Physician engagement: a concept analysis

Primary care physician engagement in health systems transformation

Physician engagement is critical to the success of primary care transformation, yet strategies to support meaningful engagement remain understudied. Despite existing research, gaps persist in understanding how physician engagement unfolds within system-level initiatives in primary care. This paper examines physician engagement through the development of the London Middlesex Primary Care Alliance (LMPCA), a regional initiative uniting primary care providers in Southwestern Ontario to advocate for system improvements and support health system transformation, including the Middlesex-London Ontario Health Team (ML-OHT). Rather than centering solely on physician perspectives, our study explores physician engagement as part of a broader collaborative effort involving healthcare administrators and support personnel. Data were collected through interviews (n = 13; including primary care physicians, healthcare administrators, and administrative support personnel), document analysis, and an environmental scan. Findings highlight the importance of grassroots leadership, governance structures, and system-level supports in driving physician engagement. The role of a primary care transformation lead emerged as a key facilitator, while lack of compensation for system-level work remained a barrier. This study provides insights into the formation of a sustainable, self-governing primary care organization and offers considerations for scaling engagement strategies while mitigating burnout and ensuring long-term participation.

The Role of the Primary Care Transformation Lead: A Qualitative Case Study

BACKGROUND

The introduction of Ontario Health Teams in Canada is a step toward achieving an equitable integrated system of care. The Middlesex-London Ontario Health Team (MLOHT) has been developed in parallel to the London-Middlesex Primary Care Alliance (LMPCA), a grassroots network for primary care physicians, health care administrators, and nurse practitioners. Key in the growth of the LMPCA was hiring a primary care transformation lead to support in engagement. This qualitative case study aims to describe the implementation of a primary care transformation lead within an integrated care setting through feedback from healthcare personnel.

METHODS AND FINDINGS

Family physicians, healthcare administrators, and administrative support personnel were recruited from the LMPCA and the MLOHT and interviewed. This analysis revealed 4 key components central to the role of a primary care transformation lead: (re)-building relationships, flexibility and adaptability, importance of role clarity, and motivation for change. Findings suggested that a primary care transformation lead can improve workflow among physicians by assisting in administrative tasks. Through streamlining information for primary care physicians, and building community networks, transformation leads can also enhance communication. Additionally, they can maintain an open environment for physicians to share their challenges to collaboratively develop solutions.

CONCLUSION

This study exemplifies the role of primary care transformation leads in improving workflow, building networks, decreasing administrative burden, and facilitating an open environment in a primary care setting.

Advancement, barriers and collaboration: the ABC's of addressing challenges and designing solutions between front-line physicians and business-oriented leaders

BACKGROUND

The complexity of US healthcare has been increasing for many years, requiring clinicians and learners to understand care delivery systems in addition to clinical sciences. Thus, there has been a major push to educate faculty and trainees on healthcare functionality. This comes as hospitals expand into health systems requiring the help of more sophisticated expertise of departments such as operations excellence when problem-solving. As a medical student with a background in operations excellence, medical education leader and clinical administration leader all currently facilitating this transition, we wanted to reflect on the barriers we have experienced in clinical implementation of quality improvement projects and educating learners on the impact of operations excellence principles in their clinical education.

METHODS

The ideas presented in this article were the result of a several collaborative discussion between the authors, on the key challenges to adopting operations excellence principles into health system science education. In an effort to add context to this reflection through the current body of research present, they supplemented a literature review on the topic which included 86 studies published between 2013 and 2021 regarding health systems science and healthcare leadership engagement in the USA. The themes that intersected between the literature review and the discussions were then expanded on in this paper.

RESULTS

Through this process, we identified four challenges: (1) the difference in thinking styles, which we term, 'mental model differences'; (2) the strategic nature of process improvement projects and how that collides with physician priorities, or 'the chess game of stakeholder engagement'; (3) the language and precise methodology, or 'consistency of language and need for administrative resilience' and (4) the issue of teaching these concepts or bridging the learning gap.'

CONCLUSION

In an increasingly complex healthcare landscape, physicians and trainee's need to bridge gaps between the mental models of administrative and clinical workflow.

An Organizational-Level Workplace Intervention to Improve Medical Doctors' Sustainable Employability: Study Protocol for a Participatory Action Research Study

Compromised Sustainable Employability (SE) of medical doctors is a concern for the viability of healthcare and, thus, for society as a whole. This study (preregistration: ISRCTN15232070) will assess the effect of a two-year organizational-level workplace intervention using a Participatory Action Research (PAR) approach on the primary outcome SE (i.e., burnout complaints, work engagement, and job satisfaction) and secondary outcomes (i.e., turnover intention, occupational self-efficacy, and perceived impact on health/well-being) in medical doctors. It will also examine whether changes in Psychosocial Safety Climate (PSC), job characteristics (i.e., job demands and resources), and perceived impact on the work situation mediate these effects, and which process factors (i.e., degree of actual implementation of changes, information provision, management support, medical doctors' involvement, and mental models) are important to the intervention's success. A pre-post design will be used, including 24 groups of medical doctors (approximately N = 650). Data will be collected at four measurement points (a pre-test, two intermediate evaluations, and a post-test) and analyzed using linear mixed-effect models. The results will provide insights into the effectiveness of the intervention in promoting SE and will inform future organizational-level workplace interventions about the mediators and factors in the implementation process that contribute to its effects.

Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction

BACKGROUND

Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members.

OBJECTIVE

Examine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction.

DESIGN

We conducted a cross-sectional provider survey about their perspectives including the single-item burnout measure. We fit separate regression models, controlling for provider type, gender, being multilingual, and fixed effects for clinic predicting outcome measures from burnout.

PARTICIPANTS

Seventy-four providers from 44 clinics in large, urban FQHC (52% response rate; n = 174).

MAIN MEASURES

Survey included a single-item, self-defined burnout measure adapted from the Physician Worklife Survey, and measures from the RAND AMA Study survey, Heath Tracking Physician survey, TransforMed Clinician and Staff Questionnaire, Physician Worklife Survey, Minimizing Errors Maximizing Outcomes survey, and surveys by Friedberg et al. 31 and Walling et al. 32 RESULTS: Thirty percent of providers reported burnout. Providers in clinics with more facilitative leadership reported not being burned out (compared to those reporting burnout; p-values < 0.05). More pressures related to patient care and lower job satisfaction were associated with burnout (p-values < 0.05).

CONCLUSIONS

Creating provider-team relationships and environments where providers have the time and space necessary to discuss changes to improve care, ideas are shared, leadership supports QI, and QI is monitored and discussed were related to not being burned out. Reducing time pressures and improving support needed for providers to address the high-need levels of FQHC patients can also decrease burnout. Such leadership and support to improving care may be a separate protective factor against burnout. Research is needed to further examine which aspects of leadership drive down burnout and increase provider involvement in change efforts and improving care.

GP Engagement: A Proposed Model to Guide Engagement Activities in Australian Primary Health Networks

BACKGROUND

Engagement with general practice is a requirement of Australia's Primary Health Networks (PHNs). We propose a model for engagement that draws on principles of stakeholder and clinician engagement, tailored to meet the needs of PHNs and general practitioners (GPs).

METHODS

A comprehensive literature review was undertaken to identify components, challenges, and approaches to optimizing clinician engagement. Interviews with GPs (n = 18), other practice staff (n = 12), PHN staff, and other stakeholders (n = 15) across 3 PHN regions in Victoria, Australia, were used to identify perceived needs of GPs and opportunities for engagement with PHNs. Interview transcripts, notes, and contact summaries were collated and organized using QSR NVivo to support the process of coding and identification of common themes and perspectives. Information from the literature and interviews was synthesized to inform development of a model for GP engagement that could guide GP strategy and engagement activities undertaken by PHNs.

FINDINGS

PHNs engaged with GPs for accreditation, quality improvement, data sharing, continuing professional development, commissioning, and population health initiatives, among others. GPs were motivated to engage with PHNs, however, the roles of PHNs and benefits of engagement were not always clear. A model to support PHN engagement with general practice was developed comprising: (1) Organizational values for engagement; (2) Needs of GPs; (3) Areas of engagement; (4) Stages of engagement; (5) Communication planning; and (6) Monitoring and Evaluation.

CONCLUSION

The proposed model represents contemporary understanding in clinician engagement, drawing upon concepts from community and stakeholder engagement, and extending established models for engagement into the setting of general practice.

Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study

BACKGROUND

Efforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians' strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, we explore physicians' experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts.

METHODS

We conducted a qualitative study of the Medical Safety Huddle initiative implemented across six sites. The initiative consisted of short, physician focused and led, weekly meetings aimed at reviewing, anticipating and addressing patient safety issues. We conducted 29 semistructured interviews with leaders and participants. We applied an interpretive thematic analysis to the data using self-determination theory as an analytic lens.

RESULTS

The results of the thematic analysis are organised in two themes, (1) relatedness and meaningfulness, and (2) progress and autonomy, representing two forms of intrinsic motivation for engagement that we found were leveraged through participation in the initiative. First, participation enabled a sense of community and a 'safe space' in which professionally relevant safety issues are discussed. Second, participation in the initiative created a growing sense of ability to have input in one's work environment. However, limited collaboration with other professional groups around patient safety and the ability to consistently address reported concerns highlights the need for leadership and organisational support for physician engagement.

CONCLUSION

The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles' implementation must align with the organisation's multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.

Pediatric Faculty Engagement and Associated Areas of Worklife After a COVID19 Surge

Purpose

Healthcare organizations strive to increase physician engagement and decrease attrition. However, little is known about which specific worklife areas may be targeted to improve physician engagement or retention, especially after stressful events such as a COVID19 surge. Our objective was to identify demographic characteristics and worklife areas most associated with increased physician engagement and decreased intent to leave in pediatric faculty.

Patients and Methods

In September 2020, we conducted a cross-sectional survey of faculty at an academic, tertiary-care children's hospital. A convenience and voluntary sampling approach was used. The survey included demographics, Maslach Burnout Index-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS). The MBI-HSS was used to measure faculty engagement. The AWS measures satisfaction with six worklife areas (workload, control, reward, fairness, community, values). We used bivariate analyses to examine relationships between worklife areas and engagement and between worklife areas and intent to leave. We included multivariate logistic regression models to examine worklife areas most associated with increased work engagement and decreased intent to leave.

Results

Our response rate was 41% (113/274 participants). In bivariate analysis, engaged faculty reported higher satisfaction in all worklife areas. In multivariate analyses, positive perceptions of workload (odds ratio (OR) 2.83; 95% confidence interval (CI), 1.2-6.9), control (OR, 3.24; 95% CI 1.4-7.3), and community (OR, 6.07; 95% CI 1.9-18.7) were associated with engagement. Positive perceptions of values (OR, 0.07; 95% CI 0.02-0.32) and community (OR, 0.19; 95% CI 0.05-0.78) were negatively associated with intent to leave.

Conclusion

We found that positive perceptions of workload, control, and community were most associated with engagement. Alignment of values and increased sense of community were associated with decreased intent to leave. Our findings suggest specific worklife areas may be targeted to increase faculty engagement and retention.

Engaging the collective voice of physicians: Optimizing participation in research and policy development in the context of COVID-19 and physician burnout

Physicians and governments work collaboratively to determine optimal healthcare policy options. Physicians are also engaged by health researchers to participate in studies. Physician engagement can be impeded by limits on physician time and remuneration for engagement, and the impact of physician burnout (exacerbated by COVID-19). Doctors Nova Scotia engaged physicians on various research and policy items throughout the pandemic. Strategies included integrating physicians into research teams, remunerating engagement activities, and leveraging existing tools and networks. Health researchers and policy-makers can improve physician engagement through physician champions, reduction of research duplication, valuing of physician contributions, and integrating networks.

Senior Hospital Physician Leaders' Perspectives on Factors That Impact Physician Engagement: A Qualitative Interview Study

Background

Physicians are essential in health-care delivery. Physician engagement, defined as active participation in administrative and leadership activities in their organization, is a useful metric for hospital leaders to evaluate as they develop and implement strategy. The purpose of this study was to gain insight into the perspectives of senior hospital physician leaders on factors impacting physician engagement.

Methods

Semi-structured interviews were conducted virtually. A purposive sample was used. Hospital physician senior leaders were recruited from Ontario public hospitals in Canada. The interviews were recorded, transcribed verbatim, and analyzed.

Results

Ten participants in senior hospital physician leadership positions were interviewed. Seven themes were identified as impacting physician engagement: being seen and being heard, accountability, trust, leadership engagement, intercommunication, organizational stability, and discord within the organization. Saturation of themes was achieved.

Conclusion

Two-way communication is essential to physician engagement. Physician input in decision-making processes is a vital way to improve engagement. For this to work, leadership must also be engaged. Trust and accountability are critical attributes for senior hospital physician leaders, especially during times of organizational instability. For physicians whose remuneration model is fee-for-service, new compensation models are required for them to actively participate in hospital decision-making.

Engaging physicians and nurses in balanced scorecard evaluation-An implication at Palestinian hospitals and recommendations for policy makers

Introduction

Healthcare workers (HCWs) are seldom involved in balanced scorecard (BSC) deployments. This study aims to incorporate Palestinian HCWs in the BSC to create health policy recommendations and action plans using BSC-HCW1, a survey designed and validated based on BSC dimensions.

Methodology

In this cross-sectional study, the BSC-HCW1 survey was delivered to HCWs in 14 hospitals from January to October 2021 to get them involved in PE. The differences between physicians' and nurses' evaluations were assessed by the Mann-Whitney U-test. The causal relationships between factors were analyzed using multiple linear regression. The multicollinearity of the model was checked. Path analysis was performed to understand the BSC strategic maps based on the Palestinian HCWs' evaluations.

Results

Out of 800 surveys, 454 (57%) were retrieved. No evaluation differences between physicians and nurses were found. The BSC-HCW1 model explains 22-35% of HCW loyalty attitudes, managerial trust, and perceived patient trust and respect. HCWs' workload time-life balance, quality and development initiatives, and managerial performance evaluation have a direct effect on improving HCWs' loyalty attitudes (β = 0.272, P < 0.001; β = 0.231, P < 0.001; β = 0.199, P < 0.001, respectively). HCWs' engagement, managerial performance evaluation, and loyalty attitudes have a direct effect on enhancing HCWs' respect toward managers (β = 0.260, P < 0.001; β = 0.191, P = 0.001; β = 0.135, P = 0.010, respectively). Quality and development initiatives, HCWs' loyalty attitudes, and workload time-life balance had a direct effect on improving perceived patient respect toward HCWs (β = 254, P < 0.001; β = 0.137, P = 0.006, β = 0.137, P = 0.006, respectively).

Conclusion

This research shows that it is important to improve low-performing indicators, such as the duration of time HCWs spend with patients, their knowledge of medications and diseases, the quality of hospital equipment and maintenance, and the inclusion of strengths and weaknesses in HCWs' evaluations, so that HCWs are more loyal and less likely to want to leave. For Palestinian hospital managers to be respected more, they must include HCWs in their action plans and explain their evaluation criteria. Patients will respect Palestinian HCWs more if they prioritize their education and work quality, spend more time with patients, and reflect more loyalty. The results can be generalized since it encompassed 30% of Palestinian hospitals from all categories.

A qualitative study exploring hospital-based team dynamics in discharge planning for patients experiencing delayed care transitions in Ontario, Canada

BACKGROUND

In attempt to improve continuity of patient care and reduce length of stay, hospitals have placed an increased focus on reducing delayed discharges through discharge planning. Several benefits and challenges to team-based approaches for discharge planning have been identified. Despite this, professional hierarchies and power dynamics are common challenges experienced by healthcare providers who are trying to work as a team when dealing with delayed discharges. The objective of this study was to explore what was working well with formal care team-based discharge processes, as well as challenges experienced, in order to outline how teams can function to better support transitions for patients experiencing a delayed discharge.  METHODS: We conducted a descriptive qualitative study with hospital-based healthcare providers, managers and organizational leaders who had experience with delayed discharges. Participants were recruited from two diverse health regions in Ontario, Canada. In-depth, semi-structured interviews were conducted in-person, by telephone or teleconference between December 2019 and October 2020. All interviews were recorded and transcribed. A codebook was developed by the research team and applied to all transcripts. Data were analyzed inductively, as well as deductively through directed content analysis.

RESULTS

We organized our findings into three main categories - (1) collaboration with physicians makes a difference; (2) leadership should meaningfully engage with frontline providers and (3) partnerships across sectors are critical. Regular physician engagement, as equal members of the team, was recommended to improve consistent communication, relationship building between providers, accessibility, and in-person communication. Participants highlighted the need for a dedicated senior leader who ensured members of the team were treated as equals and advocated for the team. Improved partnerships across sectors included the enhanced integration of community-based providers into discharge planning by placing more focus on collaborative practice, combined discharge planning meetings, and having embedded and physically accessible care coordinators in the hospital.

CONCLUSIONS

Team-based approaches for delayed discharge can offer benefits. However, to optimize how teams function in supporting these processes, it is important to consistently collaborate with physicians, ensure senior leadership engage with and seek feedback from frontline providers through co-design, and actively integrate the community sector in discharge planning.

Physician Engagement before and during the COVID-19 Pandemic in Thailand

The COVID-19 pandemic has affected not only the quality of care and patient safety but also physician engagement. The aim of this study was to investigate physician engagement before and during the COVID-19 pandemic and to identify the areas to improve regarding physician engagement. An online survey was conducted from April 2019 to September 2020 among the physicians of 44 hospitals under the Bangkok Dusit Medical Services Public Company Limited (BDMS) before and during the COVID-19 pandemic. The results were analyzed using an independent T-test and one-way ANOVA to compare the continuous variables across groups. Multiple linear regression was used to identify and adjust the variables to determine the areas for improvement. Among the 10,746 respondents, physician engagement during the COVID-19 pandemic was significantly higher than in the pre-COVID-19 period (4.12 vs. 4.06, p-value < 0.001). The top three recommendations to promote physician engagement during the COVID-19 situation comprised (1) marketing (70%), (2) intra-and inter-organizational communication (69%), and (3) the competency of clinical staff (67%). During the COVID-19 pandemic, the positive outcomes toward physician engagement focused on infra-organizational development. These results can be considered in a strategy to optimize physician engagement, which affects the quality of care and patient safety.

Engaging Frontline Physicians in Value Improvement: A Qualitative Evaluation of Physician-Directed Reinvestment

Purpose

Methods

Results

Conclusion

Factors Associated with Decision Aid Use in Localized Prostate Cancer

Purpose

Decision aids have been found to improve patients' knowledge of treatments and decrease decisional regrets. Despite these benefits, there is not widespread use of decision aids for newly diagnosed prostate cancer (PCa). This analysis investigates factors that impact men's choice to use a decision aid for newly diagnosed prostate cancer.

Materials and Methods

This is a retrospective analysis of a PCa registry from the Michigan Urological Surgery Improvement Collaborative (MUSIC). We included data from men with newly diagnosed, clinically localized PCa seen from 2018-21 at practices offering a PCa decision aid (Personal Patient Profile-Prostate; P3P). The primary outcome was men's registration to use P3P. We fit a multilevel logistic regression model with patient-level factors and included urologist specific random intercepts. We estimated the intra-class correlation (ICC) and predicted the probability of P3P registration among urologists.

Results

A total of 2629 men were seen at practices that participated in P3P and 1174 (45%) registered to use P3P. Forty-one percent of the total variance of P3P registration was attributed to clustering of men under a specific urologist's care. In contrast, only 1.5% of the variance of P3P registration was explained by patient factors. Our model did not include data on socioeconomic, literacy or psychosocial factors, which limits the interpretation of the results.

Conclusions

These results suggest that urologists' effect far outweighs patient factors in a man's decision to enroll in P3P. Strategies that encourage providers to increase decision aid adoption in their practices are warranted.

Overcoming Obstacles to Develop High-Performance Teams Involving Physician in Health Care Organizations

Many health care organizations struggle and often do not succeed to be high-performance organizations that are not only efficient and effective but also enjoyable places to work. This review focuses on the physician and organizational roles in limiting achievement of a high-performance team in health care organizations. Ten dimensions were constructed and a number of competencies and metrics were highlighted to overcome the failures to: (i) Ensure that the goals, purpose, mission and vision are clearly defined; (ii) establish a supportive organizational structure that encourages high performance of teams; (iii) ensure outstanding physician leadership, performance, goal attainment; and (iv) recognize that medical team leaders are vulnerable to the abuses of personal power or may create a culture of intimidation/fear and a toxic work culture; (v) select a good team and team members—team members who like to work in teams or are willing and able to learn how to work in a team and ensure a well-balanced team composition; (vi) establish optimal team composition, individual roles and dynamics, and clear roles for members of the team; (vii) establish psychological safe environment for team members; (viii) address and resolve interpersonal conflicts in teams; (xi) ensure good health and well-being of the medical staff; (x) ensure physician engagement with the organization. Addressing each of these dimensions with the specific solutions outlined should overcome the constraints to achieving high-performance teams for physicians in health care organizations.

Inter-physician variability in strategies linked to treatment limitations after severe traumatic brain injury; proactivity or wait-and-see

BACKGROUND

Prognostic uncertainty is a challenge for physicians in the neuro intensive care field. Questions about whether continued life-sustaining treatment is in a patient's best interests arise in different phases after a severe traumatic brain injury. In-depth information about how physicians deal with ethical issues in different contexts is lacking. The purpose of this study was to seek insight into clinicians' strategies concerning unresolved prognostic uncertainty and their ethical reasoning on the issue of limitation of life-sustaining treatment in patients with minimal or no signs of neurological improvement after severe traumatic brain injury in the later trauma hospital phase.

METHODS

Interviews with 18 physicians working in a neurointensive care unit in a large Norwegian trauma hospital, followed by a qualitative thematic analysis focused on physicians' strategies related to treatment-limiting decision-making.

RESULTS

A divide between proactive and wait-and-see strategies emerged. Notwithstanding the hospital's strong team culture, inter-physician variability with regard to ethical reasoning and preferred strategies was exposed. All the physicians emphasized the importance of team-family interactions. Nevertheless, their strategies differed: (1) The proactive physicians were open to consider limitations of life-sustaining treatment when the prognosis was grim. They initiated ethical discussions, took leadership in clarification and deliberation processes regarding goals and options, saw themselves as guides for the families and believed in the necessity to prepare families for both best-case and worst-case scenarios. (2) The "wait-and-see" physicians preferred open-ended treatment (no limitations). Neurologically injured patients need time to uncover their true recovery potential, they argued. They often avoided talking to the family about dying or other worst-case scenarios during this phase.

CONCLUSIONS

Depending on the individual physician in charge, ethical issues may rest unresolved or not addressed in the later trauma hospital phase. Nevertheless, team collaboration serves to mitigate inter-physician variability. There are problems and pitfalls to be aware of related to both proactive and wait-and-see approaches. The timing of best-interest discussions and treatment-limiting decisions remain challenging after severe traumatic brain injury. Routines for timely and open discussions with families about the range of ethically reasonable options need to be strengthened.

Health Care Staff's Experiences of Engagement When Introducing a Digital Decision Support System for Wound Management: Qualitative Study

Background

eHealth solutions such as digital decision support systems (DDSSs) have the potential to assist collaboration between health care staff to improve matters for specific patient groups. Patients with hard-to-heal ulcers have long healing times because of a lack of guidelines for structured diagnosis, treatment, and follow-up. Multidisciplinary collaboration in wound management teams is essential. A DDSS could offer a way of aiding improvement within wound management. The introduction of eHealth solutions into health care is complicated, and the engagement of the staff seems crucial. Factors influencing and affecting engagement need to be understood and considered for the introduction of a DDSS to succeed.

Objective

This study aims to describe health care staff’s experiences of engagement and barriers to and influencers of engagement when introducing a DDSS for wound management.

Methods

This study uses a qualitative approach. Interviews were conducted with 11 health care staff within primary (n=4), community (n=6), and specialist (n=1) care during the start-up of the introduction of a DDSS for wound management. The interviews focused on the staff’s experiences of engagement. Content analysis by Burnard was used in the data analysis process.

Results

A total of 4 categories emerged describing the participants’ experiences of engagement: a personal liaison, a professional commitment, an extended togetherness, and an awareness and understanding of the circumstances.

Conclusions

This study identifies barriers to and influencers of engagement, reinforcing that staff experience engagement through feeling a personal liaison and a professional commitment to make things better for their patients. In addition, engagement is nourished by sharing with coworkers and by active support and understanding from leadership.

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

OBJECTIVE

The influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance.

DESIGN

Systematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement.

DATA SOURCES

We searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020.

ELIGIBILITY CRITERIA

We included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare.

DATA EXTRACTION AND SYNTHESIS

Data extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model.

RESULTS

The search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism.

CONCLUSIONS

This review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.