

Reference’s

• Minvielle, E., Dervaux, B., Retbi, A., Aegerter, P., Boumendil, A., Jars-Guincestre, M. C., & Guidet, B. (2005). Culture, organisation, and management in intensive care: Construction and validation of a multidimensional questionnaire. Journal of Critical Care, 20, 126-138.

Items of the Culture, Organization, and Management in Intensive Care questionnaire

Questionnaire on the Internal Organization of an Intensive Care Unit

Individual/Physician Questionnaire

Information for respondents

This questionnaire is designed to assess your opinion on the organization of the unit in which you work. It consists of three parts. The first concerns the general functioning of the unit, the second deals specifically with organizational aspects, and the third concerns working relationships. All your answers will remain strictly confidential. Information on how to respond to the different items is given in forewords 1 and 2, and on page 3.

Foreword 1

The following 13 questions concern the general functioning of your unit. All medical wards function in a specific way, and staff are expected to fulfill certain criteria. For example, some ward managers encourage competition among staff; as a result, each employee feels obliged to perform better than his or her colleagues.

When answering the following 13 questions, first read the initial statement and then indicate to what extent you feel the type of behavior it describes helps staff to integrate the unit and to meet the demands placed upon them.

When judging each statement it may be helpful to think of the behaviors that are encouraged and rewarded by your superiors. Don’t forget that all the statements refer to relationships between the unit’s staff members, not to relationships with persons who are not an integral part of the unit.

1. Organizational culture

To what extent are people expected or implicitly required to…?

	… to a very great extend
	… to a  great extend					½
	… to a moderate extend				½	½
	… to a slight extend			½	½	½
	not at all		¯	¯	¯	¯
			‚	ƒ	„	…
1.1	Contribute to other staff members’ personal and professional well-being	!	!	!	!	!
1.2	Pay attention to the quality of human relations within the unit	!	!	!	!	!
1.3	Endeavor to be well considered	!	!	!	!	!
1.4	Apply norms and procedures without question	!	!	!	!	!
1.5	Not to question instructions	!	!	!	!	!
1.6	Turn a blind eye to problems	!	!	!	!	!
1.7a	Remain cool and collected in all circumstances

	… to a very great extend gly
	… to a  great extend					½
	… to a moderate extend				½	½
	… to a slight extend			½	½	½
	not at all		¯	¯	¯	¯
			‚	ƒ	„	…
1.7b	Indirectly question orders	!	!	!	!	!
1.8	Exert their authority to the full	!	!	!	!	!
1.9	Do whatever it takes to appear “the best”	!	!	!	!	!
1.10	Be perfectionists	!	!	!	!	!
1.11	Ensure they have the means required to fulfill their tasks	!	!	!	!	!
1.12	Remain personally well-balanced while at work	!	!	!	!	!

Organization of the unit

Foreword 2

The following questions concern communication, coordination (between and within units, and reactions to unexpected situations), problem management,  relationships with users, and, the capacity to learn, and to change. Finally, the last 22 items concern the psychological conditions in which you work.

We would like you to give your opinion of how people most often behave in your unit, independently of how you personally judge their behavior.

The word “physician” is used here to refer to all medical doctors who work in the unit, whether permanently, temporarily or occasionally. The term “nursing personnel” includes all other care-givers, from staff nurses to assistant nurses.

In the section on your psychological working conditions, please express your personal feelings.

2-Relations and communications within the unit

For each of the following statements, please select the response that best reflects your judgment.

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
	The following statements refer to relationships among the unit’s physicians.
2.1	I find it easy to discuss openly with the unit’s physicians	!	!	!	!	!
2.2	I have sometimes been poorly informed by the unit’s physicians	!	!	!	!	!
2.3	Communication among the unit’s physicians is very open	!	!	!	!	!
2.4	I often have to check the accuracy of the information I receive from the unit’s physicians	!	!	!	!	!
2.5	I find it very enjoyable to talk with the unit’s physicians	!	!	!	!	!
2.6	When physicians talk with each other in this unit they understand each other well	!	!	!	!	!
2.7	The information exchanged by the unit’s physicians is sometimes inaccurate	!	!	!	!	!
2.8	It’s easy to ask for advice from the unit’s physicians	!	!	!	!	!
2.9	I feel that some of the unit’s physicians don’t fully understand the information they receive	!	!	!	!	!

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
	The following statements refer to relationships between the unit’s physicians and nursing staff.
2.10	I find it easy to discuss openly with the unit’s nursing staff	!	!	!	!	!
2.11	I have sometimes been poorly informed by the unit’s nursing staff	!	!	!	!	!
2.12	Communication between the unit’s physicians and nursing staff is very open	!	!	!	!	!
2.13	I frequently have to check the accuracy of the information I receive from the unit’s nursing staff	!	!	!	!	!
2.14	I find it very enjoyable to talk with the unit’s nursing staff	!	!	!	!	!
2.15	When physicians talk in this unit with the nursing staff, they understand each other well	!	!	!	!	!
2.16	The information exchanged between the unit’s physicians and nursing staff is sometimes inaccurate	!	!	!	!	!
2.17	It’s easy to ask for advice from the unit’s nursing staff	!	!	!	!	!
2.18	I feel that some of the unit’s nursing staff don’t fully understand the information they receive	!	!	!	!	!

2-Relations and communications within the unit (continued)

For each of the following statements, please select the response that best reflects your judgment.

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
	The following statements refer to relations and communication within the unit.
2.19	I obtain the information I need on a given patient’s condition in a timely manner	!	!	!	!	!
2.20	I rapidly obtain the relevant information when a patient’s condition changes	!	!	!	!	!

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
2.21	There are needless delays in relaying information regarding patient care	!	!	!	!	!
2.22	Nurses call physicians in a timely manner during patient care procedures	!	!	!	!	!

3-Relations with users

For each of the following statements, please select the response that best reflects your judgment.

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
3.1	The unit’s nursing staff possess the necessary skills	!	!	!	!	!
3.2	The unit’s nursing staff do not fully inform the patient or family/friends of how the patient is progressing	!	!	!	!	!

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
3.3	The unit’s nursing staff take into account the expectations of the patients and family/friends	!	!	!	!	!
3.4	The unit’s nursing staff are sometimes impolite to patients or family/friends	!	!	!	!	!

4-Coordination

Coordination with other hospital units

For each of the following statements, please select the response that best reflects your judgment.

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
4.1	My unit has a constructive working relation with the hospital’s other units	!	!	!	!	!
4.2	My unit does not receive sufficient cooperation from the hospital’s other units	!	!	!	!	!

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
4.3	Some of the hospital’s other units seem to have a very poor opinion of my unit	!	!	!	!	!
4.4	Poor working relationships with some of the hospital’s other units hinder the work of my unit	!	!	!	!	!

Coordination within the unit

Various strategies and procedures are used to coordinate care in intensive care units. In your unit, to what extent do you feel each of the following measures contributes to the coordination of patient care and management? Select the answer that you feel applies best to your unit. If the measure is not used in your unit, please tick the last column (“not used”.

		€ Not used
	… Very effective							½
	„ Effective						½	½
	ƒ Moderately effective					½	½	½
	‚ Poorly effective				½	½	½	½
	Ineffective			¯	¯	¯	¯	¯
				‚	ƒ	„	…	€
4.5	Written rules and procedures		!	!	!	!	!	!
4.6	Written schedules and timetables		!	!	!	!	!	!
4.7	Managerial attempts to coordinate the unit’s activities		!	!	!	!	!	!
4.8	Face-to-face meetings between managerial staff		!	!	!	!	!	!
4.9	Special ad hoc task forces		!	!	!	!	!	!
4.10	Written protocols for diagnostic and therapeutic management of certain clinical situations		!	!	!	!	!	!
4.11	Daily visits		!	!	!	!	!	!

Reactions to unexpected situations

For each of the following statements, please select the response that best reflects your judgment.

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
4.12	Usually, the unit’s staff react rapidly to unexpected situations	!	!	!	!	!

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
4.13	The unit’s staff generally show a lack of initiative when confronted with unusual tasks	!	!	!	!	!

5-organizational learning and change

For each of the following statements, please select the response that best reflects your judgment.

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
5.1	The unit’s staff are somewhat reticent to adopt new organizational ideas	!	!	!	!	!
5.2	The unit’s staff have a fairly good attitude to new organizational ideas	!	!	!	!	!
5.3	There is not enough time to weigh up proposed changes to the unit’s organization	!	!	!	!	!

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
5.4	Dysfunctions in the unit are not sufficiently discussed	!	!	!	!	!
5.5	The unit’s staff learn rapidly when confronted with new problems	!	!	!	!	!
5.6	The unit’s staff do not like handling new tasks	!	!	!	!	!
5.7	The unit’s staff are open to change	!	!	!	!	!

6-Management of disagreements and conflicts within the unit

Consider what happens when a disagreement or conflict arises between the unit’s physicians. On the basis of your own experience in the unit, estimate the likelihood of the following statements.

	… Almost certain
	„ Very likely					½
	ƒ Quite likely				½	½
	‚ Unlikely			½	½	½
	Not at all likely		¯	¯	¯	¯
			‚	ƒ	„	…
	The following statements refer to the way in which disagreements and conflict between physicians are handled.
6.1	If physicians disagree, they ignore the problem and “hope it goes away”	!	!	!	!	!
6.2	The physicians will withdraw from the conflict	!	!	!	!	!
6.3	All the different viewpoints are carefully examined to arrive at the best possible solution	!	!	!	!	!
6.4	All the physicians do everything they can to arrive at the best solution	!	!	!	!	!
6.5	The physicians involved continue to discuss the problem until they are all satisfied with the decision taken	!	!	!	!	!
6.6	Each person contributes to finding an acceptable solution by drawing on his/her own experience	!	!	!	!	!
6.7	Disagreements between physicians will be ignored or avoided	!	!	!	!	!

	… Almost certain
	„ Very likely					½
	ƒ Quite likely				½	½
	‚ Unlikely			½	½	½
	Not at all likely		¯	¯	¯	¯
			‚	ƒ	„	…
	The following statements refer to how disagreements and conflicts between physicians and nursing staff are handled.
6.8	If physicians and members of the nursing staff disagree, they ignore the problem and “hope it goes away”	!	!	!	!	!
6.9	The two parties will withdraw from the conflict	!	!	!	!	!
6.10	All the different viewpoints are carefully examined in order to arrive at the best possible solution	!	!	!	!	!
6.11	The physicians and nursing staff do everything they can to arrive at the best solution	!	!	!	!	!
6.12	The two parties continue to discuss the problem until they are all satisfied with the decision taken	!	!	!	!	!
6.13	Each person contributes to finding a good solution by drawing on his/her experience	!	!	!	!	!
6.14	Disagreements between physicians and nursing staff will be ignored or avoided	!	!	!	!	!

7-Perceived effectiveness

For each of the following statements, please select the response that best reflects your judgment.

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
7.1	Our unit almost always meets its treatment aims	!	!	!	!	!
7.2	We get good results, considering the severity of the patients we treat	!	!	!	!	!
7.3	The unit correctly handles the needs of the patients’ families	!	!	!	!	!
7.4	The unit correctly uses the latest available technology to meet patients’ needs	!	!	!	!	!
7.5	We are able to recruit the best intensive-care nursing staff	!	!	!	!	!

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
7.6	We manage to keep our best intensive-care nursing personnel	!	!	!	!	!
7.7	We are able to recruit the best intensive-care physicians	!	!	!	!	!
7.8	We manage to keep the best intensive-care physicians	!	!	!	!	!
7.9	In general the unit functions very well, as a  team	!	!	!	!	!

8-psychological working conditions

Please read carefully the following 22 statements, then give your opinion on your current working situation.

‡ Every day

† A few times a week

½

… Once a week

½

½

„ A few times a month

½

½

½

ƒ Once a month or less

½

½

½

½

‚ A few times a year or less

½

½

½

½

½

Never

¯

¯

¯

¯

¯

¯

‚

ƒ

„

…

†

‡

8.1

I feel mentally exhausted by my work

!

!

!

!

!

!

!

8.2

I feel tired when I get up in the morning, knowing I have to go to work

!

!

!

!

!

!

!

8.3

I understand very well how my patients feel

!

!

!

!

!

!

!

8.4

I feel I treat some patients as if they were “objects”

!

!

!

!

!

!

!

8.5

I find it hard to work all day as part of this team

!

!

!

!

!

!

!

8.6

I deal with my patients’ problems very effectively

!

!

!

!

!

!

!

8.7

I feel burn out by my work

!

!

!

!

!

!

!

8.8

I have become more insensitive to others since I arrived in this unit

!

!

!

!

!

!

!

8.9

I worry that this job is  hardening  me emotionally

!

!

!

!

!

!

!

8.10

I don’t really care about what happens to some patients

!

!

!

!

!

!

!

8.11

I find it easy to create a relaxed atmosphere with my patients

!

!

!

!

!

!

!

8.12

I feel I’ve achieved a lot in this job

!

!

!

!

!

!

!

8.13

I feel like I am at the end of my rope

!

!

!

!

!

!

!

9-General job satisfaction and intention to quit

Please tick the appropriate response

	… I entirely agree
	„ I agree					½
	ƒ I neither agree nor disagree				½	½
	‚ I disagree			½	½	½
	I strongly disagree		¯	¯	¯	¯
			‚	ƒ	„	…
9.1	In general, I’m satisfied with my job	!	!	!	!	!
9.2	As things stand, it wouldn’t take much to make me leave the unit	!	!	!	!	!

PERSONAL INFORMATION

Sex                                         Male                                   Female          

Age:                                                                                        years

Position                                  Full-time Physician             

                        Part-time Physician                                    

                        Resident                                                       

                                                Other (please specify): ………………….……….

Time spent:               in the unit                              years months

                                    in the hospital                       years months

                                    in my current position          years months

                                    in intensive care                   years months

Thank you for your help. Your answers will remain fully confidential. No individual answers will be communicated. The questionnaire will be analyzed to assess the situation in your unit, which will then be compared with that in the other units that participated in this survey. The results will be sent to each unit’s director for distribution.