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.

Painting by numbers: a guide for systematically developing indicators of performance at any level of health care

OBJECTIVES

There is a need for methods to facilitate selection of robust indicators in health care settings. This research aims to determine the key steps in, and delineate a systematic process for, construction of health care performance indicators.

METHODS

Information derived from a review of the published literature and analysis of key informant interviews was synthesised to derive key activities and concepts fundamental to, and essential for, the development of robust and meaningful indicators. These activities and concepts were ordered into a logical sequence.

RESULTS

A sequence of six stages (prioritisation; intent; implementation requirements; measure specifications; indicator assessment; target development), with a series of steps within each stage, was delineated. This sequence comprises the Systematic Indicator Development (SID) Method, which may be utilised by health care policy decision makers, providers, or clinicians in a 'paint by numbers' manner to create robust and meaningful indicators, or to refine or amend existing indicators.

CONCLUSIONS

The SID Method blends different aspects of indicator art and science and structures it in a logical way to provide transparency, consistency and rigour to indicator construction. The approach ensures that all health care sector stakeholders can make informed decisions when selecting indictors or interpreting obtained results.