How Well Are We Supporting Hospice Staff? Initial Results of the Survey of Team Attitudes and Relationships (STAR) Validation Study

Despite the emotional and interpersonal challenges that hospice staff face in providing care to patients near the end of life, no systematic effort has been made to evaluate the work environment that hospices provide to their staff. The aim of this project was to develop a job satisfaction survey that could be used to evaluate the hospice work environment and, ultimately, to guide interventions to improve the work experience for hospice staff. A first draft of the Survey of Team Attitudes and Relationships (STAR) was developed through semi-structured interviews with an interdisciplinary sample of staff from nine hospices, and then refined with input from additional interviews and from an expert panel. The draft was tested on larger samples of staff (n = 160) from six hospices and revised with input from the expert panel. The final survey was tested with 599 staff from 10 hospices. The final survey contains 45 items in six domains: individual work rewards, teamwork, management support, organizational support, workload issues, and global assessment of job satisfaction. Items had excellent psychometric characteristics, with acceptable floor and ceiling effects. The overall STAR had a Cronbach's alpha of 0.93, indicating good homogeneity, and each domain had alpha values that are appropriate for between-group comparisons (range 0.74–0.84). These results suggest that the STAR offers a unique instrument to measure the work environment hospices provide to their staff.