Safely Practicing in a New Environment: A Qualitative Study to Inform Physician Onboarding Practices

Faculty Onboarding for Workforce Readiness and Belonging

INTRODUCTION

An academic anesthesiology department benefits from recruiting faculty from various centers, from new graduates to experienced clinicians. Two critical objectives for a department are getting the faculty members up-to-speed thoroughly and efficiently and retaining the faculty members to benefit from their contributions over time. Onboarding plays a pivotal role in meeting both objectives. A successful onboarding process is critical to the enculturation of new employees into an existing work environment. Organizations focusing on improving onboarding practices increase overall success, decrease attrition, and enhance member performance and satisfaction. In this study, we examine our onboarding practices and then create structured tools to improve our processes.

METHODS

A survey gauging the effectiveness and satisfaction of our existing onboarding practices was administered to 11 faculty members hired between 2016 and 2018. Using feedback from the survey, our team identified critical components for improvement and quality measures for onboarding from before faculty arrival until after starting clinical duties. We also measured faculty satisfaction with the onboarding process at different time points. Updated onboarding practices targeting identified areas were implemented in one hiring cycle. Thirteen new faculty members hired over the course of the course of six months assessed the new system's effectiveness. The experience of the previous cohort was compared to the new cohort, highlighting the impact of their feedback on the onboarding process.

RESULTS

Our new best practices model, implemented to address primary gaps in our system, has shown promising results. The post-intervention cohort reported more favorable responses to the process, suggesting a positive shift in the onboarding experience. Further free-text feedback included recommendations for additional updates, offering a proactive approach to continuous improvement.

CONCLUSION

A structured, feedback-responsive onboarding process improved the overall experience for new hires. While the response was overwhelmingly positive, further refinement with subsequent iterations is needed to continually improve this process.

Approaches to locum physician recruitment and retention: a systematic review

A robust workforce of locum tenens (LT) physicians is imperative for health service stability. A systematic review was conducted to synthesize current evidence on the strategies used to facilitate the recruitment and retention of LT physicians. English articles up to October 2023 across five databases were sourced. Original studies focusing on recruitment and retention of LT's were included. An inductive content analysis was performed to identify strategies used to facilitate LT recruitment and retention. A separate grey literature review was conducted from June-July 2023. 12 studies were retained. Over half (58%) of studies were conducted in North America. Main strategies for facilitating LT recruitment and retention included financial incentives (83%), education and career factors (67%), personal facilitators (67%), clinical support and mentorship (33%), and familial considerations (25%). Identified subthemes were desire for flexible contracts (58%), increased income (33%), practice scouting (33%), and transitional employment needs (33%). Most (67%) studies reported deterrents to locum work, with professional isolation (42%) as the primary deterrent-related subtheme. Grey literature suggested national physician licensure could enhance license portability, thereby increasing the mobility of physicians across regions. Organizations employ five main LT recruitment facilitators and operationalize these in a variety of ways. Though these may be incumbent on local resources, the effectiveness of these approaches has not been evaluated. Consequently, future research should assess LT the efficacy of recruitment and retention facilitators. Notably, the majority of identified LT deterrents may be mitigated by modifying contextual factors such as improved onboarding practices.

Psychological safety and emergency department team performance: A mixed‐methods study

OBJECTIVES

Team culture underpins team performance. Psychological safety - 'a shared belief held by members of a team that the team is safe for interpersonal risk taking' - is a critical component of team culture for high-performing teams across contexts. However, psychological safety in ED teams has not been well explored. We aimed to explore this core teamwork concept in the ED.

METHODS

This was a sequential mixed-methods study of nursing and medical staff at a large tertiary care ED in Australia from October 2020 to March 2021. First, participants completed the 'Team Learning and Psychological Safety Survey' and a narrative questionnaire. These findings informed semi-structured interviews. We determined median psychological safety and compared results across role and length of time working in the department. Qualitative results were analysed using a deductive thematic analysis using a previously generated framework for enablers of psychological safety at the individual, team and organisational levels.

RESULTS

The survey was completed by 72/410 participants and 19 interviews were conducted. The median psychological safety score was 37/49 (IQR 13). Psychological safety was not experienced universally, with nurses and new staff experiencing lower levels. Individual, team and organisational factors impacted psychological safety. The primary force shaping psychological safety was familiarity with colleagues and leaders.

CONCLUSION

Familiarity of team members and leaders was critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams.