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Updated: Dec 23, 2025

Qualitative and Quantitative Validation of Tools with Rating Scales Aimed at Assessing the Quality of University Service-Learning
Published on: August 29, 2025
Development and Validation of the Systems Thinking Scale.
Mary A Dolansky1, Shirley M Moore2, Patrick A Palmieri3
1Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA. Mary.dolansky@case.edu.
A new 20-item Systems Thinking Scale (STS) was developed and psychometrically tested. This reliable and valid instrument can advance quality improvement science and education by measuring systems thinking skills.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Educational Measurement
Background:
- Systems thinking is crucial for quality and safety initiatives.
- A validated measure is needed to understand improvement mechanisms.
- This study aimed to develop and test a Systems Thinking Scale (STS).
Purpose of the Study:
- Develop a psychometric instrument to measure systems thinking.
- Validate the Systems Thinking Scale (STS) in healthcare professionals and students.
- Provide a tool to advance quality improvement education and research.
Main Methods:
- Expert conceptual domains informed item generation.
- Psychometric testing involved interprofessional healthcare faculty and students.
- Factor analysis, reliability, and validity testing were conducted.
Main Results:
- A 20-item STS emerged after factor analysis.
- The STS demonstrated good test-retest reliability (r=0.74).
- Internal consistency was high (Cronbach's alpha=0.89), and discriminant validity was confirmed.
Conclusions:
- The 20-item STS is a valid and reliable measure.
- The scale is easy to administer, requiring less than 10 minutes.
- The STS can enhance understanding of quality improvement mechanisms and evaluate educational effectiveness.

