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Maturity Matrix: a criterion validity study of an instrument to assess organisational development in European general practice

Melody Rhydderch

Introduction The Maturity Matrix is a self-assessment measure of organisational development designed to be used by general practice teams with the aid of a trained facilitator. To date, its content validity, feasibility and reliability have been studied with UK and European practices. There is increasing interest in combining practice-led assessmentswith externally led assessments such as professionally led accreditation schemes. The aim of this research is to evaluate the criterion validity of the Maturity Matrix when it is used with another more established quality improvement instrument known as the European Practice Assessment Instrument (EPA).Design Criterion validity study.Sample One-hundred and forty-five general practices from five European countries (Germany, The Netherlands, Slovenia, Switzerland, UK).Methods A mapping process was used to identify which of the 11 Maturity Matrix dimensions were similar to EPA items and could therefore be included in the study. The mapping process revealed that 12 EPA items were similar to eight Maturity Matrix dimensions. The included Maturity Matrix dimensions were clinical data, audit of clinical performance, clinician access to clinical information, human resources management, continuing professional development, riskmanagem ent, practice meetings and sharing information with patients. The EPA items were assessed by an external assessor using a categorical yes/no response. The Maturity Matrix dimensions were each scored on a 1–8 scale. Mann–Whitney U tests for statistically significant differences between the median scores on the Maturity Matrix and EPA were applied.Results Twelve analyses were conducted. Analyses fromsix dimensions revealed statistically significant differences between the median Matrix scores for yes and no responses on the EPA, five of which were significant at P 0.01 and one at P 0.05. These six dmensions were: clinical data, audit of clinical performance, clinician access to clinical information, human resources management, meetings and sharing information with patiets, although forboth the human resources management and sharing of information dimensions the evidence was mixed with some analyses not being significant. The analyses where no significant differences at all were found related to the following Maturity Matrix dimensions: riskman agement, continuing professional development. The box plot graphs for each analysis revealed that in some cases practices viewed themselves more positively using the MaturityMatrix than when they were rated on similar EPA items by an external assessor. Discussion The Maturity Matrix possesses partial criterion-related validity when compared with the EPA. Item wording may have been a factor in the six analyses that were not statistically significant. Alternatively the method of  assessment (self- vs external assessment) may be a factor in the remaining analyses that were not statistically significant.Conclusion Although combining self-assessment with external assessments is desirable to increase practices’ ownership of the process, thought needs to be given to the way in which they are used alongside each other.