Exploring physician engagement in health care organizations: a scoping review

RATIONALE

Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes.

OBJECTIVES

Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement.

METHOD

A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability.

RESULTS

The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records.

DISCUSSION

Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce.

CONCLUSIONS

Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement's actual impact on health care organizations' performance.

Changing me to we: Developing teambuilding in radiation therapy

BACKGROUND

There has been a causal link identified within the literature between poor team function and errors, patient outcomes, staff satisfaction and performance. Lacking is supporting evidence on teambuilding and its impact on overall team performance and team dynamics. Within radiation therapy, there is difficulty in understanding the inner workings of team dynamics due to the unique complex nature of teams and with very little evidence on the impact of team building specific to radiation therapy. The focus of this research is to form a better understanding of the effects of teambuilding before and after a teambuilding education session.The knowledge gained can help in future trainings to promote and facilitate teambuilding to develop team dynamics and lead a change in culture.

METHODS

Team building sessions were booked and scheduled for 148 radiation therapists. Pre and post session evaluations were distributed to all participants and collected at the end of each team building session. Descriptive statistics were used to analyze Likert scale responses. Open-ended question responses were coded and analyzed for emerging themes using thematic analysis.

RESULTS

110 of 148 radiation therapists attended one of the scheduled team building sessions. Pre-session evaluations indicated radiation therapists have a good understanding of factors that affect teamwork (88% agree); are aware of the multi-generational impact (78% agree); have the skill set to build a respectful team (86% agree); and are comfortable dealing with conflict (67% agree). Post-session evaluations indicated that participants had gained increased knowledge on teamwork (66.3% agree; 30.7% strongly agree); are more aware of the generational impact within teams (59% agree); new strategiesdeveloped to help improve team dynamics and the ability to use the lessons learnt immediately (67% and 71% respectively agree). Open ended comments indicated an interest in additional teambuilding sessions and further education on conflict resolution.

CONCLUSION

Results showed an increased awareness of the factors that impact team dynamics amongst radiation therapists and an interest in receiving further education in teambuilding. Findings will be utilized to better inform debate in future development of teambuilding educational sessions to improve overall team dynamics in radiation therapy.

Health care clinicians' engagement in organizational redesign of care processes: The importance of work and organizational conditions

The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.

Quality of life in caregivers with and without chronic disease: Welsh Health Survey, 2013

Background

The aim of the present study was to investigate and compare quality of life after regular care provision in people with and without currently treated chronic disease in a country-wide and population-based setting.

Methods

Data were retrieved from Welsh Health Survey, 2013. Information on demographics, lifestyle factors, health conditions, regular care provision and quality of life was obtained by household interview. Chi-square test, t-test and survey-weighted multi-nominal regression modelling were performed.

Results

Of 15 007 Welsh adults aged 16 and above, 2751 (19.1%) people reported that they have been giving care for any sick, disabled or frail person. They tended to be aged 40-74, being female, education <degree, body mass index >25, physically active, current smokers and living in second-hand smoking households. In caregivers with current chronic disease (n = 1562), they have experienced physical health limits, bodily pains, emotional problems, less calm and less cheerful. In caregivers without current chronic diseases (n = 1151), they have experienced physical health limits, bodily pains, less cheerful, downhearted and unhappiness.

Conclusions

This is the first study to examine quality of life in caregivers both with and without currently treated chronic disease. Longitudinal monitoring and increasing education, training and support to lessen caregiving burden would be suggested.

Assessing quality of life in Welsh carers with and without back pain

BACKGROUND

The author aimed to study the prevalence and characteristics of care provision in Welsh adults with and without back pain, as well as their quality of life. The study used a country-wide and population-based setting from an independent dataset.

METHOD

Data were retrieved from and analysed in the Welsh Health Survey 2013. Information on demographics, lifestyle factors, regular care provision, and quality of life was obtained from household interviews. Chi-square tests, t-tests, and survey-weighted multinomial regression modelling were performed.

RESULTS

Of 15,007 Welsh adults aged 16 years and above, 2751 (18.3%) reported they had been caring for a sick, disabled, or frail person. The carers tended to be between 40-74 years, female, had not obtained a bachelor's degree, with a body mass index>25, physically active, smokers, and living in indoor secondhand smoke households. People who lived in mid and western Wales tended to give care, compared with those who lived in southeast and north Wales. Carers with back pain experienced slight physical health and emotional problems, whereas carers without back pain experienced worse physical health and emotional problems, which could disrupt normal life.

CONCLUSION

Nearly one in five Welsh adults, with or without back pain, have provided care for other people. Future socioeconomic structure, health policy, and nursing programmes to reinvest in long-term care, such as a national psychiatric care initiative, should be encouraged, to lessen mental suffering alongside chronic pains and to optimise adult mental health and quality of life in all people, with or without back pain.