Physician engagement: the Vancouver Medical Staff Association engagement charter

Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial

Importance

Physician burnout is problematic despite existing interventions. More evidence-based approaches are needed.

Objective

To explore the effect of individualized coaching by professionally trained peers on burnout and well-being in physicians.

Design, Setting, and Participants

This randomized clinical trial involved Mass General Physician Organization physicians who volunteered for coaching from August 5 through December 1, 2021. The data analysis was performed from February through October 2022.

Interventions

Participants were randomized to 6 coaching sessions facilitated by a peer coach over 3 months or a control condition using standard institutional resources for burnout and wellness.

Main Outcomes and Measures

The primary outcome was burnout as measured by the Stanford Professional Fulfillment Index. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement, and self-valuation. Analysis was performed on a modified intention-to-treat basis.

Results

Of 138 physicians enrolled, 67 were randomly allocated to the coaching intervention and 71 to the control group. Most participants were aged 31 to 60 years (128 [93.0%]), women (109 [79.0%]), married (108 [78.3%]), and in their early to mid career (mean [SD], 12.0 [9.7] years in practice); 39 (28.3%) were Asian, 3 (<0.1%) were Black, 9 (<0.1%) were Hispanic, 93 were (67.4%) White, and 6 (<0.1%) were of other race or ethnicity. In the intervention group, 52 participants underwent coaching and were included in the analysis. Statistically significant improvements in burnout, interpersonal disengagement, professional fulfillment, and work engagement were observed after 3 months of coaching compared with no intervention. Mean scores for interpersonal disengagement decreased by 30.1% in the intervention group and increased by 4.1% in the control group (absolute difference, -0.94 poimys [95% CI, -1.48 to -0.41 points; P = .001), while mean scores for overall burnout decreased by 21.6% in the intervention group and increased by 2.5% in the control group (absolute difference, -0.79 points; 95% CI, -1.27 to -0.32 points; P = .001). Professional fulfillment increased by 10.7% in the intervention group compared with no change in the control group (absolute difference, 0.59 points; 95% CI, 0.01-1.16 points; P = .046). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65 points; P = .04). Self-valuation increased in both groups, but not significantly.

Conclusions and Relevance

The findings of this hospital-sponsored program show that individualized coaching by professionally trained peers is an effective strategy for reducing physician burnout and interpersonal disengagement while improving their professional fulfillment and work engagement.

Trial Registration

ClinicalTrials.gov Identifier: NCT05036993.

The engagement chasm: Time for competency-based training in employee engagement for healthcare and beyond

BACKGROUND

Employee disengagement in healthcare and business is currently at unexceptionally high levels worldwide. Disengagement negatively impacts productivity, profitability, efficiency (waste reduction), innovation, quality, customer satisfaction and experience, staff well-being, safety, mortality, staff attendance, and turnover. Despite its serious detrimental impacts, no dedicated competency-based training curriculum exists for engagement as a competency.

OBJECTIVE

To develop a competency-based educational curriculum for an Engagement Competency.

METHODS

A curricular roadmap comprising the following steps was observed 1. Identifying the desired outcomes needed of trainees. These must help fulfill all the Q12 Gallup survey engagement items. 2. Explicitly defining the required Competencies, Entrustable Professional Activities, and Milestones, 3. Selecting the educational activities, and instructional methods, 4. Selecting the tools to assess progress along the milestones, and finally, 5. Designing an evaluation system to assess the outcomes of the engagement competency program.

RESULTS

We developed an Engagement Competency Framework with 7 Entrustable Professional activities "rationally and practically" arranged. These are: Envision E1, Embrace E2, Empower E3, Enlighten E4, Empathize E5, Energize E6, and Evaluate E7 (the 7Es).

CONCLUSION

The unfortunate global issue of disengagement in healthcare and in the business arena may be practically tackled by introducing Engagement Competency and training. It should be compulsory for all in the "leadership role". Such training may lead to remarkable performance improvement and a happier, more prosperous, and safer world.

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.

Linking work engagement of emergency physicians to patient centricity in underdeveloped regions

Orientation: Health facilities in underdeveloped regions present their challenges in terms of research, especially regarding the work engagement (WE) of health workers, in this case, emergency physicians. Adjustments to existing research models are needed to obtain accurate responses. Patient centricity (PC) as a new term in healthcare is the estimated variable in this study.Research purpose: This study aimed to examine the relationship between the antecedents of WE and PC in emergency physicians who worked at hospitals in underdeveloped regions in Indonesia, incorporating WE as a mediator.Motivation for the study: Studies linking WE to PC have never been established. Furthermore, studies regarding WE have never been carried out in underdeveloped regions, and most of them are only limited to job resources as a benchmark.Research design/approach, and method: A quantitative survey was conducted through a purposive sampling technique to collect data from emergency physicians in hospitals in East Nusa Tenggara. There are 183 eligible respondents, whose responses were analysed through partial least squares structural equation modelling (PLS-SEM).Main findings: The direct link to WE was found to be predominated by physician autonomy and public service motivation. It was found that WE positively and significantly connected to PC. The PLS-predict resulted in large cross-validated redundancy for this model.Practical/managerial implications: This study has implications for policymakers and hospital management in developing personal and job resources in optimising PC through WE.Contribution/value-add: This study will show a new approach where WE can estimate PC, and this model can be replicated and tested in a larger population of physicians.

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.

Physicians Leading Physicians: A Physician Engagement Intervention Decreases Inappropriate Use of IICU Level of Care Accommodations

Following the adoption of an acuity-adaptable unit model in an academic medical center, a $13M increase in cost of intermediate intensive care unit (IICU) accommodations was observed. The authors followed A3 methodology to determine the root cause of this increase and developed a 3-prong intervention centered on physician engagement, given that physicians have the ability to order a patient's level of care. This intervention consisted of: (1) identifying physician champions to promote appropriate IICU use, (2) visual changes to essential electronic medical record tools, and (3) data-driven feedback to physician champions. In the year following intervention deployment, average IICU length of stay decreased from 1.08 to 0.62 days and average IICU use decreased from 21.4% to 12.3%, corresponding to ~$5.7M cost savings with no significant change in balancing measures observed. Together, these results demonstrate that a multicomponent intervention aimed at engaging physicians reduced inappropriate IICU use with no increase in adverse events.