AACN Healthy Work Environment Assessment Tool

About the Assessment

In 2009, AACN, in collaboration with VitalSmarts, developed the Healthy Work Environment Assessment Tool (HWEAT) to help hospital units and teams assess and measure progress in establishing and sustaining a HWE. Since then, the tool significantly expanded internationally, interprofessionally and as a research instrument. Based on feedback from the AACN community, researchers and internal staff, it was evident that we needed an assessment tool that was more specifically related to the six HWE standards and offered greater sensitivity for more informative analysis.

In this second version, the HWEAT expands from 18 to 24 questions; four questions per HWE standard. The revised questions drill deeper into the six AACN HWE standards and include items that reflect both unit and organizational influences on the health of the work environment. In addition, the response scales were revised to achieve greater sensitivity and specificity to enhance the interpretation of results. Another major change is that the response scales now measure agreement and quality.

Test Development & Psychometrics

To update the instrument, AACN’s HWEAT team gathered feedback on an initial draft of 53 question items from the community to ensure the reliability and validity of the new instrument. In this first phase of the revision, an HWEAT focus group was assembled to include nurses on staff, HWE tool users, researchers and AACN volunteers. We then reached out to several HWE subject matter experts (SMEs) to gather and incorporate their feedback on these items.

The second phase included engaging eight AACN staff nurses to assess face validity - indicating whether the assessment items were clear. Additionally, five internal SMEs assessed content validity - indicating whether each item was representative and relevant. This change ensured the questions reflected HWEs through the HWE standards lens. Both panels provided open-ended feedback about the draft questions that helped the HWEAT team further refine them.

In the third phase, 489 AACN volunteers piloted the assessment tool. The data provided by volunteers helped the HWEAT team greatly reduce the number of items through factor analysis (a principal component analysis).

In the final phase, using data collected throughout each step, the HWEAT team narrowed the questions from 53 items to 24 items, ensuring four questions for each of the six standards.

• View Assessment Questions - RN Version
• Download Sample Report - RN Version
• View Assessment Questions - Team Version
• Download Sample Report - Team Version

For all assessment tool questions, please use the following operational definitions.

• Organization: Refers to the institution as a whole.
• Unit: Refers to the work unit, area, or department.
• Top-level leadership: Executive roles such as CEO, CCO, CNE, CMO, CNO, Vice President, Executive Director, etc.
• Team members accountable for leading: Formal leaders responsible for directly managing staff in the work unit, area, or department.
• Team members: Everyone who contributes to the care and treatment provided to the patient and those involved with the functioning and management of the work unit, area, or department.

Frequently Asked Questions

Should I administer the HWEAT-RN Version (Formerly HWEAT 2.0) or HWEAT-Team Version?

The answer to this depends on your objectives. If you would like to assess the health of the work environment through the perceptions of RNs only, use the RN version. If you would like perceptions of the team (with team members from various professional disciplines), use the team version. If you were previously using HWEAT 2.0, that is now known as HWEAT-RN.

Who is the assessment point of contact (POC)?

This person registers a group for the assessment. It can be anyone, but most often it will be a facility’s manager or clinical leader.

How long does the assessment take to administer?

Depending on how many people will be invited to take the assessment, the POC can register and send email invitations in less than 15 minutes.

How long does it take to complete the assessment?

The 24-question assessment should take less than 15 minutes to complete.

Do I have to complete the assessment in one sitting?

Yes. If you cannot finish the assessment in one sitting, your responses will need to be reentered. Please make sure you have enough time to complete the assessment in one sitting.

Are the responses anonymous?

Yes, all responses are anonymous and confidential. The report will not contain individual participants’ answers, but it will compile the results anonymously. Surveys can only be created for five or more participants per work unit to protect anonymity.

Who receives the assessment report?

The assessment POC receives an anonymous summary report for their group. This report does not contain the answers of the individual participants.

What information does the assessment report provide?

View a sample assessment report.

When can I view my unit’s report?

You may download the results of your unit’s assessment after the survey window has closed. Please note: Once your survey has closed and the summary report has been generated, you will not be able to reopen your survey window.

Will information collected in the assessment be shared with outside groups?

AACN may analyze aggregate data. If reports are published, we will not disclose the names of participating organizations, assessment administrators or assessment subjects.

Why is the HWEAT a new application requirement for Beacon 3.0?

• Data from the most recent National Nurse Work Environment Survey indicates that Beacon units tend to have a healthier work environment.
• In order to successfully drive improvements of any kind, you need to have a healthy work environment.
• Measuring the health of the work environment is as valuable as any other clinical measurement (e.g., CLABSI & CAUTI rates).

Troubleshooting

What if my initial response rate is low?

The point of contact (POC) is encouraged to email a reminder to assessment participants one to two weeks following the initial email request. To send a follow-up email, click here. Copy and paste the email template into a new message and send it to your distribution list. You may personalize your message.

What if I would like to add additional respondents to take the survey?

The POC may use the email invitation text sent to the initial distribution list and send it to all respondents. Copy and paste the invitation template into the email message. You may personalize it.

How long do participants have to take the survey?

The POC can determine how long they would like to keep a survey open when the assessment is initially created. The assessment end date is communicated in your email to all participants. When the deadline occurs, participants are no longer allowed to complete the survey.

How do I adjust my survey window?

In the team portal, locate your organization by entering the name you used to register your department. After clicking the “continue” button you will be directed to a page that will allow you to adjust your survey window. Revise the survey end date and click confirm. Please note that you will not be able to adjust your survey window once the survey period closes and the summary report has been generated.

What if emails on my distribution list “bounce back” to my email inbox as undeliverable?

Before sending the survey invitations, the POC should check that all email addresses on their distribution list are current and accurate. The POC sends survey invitations through their own email systems, whether they are served by the hospital/company or an internet service provider (such as aol, yahoo, etc.) Contact the service provider to address any issues with undeliverable emails.