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Prenestini A, Palumbo R, Grilli R, Lega F. Exploring physician engagement in health care organizations: a scoping review. BMC Health Serv Res 2023; 23:1029. [PMID: 37749568 PMCID: PMC10521513 DOI: 10.1186/s12913-023-09935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
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.
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Affiliation(s)
- Anna Prenestini
- Department of Economics, Management and Quantitative Methods (DEMM) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy.
| | - Rocco Palumbo
- Department of Management & Law, Università Degli Studi Di Roma Tor Vergata, Rome, Italy
| | - Roberto Grilli
- Health Services Research, Evaluation and Policy Unit, Local Health Authority of Romagna, Ravenna, Italy
| | - Federico Lega
- Department of Biomedical Sciences for Health (SCIBIS) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy
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Jarrar M, Al-Bsheish M, Albaker W, Alsaad I, Alkhalifa E, Alnufaili S, Almajed N, Alhawaj R, Al-Hariri MT, Alsunni AA, Aldhmadi BK, Alumran A. Hospital Work Conditions and the Mediation Role of Burnout: Residents and Practicing Physicians Reporting Adverse Events. Risk Manag Healthc Policy 2023; 16:1-13. [PMID: 36636034 PMCID: PMC9830421 DOI: 10.2147/rmhp.s392523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background "Patient Safety" in everyday practices is a target of healthcare leaders, and adverse events reported by healthcare providers directly reflect patient safety in the health system. Recognising how residents and practising physicians rate adverse events concerning their work conditions and burnout must be explored. Objective This study aims to explore the mediation effect of burnout dimensions (emotional exhaustion and burnout-interpersonal disengagement) between the effects of work conditions on perceived patient safety by exploring the adverse events that residents and practising physicians reported. Methods A quantitative and cross-sectional study collected data from 249 residents and practising physicians in a huge teaching hospital and primary health care centre (PHC) in the Eastern Province of Saudi Arabia. Hayes Macro regression analysis was employed to evaluate the multiple mediation effect of burnout dimensions, with 5000 bootstrapping and a confidence interval (CI) of 95% for statistical inference and p≤0.05 for the significance level. Results Leadership support (B= 0.39, t= 6.24, p<0.001) and physician engagement (B=0.43, t=6.50, p<0.001) were associated with a decreased rate of adverse events to patient safety, whereas workload (B=-0.23, t=-3.73, p<0.001) was negatively associated with an increased rate of adverse events. Burnout was shown to mediate the relationship between the effects of physician's leadership support (R2=0.26, F=27.50, p<0.001), work engagement (R2=0.25, F=27.07, p<0.001) and workload (R2=0.23, F=24.23, p<0.001) on the rate of adverse events. Conclusion This study provides insights into burnout dimensions and their consequences on patient safety indicators (ie, adverse events). Work conditions (ie, leadership support, physician engagement, and workload) directly affect the rate of adverse events and indirectly through mediators like burnout-emotional exhaustion and burnout-interpersonal disengagement.
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Affiliation(s)
- Mu’taman Jarrar
- Medical Education Department, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia,College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia,Correspondence: Mu’taman Jarrar, Al-Khobar, 34445, Saudi Arabia, Tel +966 54 471 8523, Email ;
| | - Mohammad Al-Bsheish
- Health Management Department, Batterjee Medical College, Jeddah, Saudi Arabia,Al-Nadeem Governmental Hospital, Ministry of Health, Amman, Jordan,Mohammad Al-Bsheish, Jeddah, 21442, Saudi Arabia, Tel +966 59 103 6065, Email
| | - Waleed Albaker
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibtihal Alsaad
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Eiman Alkhalifa
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sara Alnufaili
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nour Almajed
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem Alhawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad T Al-Hariri
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed A Alsunni
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Badr K Aldhmadi
- Department of Health Management, College of Public Health and Health Informatics, University of Ha’il, Ha’il, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Salenger R, Martin W. Physician Leadership in the Employed Universe. Hosp Top 2022; 100:151-158. [PMID: 34635036 DOI: 10.1080/00185868.2021.1938768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Physicians are increasingly becoming employed by hospitals and health systems. While associated with less professional autonomy, such employment offers physicians the opportunity to become leaders within a vertically integrated healthcare environment. Multidisciplinary care teams, led by physician champions, can impact care for a large swath of patients and establish clinical excellence. Successful teams can improve outcomes, increase professional satisfaction, and potentially set physicians on a path to becoming leaders within their health system.
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Affiliation(s)
- Rawn Salenger
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Maryland, USA
| | - William Martin
- Department of Management, Depaul University, Chicago, Illinois, USA
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Apker J, Brim L, Isacksen R. Exploring Workplace Communication Contributors to Primary Care Provider Experiences of Role Engagement. HEALTH COMMUNICATION 2021; 36:1320-1330. [PMID: 32336141 DOI: 10.1080/10410236.2020.1751382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current and anticipated shortage of primary care providers (PCPs) has increased scholarly and health system leader attention on how to attract and retain qualified PCPs. To date, the research literature in medicine and in health communication has not fully considered the ways in which role communication may shape PCP engagement. Drawing upon role theory and role communication research, this qualitative study explores varied workplace interactions that contribute to PCPs' experience of engagement. We conducted focus groups and individual interviews with 21 PCPs employed in family medicine practices at a Midwestern health system. We used a grounded, iterative approach consisting of multiple stages of analysis to identify emergent themes. Communication with patients, interactions with health leaders, and electronic communication via the MyChart patient portal and electronic health record system function as major contributors to PCP engagement. Findings extend role theory scholarship by identifying specific communicative phenomena that makes up engaging working conditions and add to the role communication research literature by drawing connections between engagement and social support. We offer ideas for practical interventions at the study health system and other, similar organizations that desire to improve provider engagement and well-being.
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Affiliation(s)
- Julie Apker
- School of Communication, Western Michigan University
| | - Lacey Brim
- Department of Communication, Wayne State University
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Sieck CJ, Pearl N, Bright TJ, Yen PY. A qualitative study of physician perspectives on adaptation to electronic health records. BMC Med Inform Decis Mak 2020; 20:25. [PMID: 32039728 PMCID: PMC7008538 DOI: 10.1186/s12911-020-1030-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation. Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis. Results We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation. Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.
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Affiliation(s)
- Cynthia J Sieck
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, 43201, USA. .,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, Columbus, OH, USA.
| | - Nicole Pearl
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA.,Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO, USA
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Perreira TA, Perrier L, Prokopy M, Neves-Mera L, Persaud DD. Physician engagement: a concept analysis. J Healthc Leadersh 2019; 11:101-113. [PMID: 31440112 PMCID: PMC6666374 DOI: 10.2147/jhl.s214765] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
The term "physician engagement" is used quite frequently, yet it remains poorly defined and measured. The aim of this study is to clarify the term "physician engagement." This study used an eight step-method for conducting concept analyses created by Walker and Avant. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on February 14, 2019. No limitations were put on the searches with regard to year or language. Results identify that the term "physician engagement" is regular participation of physicians in (1) deciding how their work is done, (2) making suggestions for improvement, (3) goal setting, (4) planning, and (5) monitoring of their performance in activities targeted at the micro (patient), meso (organization), and/or macro (health system) levels. The antecedents of "physician engagement" include accountability, communication, incentives, interpersonal relations, and opportunity. The results include improved outcomes such as data quality, efficiency, innovation, job satisfaction, patient satisfaction, and performance. Defining physician engagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.
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Affiliation(s)
- Tyrone A Perreira
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Prokopy
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Lina Neves-Mera
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - D David Persaud
- School of Health Administration at Dalhousie University, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
BACKGROUND Literature on health system transformation highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. "Engagement" in health care is often defined as a positive, fulfilling work-related state of mind, which is characterized by vigor, dedication and absorption. The aim of this scoping review is to identify factors associated with, and tools used to measure physician engagement. METHODS MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and gray literature were searched. Supplementary articles were obtained by searching article references. All quantitative and qualitative study designs were eligible that described factors associated with, and tools used to measure, hospital physician engagement. Quantitative and qualitative analyses were conducted. Groupings and clustering were conducted to determine dominant groups or cluster of characteristics. Conceptual mapping was then conducted to identify patterns. RESULTS A total of 15 studies fulfilled the eligibility criteria. All were published between 2012 and 2017. Studies were predominantly conducted in Germany (n=8). Factors associated with physician engagement were synthesized into individual characteristics (n=7), work environment characteristics (n=7), and work outcomes (n=5). The Utrecht Work Engagement Scale was the most commonly used tool (n=14). CONCLUSIONS This scoping review provides a strong evidence-based platform to further advance knowledge in the area of physician engagement. The identification of environmental factors assists hospital administrative leaders in understanding how they might intervene to affect engagement, while the identification of individual characteristics enable identification of vulnerable physicians, permitting identification of the most pertinent targeted areas for focus.
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Wilson KM, Leeman J, Saunders B, Havens DS. Improving physician engagement in interprofessional collaborative practice in rural emergency departments. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.xjep.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
INTRODUCTION Literature on healthcare reforms highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. As a result, many hospitals have adopted physician engagement as a top strategic priority, but little is known about the actual evidence, making it difficult for hospital leadership to identify relationships between true physician 'work engagement' and work outcomes. The aim of this scoping review is to identify factors associated with, and tools used to measure, physician engagement. METHODS AND ANALYSIS This scoping review will be conducted as per Arksey and O'Malley (2005). The electronic databases that will be searched from inception onwards include MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Grey literature will be searched via websites of relevant agencies such as Agency for Healthcare Research and Quality. Conferences and abstracts will be viewed and full paper requests made as required. Supplementary articles may be obtained by contacting field experts and searching references of relevant articles. All quantitative and qualitative study designs will be eligible that describe factors associated with, and tools used to measure, hospital physician engagement. After a small calibration exercise, screening and abstraction will be completed separately by two individuals, with discrepancies resolved by a third. Quantitative (frequencies) and qualitative analyses (generation of descriptives) will be conducted. Thematic analysis will be used to evaluate and categorise study findings. IMPLICATIONS AND DISSEMINATION This project is part of the Ontario Hospital Association's (OHA) initiative to improve its understanding of physician engagement. The review findings will be shared with all Ontario hospitals. Dissemination will occur through peer-reviewed publications and to the OHA membership through the OHA Learning and Engagement team.
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Affiliation(s)
- Tyrone Perreira
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Ontario Hospital Association, Toronto, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, Canada
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Skillman M, Cross‐Barnet C, Singer RF, Ruiz S, Rotondo C, Ahn R, Snyder LP, Colligan EM, Giuriceo K, Moiduddin A. Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services' Health Care Innovation Awards Program. Health Serv Res 2017; 52:291-312. [PMID: 27910099 PMCID: PMC5264033 DOI: 10.1111/1475-6773.12622] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs. DATA SOURCES Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations. STUDY DESIGN NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews. DATA COLLECTION/EXTRACTION METHODS We used qualitative thematic coding for data from 21 programs actively engaging physicians as part of HCIA interventions. PRINCIPAL FINDINGS Establishing physician champions and ensuring an innovation-values fit between physicians and programs, including the strategies programs employed, facilitated engagement. Among engagement practices identified in this study, tailoring team working styles to meet physician preferences and conducting physician outreach and education were the most common successful approaches. CONCLUSIONS We describe engagement strategies derived from a diverse range of programs. Successful programs considered physicians' values and engagement as components of process and policy, rather than viewing them as exogenous factors affecting innovation adoption. These types of approaches enabled programs to accelerate acceptance of innovations within organizations.
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Affiliation(s)
| | | | | | - Sarah Ruiz
- NORC at the University of ChicagoBethesdaMD
| | | | - Roy Ahn
- NORC at the University of ChicagoChicagoIL
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