Work Relationships Scale (WRS)

Abstract

The Work Relationships Scale (WRS) is a psychological instrument developed to measure the quality of relationships and interactions among staff members within healthcare settings, specifically in Primary Care clinics. Developed and validated by Finley et al. (2013), the WRS is designed to assess key organizational factors—including communication, continuous learning, trust, and leadership—that underpin effective teamwork and potentially influence patient-assessed quality of care. The scale demonstrates exceptionally high internal consistency, supporting its use as a reliable measure of relationship quality in complex clinical environments.

The structure of the scale encompasses 15 items distributed across four major domains: Cognitive, Affective/Relational, Behavioral, and Leadership. Responses are captured using a 5-point Likert scale, allowing for nuanced measurement of staff perceptions regarding their clinic’s organizational culture and relational dynamics.

Keywords

Work Relationships Scale, WRS, Relationship Quality, Healthcare Teamwork, Organizational Climate, Continuous Learning, Conflict Resolution, Primary Care, Staff Interaction.

Authors

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

Purpose

The primary purpose of the Work Relationships Scale is to provide a quantitative measure of the quality of interpersonal and organizational relationships among clinical staff. It was specifically developed in the context of VA Primary Care clinics to understand how staff interactions, communication patterns, and leadership support contribute to the overall quality of care delivered to patients.

By assessing these relational dynamics, the WRS helps researchers and administrators identify areas of strength and weakness within the organizational structure, facilitating targeted interventions aimed at improving teamwork, reducing conflict, and fostering a culture of continuous improvement and patient safety.

Construct

The WRS measures the psychological construct of Work Relationship Quality, which is operationalized as the collective capacity of a clinical team to engage in effective communication, mutual respect, shared understanding, and adaptive behavior. This construct moves beyond simple job satisfaction to capture the underlying mechanisms of organizational learning and collaboration necessary for high-reliability performance in healthcare.

The scale is multidimensional, reflecting the complexity of organizational relationships. It integrates elements related to how teams think (Cognitive domain), how they feel and interact (Affective/Relational domain), what they do (Behavioral domain), and how they are managed (Leadership domain). These dimensions align with established theories of team effectiveness and organizational development.

Validity

The development process for the WRS included rigorous steps to ensure its validity, focusing on the relationship between staff-assessed relationship quality and patient-assessed quality of care. The scale was validated in a population of VA Primary Care clinics, demonstrating its relevance and applicability in real-world clinical settings.

The authors established construct validity by ensuring the items map logically onto the intended domains (Cognitive, Affective/Relational, Behavioral, and Leadership). Furthermore, the scale’s ability to predict or correlate with external outcomes, such as patient-reported quality measures, provides evidence of its predictive utility within the healthcare context.

Reliability

The Work Relationships Scale exhibits excellent psychometric properties regarding reliability. The measure of internal consistency, calculated using Cronbach’s alpha, was reported as 0.95.

This high value of 0.95 indicates that the scale items are highly interrelated and consistently measure the same underlying construct of work relationship quality. Additionally, the inter-item correlations ranged from 0.29 to 0.80, confirming a strong and appropriate level of consistency among the individual items.

Factor Analysis

The factor structure of the WRS organizes the 15 items into four principal domains, which further subdivide into specific organizational processes:

• Cognitive Domain: Focuses on shared understanding and learning processes.
  • Sense-making (n=2): Items 10, 12
  • Continuous learning (n=6): Items 1, 2, 3, 6, 10, 13
  • Shared explicit goals and accountability (n=1): Item 12
  • Evolving mental models of roles (n=0): No items explicitly assigned in this category in the provided data.
• Affective/Relational Domain: Focuses on emotional safety and interpersonal dynamics.
  • Trust (n=1): Item 4
  • Respectful interaction (n=4): Items 1, 8, 13, 14
  • Heedful inter-relating (n=1): Item 5
  • Commitment (n=0): No items explicitly assigned in this category in the provided data.
• Behavioral Domain: Focuses on practical actions and observable team processes.
  • Communication (n=4): Items 4, 6, 7, 9
  • Adaptable to context and needs, improvisation (n=1): Item 2
  • Conflict resolution (n=2): Items 9, 11
• Leadership Domain: Focuses on the role of leadership in facilitating relationship quality.
  • Leadership (n=1): Item 15

Instrument

Test Type: Organizational Climate/Relationship Quality Self-Report Scale

Format: 15 items rated on a 5-point Likert scale, where 1=Disagree Strongly, 2=Disagree, 3= Neutral, 4= Agree, 5= Strongly Agree.

Language Available: English (Original development language)

Population Group: Healthcare personnel (e.g., nurses, medical assistants, clinical staff, and management)

Age Group: Adult (Working professional age)

Population Details: Primarily validated among staff in Veterans Affairs (VA) Primary Care clinics.

Test Methodology: Survey methodology administered to clinical staff to assess their perception of internal organizational relationships and culture.

Keywords

Organizational Development, Healthcare Management, Team Dynamics, Psychometric Scale, VA System, Communication Assessment, Cronbach’s alpha, Affective Domain, Behavioral Domain.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Not provided in source material.

Correspondence Address: Not provided in source material.

Permissions & Fee and Test Year

The Work Relationships Scale was published and validated in 2013. The original research article outlining its development and validation is publicly available through the sources cited below, suggesting that the instrument is generally accessible for non-commercial academic research purposes, though specific licensing terms should be confirmed with the authors or the journal publisher.

The instrument can be found online via the following academic sources:
http://www.annfammed.org/content/11/6/543.full and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823725/.

Reference’s

The primary developmental and validation reference for the WRS is:

• Finley, Erin P., Pugh, Jacqueline A., Lanham, Holly Jordan., Leykum, Luci K., Cornell, John., Veerapaneni, Poornachand., and Parchman, Michael L. (2013). Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale. Annals Family Medicine; 11(6): 543–549.

A related study utilizing concepts of workplace relationships is:

• Khodarahimi, Siamak., Hashim, Intan H. M., Mohd-Zaharim, Norzarina. (2012). Workplace Relationships, Stress, Depression and Anxiety in a Malaysian Sample. International Journal of Psychology and Behavioral Sciences, 2(2): 1-9.

Items of the Work Relationships Scale (WRS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. This clinic encourages nursing staff (ie‚ RN‚ LVN‚ MA‚ CMA) input for making changes.
2. Most people in this clinic are willing to change how they do things in response to feedback from others.
3. Most people in this clinic actively seek new ways to improve how we do things.
4. Most people in this clinic are comfortable voicing their opinion even though it may be unpopular.
5. Most people in this clinic pay attention to how their actions affect others in the clinic.
6. After making a change‚ we usually discuss what worked and what didn’t.
7. Most people in this clinic get together to talk about their work.
8. This clinic values people who have different points of view.
9. Difficult problems in this clinic are usually solved through face-to-face discussion.
10. We regularly take time to consider ways to improve how we do things.
11. When there is a conflict in this clinic‚ the people involved are encouraged to talk about it.
12. Most people in this clinic understand how their job fits into the rest of the clinic.
13. This clinic usually encourages everybody’s input for making changes.
14. My opinion is valued by others in this clinic.
15. The leadership in this clinic usually makes sure that we have the time and space necessary to discuss changes to improve care.

Note: CMA = certified medical assistant; LVN = licensed vocational nurse; MA = medical assistant; RN = registered nurse.