Factors affecting social accountability of medical schools in the Korean context: exploratory factor and multiple regression analyses

Figures & data

Table 1. The 39 items assessing the five hypothesized factors affecting the implementation of social accountability

Factor	Items assessing factors affecting implementation of social accountability	Reference
1. Human resource (HR)	1.1 Members’ understanding of the concept of social accountability	[7,32]
	1.2 Members’ empathy for the importance of implementing social responsibility	[4]
	1.3 Leaders’ interest in implementation of social accountability of medical school	[10]
	1.4 Participation of stakeholders in the implementation of social accountability (planning, implementing, evaluating)	[8,55]
2. Education program (ER)	2.1 Organization of education curriculum reflecting the social needs of health care in the community	[33,34]
	2.2 Education programs, projects based on communities for the underprivileged in the society	[35,36]
	2.3 Drive research projects on national and regional health care issues and health inequality	[37],
	2.4 Conduct clinical practice on the patient population in the community where the graduates come from	[13,37,38]
	2.5 Encourage faculty and students to participate in community-based service learning	[39,40]
3. Organization internal (OI)	3.1 Statement on social accountability to establish ideology, mission, or educational objectives	[20,21,41]
	3.2 Organization of a committee or dedicated department in charge of performing social accountability	[42]
	3.3 Establishment of an organizational system for the performance of social accountability	[43]
	3.4 Expertise of dedicated personnel responsible for the performance of social accountability	[42,44]
	3.5 Incentives for implementing social accountability (including performance assessment)	[42,44]
	3.6 Policy to select vulnerable or socially disadvantaged students	[42,44]
	3.7 Establish an organizational culture that emphasizes social accountability	[15,45]
	3.8 Encourage students to pursue a career in primary care	[34,46]
	3.9 Budget and financial support for the performance of social accountability	[16]
	3.10 Environment of education, research, and medical facilities related to the performance of social accountability	[20,21]
	3.11 Development of social accountability framework model	[15,25,47]
	3.12 Development of indicators to measure the implementation of social accountability	[20,21,23]
	3.13 Establishment of social accountability monitoring system	[28]
	3.14 Periodic assessment of social accountability performance	[14]
	3.15 Train graduates who influence society’s needs as the main agents of health care system change beyond fostering good clinical doctors	[48,49]
	3.16 Regularly hold report and seminar evaluation activities for performing social accountability	[14,28]
4. Partnership interaction (PS)	4.1 Establish goals with key stakeholders	[11,45]
	4.2 Establish partnerships with diverse stakeholders	[45]
	4.3 Conduct regular monitoring of health care needs in the society	[23]
	4.4 Satisfaction of graduates working at national and regional health care institutions	[34,46]
	4.5 Seamless communication and information exchange with key stakeholders	[3,5]
	4.6 High understanding of key stakeholders	[22]
	4.7 Balance of role-sharing between medical schools, community, government	[9,17]
	4.8 Regularly hold social accountability consortiums with key stakeholders	[30,54]
	4.9 Evaluate whether social accountability performance activities have a positive impact on the society	[4,50]
5. Environment (EV)	5.1 Social accountability standards in accreditation	[22,51]
	5.2 State support for implementation of outstanding social accountability of medical school	[9,17]
	5.3 Possibility of access to targets that carry out social accountability	[7,10,52]
	5.4 Ease of establishing organic cooperative relationships with key stakeholders	[3,8],
	5.5 Association of health care needs and priorities in medical school and community	[53]

Table 2. Results of the exploratory factor analysis: HSP model

Item no	Statement	Factor
		1	2	3	4	5	6	7	8
4–1	Establishment of goals with key stakeholders	.973
4–2	Establishment of partnerships with diverse stakeholders	.845
3–12	Development of indicators to measure the implementation of social accountability		.950
3–13	Establishment of social accountability monitoring system		.934
3–14	Periodic assessment of social accountability performance		.886
3–3	Establishment of an organizational system for the performance of social accountability			.930
3–4	Expertise of dedicated personnel responsible for the performance of social accountability			.858
3–2	Organization of a committee or dedicated department in charge of performing social accountability			.801
3–7	Establishment of an organizational culture that emphasizes social accountability			.652
3–16	Regular holding of report and seminar evaluating activities for performing social accountability			.614
2–1	Organization of education curriculum reflecting the social needs of health care in the community				.855
2–2	Education programs, projects based on communities for the underprivileged in the society				.700
2–4	Conduct clinical practice on the patient population in the community where the graduates come from				.674
2–3	Drive research projects on national and regional health care issues and health inequality				.699
1–1	Members’ understanding of the concept of social accountability				.619
4–6	High understanding of key stakeholders					.882
4–4	Satisfaction of graduates working at national and regional healthcare institutions					.787
4–5	Seamless communication and information exchange with key stakeholders					.720
4–8	Regular holding of social accountability consortiums with key stakeholders					.727
4–3	Conduct regular monitoring of health care needs in the society					.694
4–9	Evaluation of whether social accountability performance activities have a positive impact on the society					.692
4–7	Balance of role-sharing among medical schools, community, government					.636
5–3	Possibility of access to targets that carry out social accountability						−.708
5–4	Ease of establishing organic cooperative relationships with key stakeholders						−.531
3–9	Budget and financial support for the performance of social accountability							.798
3–10	Environment of education, research, and medical facilities related to the performance of social accountability							.761
3–11	Development of social accountability framework model							.696
3–15	Training of graduates who influence society’s needs as the main agents of health care system change beyond fostering good clinical doctors								−.802
3–1	Statement on social accountability to establish ideology, mission, or educational objectives								−.563
Eigenvalues		15.62	2.72	2.19	1.99	1.89	1.59	1.23	1.15
% of variance		42.21	7.36	5.93	5.37	5.11	4.29	3.32	3.10
Total variance		42.21	49.57	55.50	60.87	65.98	70.27	73.59	76.69

F1 = building partnerships among stakeholders, f2 = monitoring and evaluation system, f3 = organizations and system for implementing social accountability, f4 = curriculum design based on social accountability, f5 = interactions between partners, f6 = contributing to proximity between partners, f7 = the physical and financial environment, f8 = the declaration of social accountability and physician workforce.

Table 3. Internal consistency of the HSP model

Area	Factor	Subscale	No. of items	Item no.	Cronbach’s alpha coefficient
H (Hardware)	F3	Organizations and system for implementing social accountability	5	3–3, 3–4, 3–2, 3–7, 3–16	0.90
	F7	The physical and financial environmental	3	3–9, 3–10, 3–11	0.85
	F8	The declaration of social accountability and physician workforce	2	5–15, 3–1	0.71
S (Software)	F4	The curriculum design based on social accountability	5	2–1, 2–2, 2–4, 2–3, 1–1	0.84
	F2	The monitoring and evaluation system	3	3–12, 3–13, 3–14	0.95
P (Partner)	F1	Building partnerships among stakeholders	2	4–1, 4–2	0.93
	F5	Interactions between partners	7	4–6, 4–4, 4–5, 4–8, 4–3, 4–9, 4–7	0.92
	F6	Contributing to proximity between partners	2	5–3, 5–4	0.89
			29		0.96

Table 4. Goodness-of-fit indices: root-mean-square error of approximation (RMSEA)

Factor model	KMO	X^2	df	p	RMSEA	Described variance values
2	.71	1002.98	593	.000	0.11	49.57
3	.71	893.92	558	.000	0.11	55.50
4	.71	783.84	524	.000	0.10	60.87
5	.71	699.72	491	.000	0.09	65.97
6	.71	627.16	459	.000	0.08	70.26
7	.71	568.58	428	.000	0.08	73.58
8	.71	502.48	398	.000	0.07	76.68

Cut-offs used to indicate goodness of fit: RMSEA ≤0.08

Table 5. Pearson’s correlations of variables

Factor	Importance
The declaration of social accountability and physician workforce	^.661**
The curriculum design based on social accountability	.727**
Organizations and system for implementing social accountability	.823**
The monitoring and evaluation system	.766
The physical and financial environmental	.723**
Contributing to proximity between partners	.778**
Building partnerships among stakeholders	.772**
Interactions between partners	.880**

**p < 0.01

Table 6. Multiple regression analysis of the HSP model

Variable	Unstandardized coefficient		Standardized coefficient	t	VIF	R^2	F
	B	SE	ß
(Constants)	.127	.088		1.434		0.978	303.642***
Interactions between partners	.230	.026	.292	8.814**	2.615
The curriculum design based on social accountability	.228	.025	.261	9.111***	1.960
Organizations and system for implementing social accountability	.144	.020	.210	7.092***	2.081
Physical and financial environment	.115	.020	.163	5.640***	2.002
Monitoring and evaluation	.092	.021	.131	4.314***	2.193
The declaration of social accountability and physician workforce	.095	.021	.120	4.421***	1.756
Contributing to proximity between partners	.062	.022	.090	2.777***	2.478

**p < 0.05 ***p < .001

Table 7. t-Test showing differences between deans and experts in evaluation of factors

Variable	Deans (N = 40)		Medical Education Experts (N = 15)		t	p
	M	SD	M	SD
The declaration of social accountability and physician workforce	4.56	0.47	3.83	0.52	4.974***	0.000
The curriculum design based on social accountability	4.27	0.58	3.97	0.38	2.259*	0.030
Organizations and system for implementing social accountability	3.96	0.62	3.45	0.68	2.605*	0.012
Monitoring and evaluation	4.02	0.65	3.98	0.66	0.906	0.369
Physical and financial environment	4.06	0.73	4.02	0.66	0.963	0.341
Contributing to proximity between partners	4.10	0.67	3.80	0.62	1.504	0.138
Building partnerships among stakeholders	4.18	0.67	3.80	0.65	1.873	0.067
Interactions between partners	4.08	0.60	3.68	0.43	2.400*	0.020
Total	4.13	0.50	3.76	0.34	3.055**	0.004

*p < .05, **p < .01, ***p < .001

Table 8. Barriers and challenges of the HSP model

Area	Hindrance factor	Action strategy
H (Hardware)	Unbalanced regional distribution of incoming students Lack of dedicated organization and staff within the medical school Lack of financial support and physical conditions	Equal opportunity and priority to students from underrepresented communities Commission dedicated to social accountability (department) and personnel dedicated to social accountability Support for financial projects for the implementation of social accountability of medical schools, hospitals, communities, and government agencies
S (Software)	Absence of social accountability implementation model reflecting the characteristics of medical schools Lack of link between community and medical school curriculum Lack of programs for post graduates	Development of social accountability implementation model reflecting the characteristics of medical schools Opening and expanding training for community-linked services learning Development of training programs reflecting the context of graduates
P (Partner)	Poor understanding of the social accountability of partner institutions Unclear or weak governance structure between partner organizations Lack of shared vision among stakeholders	Establishing and sharing social accountability concepts with key stakeholders Continuous interchange and cooperation between medical schools and communities Joint consortium of medical schools, hospitals, and government agencies

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Data availability statement

The data that support the findings of this study are available on request from the corresponding author, [EBY, [email protected]].