Abstract: The term “ physicianengagement ” is used quite frequently, yet it remains poorly de ﬁ ned and measured. The aim of this study is to clarify the term “ physicianengagement. ” 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 “ physicianengagement ” 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 antece- dents of “ physicianengagement ” include accountability, communication, incentives, inter- personal relations, and opportunity. The results include improved outcomes such as data quality, ef ﬁ ciency, innovation, job satisfaction, patient satisfaction, and performance. De ﬁ ning physicianengagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.
Methods: Surveys were administered by Advisory Board Survey Solutions for staff physi- cian engagement, Press Ganey for Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) for outpatient satisfaction, and Accreditation Council for Graduate Medical Education (ACGME) for the ACGME Resident/Fellow Survey. Survey sample sizes were 685, 697, and 763 for physicianengagement and 621, 625, and 618 for resident satisfaction in 2014 – 2016, respectively; only respondents were available for CGCAHPS (24,302, 34,328, and 43,100 for 2014 – 2016, respectively). Two groups were analyzed across 3 years: (1) percentage of “ engaged ” staff physicians versus percentage of outpatient top box scores for physician communication, and (2) percentage of “ engaged ” staff physicians versus percentage of residents “ positive ” on program evaluation. For resident evaluation of faculty, the number of programs that met/exceeded ACGME national compli- ance scores were compared. Univariate chi-squared tests compared data between 2014, 2015, and 2016.
Each year, HealthStream surveys various people from the health care community: employees, physicians/providers, and patients. We have nationally representative databases and statistically validated surveys allowing benchmarking for employee engagement, patient experience, and physicianengagement. Our research team sought to test the impact of culture on these outcome measures, along with VBP and turnover. Due to the size and magnitude of our national data- bases, we are able to map hospital results across various data sets, compare results, and evaluate performance variations.
Communication score but also the scores on the following questions: How often did doctors explain in a way you could understand:; how often did doctors treat you with courtesy and respect?; how often did doctors listen carefully to you?. The scoring scale was: never, sometimes, usually and always. While our organization prides itself on transparency, we had not focused on patient experience as much as we had on our quality initiatives. We did not have physician data reports in place prior to this pilot; therefore in addition to providing the medical directors with this information, we began to share the scores of all of the Hospitalist groups with each other on a monthly basis. This not only helped to show the differences in the scores and physicianengagement but also allowed for open communication between groups about best practice opportunities. Teaching sessions focused on 3 initial behavioral initiatives: Knock, Sit, Ask. 2
Finding a common purpose can also be done less formally. The desire to improve patient satisfaction and outcomes is an example of a goal that would be mutually rewarding (Guthrie, 2005). Leaders at two different major health systems reported success in engaging physicians in their organizational initiatives by connecting projects to patient related problems (Duberman et al., 2015; Spaulding et al., 2014). One of the key characteristics of physician culture is that patient welfare is their top concern (Byrnes, 2015). This characteristic can be leveraged to encourage physicianengagement in efforts geared at improving the quality of patient care (Byrnes, 2015). Physicians will also be more motivated to engage in efforts if they are told how these efforts will reduce their own frustrations, make their lives easier, or improve efficiencies that will allow them to spend more time providing patient care (Rosenstein, 2015). Successful physicianengagement was also found to occur when programs explained the benefits of new health delivery innovations, such as workflow efficiencies (Skillman et al., 2017).
In 2006, the Federal Advisor on Wait times recom- mended the development of targets for appropriate wait- ing . This process has been undertaken for paediatric nephrology, though not for adult kidney disease, which is more prevalent . The BC Nephrologists’ Access Study (BCNAS) was designed as a Provincial collaboration to study wait time I. We conceived of a change management strategy based on physicianengagement and wait time benchmark development. We hypothesized that involving local physician stakeholders in generating consensus wait- ing time I benchmarks, would reduce the wait for out- patient nephrology consultations. To test the hypothesis, we: 1) Conducted an environmental scan to measure wait times in the Province; 2) Engaged nephrologists and refer- ring physicians to develop maximally-recommended wait time targets; 3) Encouraged pooled triage (patients assigned
A health policy analysis was undertaken using an inves- tigative reporting technique. The qualitative strategy was selected when attempts to obtain reports or litera- ture using customary electronic bibliography (PubMed, CINAHL, Google Scholar, EBSCO, and MEDLINE) searches in English and French, from 1970 through 2010, identi- fied only 14 documents (including gray literature) of rel- evance. Additional information was collected through review of citations in published literature, the archives of the Canadian Association of Physician Assistants (CAPA), provincial ministry reports, and professional soci- ety documents. Individuals were interviewed for detailed information about the development, policy discussions, documents, and issues surrounding the use of PAs. Key informants include early developers of PAs, leaders, researchers, and policy makers. Information was veri- fied, and no single individual source was used. This work combines a review of the literature, along with qualitative information, and serves as a historical bookmark. The work is purposefully Canadian focused and defers inclu- sion of the broad international literature on PAs (or nurse practitioners [NPs]) to other scholars.
This is the first published study to document the opin- ions of the users of a physician help program in Canada. Results showed that physicians were largely satisfied with the QPHP consultation services and the external ser- vices they were referred to. However, the fact that 9% of respondents expressed a low level of satisfaction (fair or poor) with the QPHP services, and that 13% of respond- ents had a similar opinion of the external services, is very worrying, and this deserves special attention. Even though most respondents were satisfied with the QPHP services, only 57% declared that their situations improved after receiving services from or through the QPHP. Could this finding reflect the ill-being associated with physicians’ work organization, which has not improved in recent years? In addition, although the QPHP managers carefully select the professionals (eg, psychologists, psychiatrists) who provide external services, for reasons of confidenti- ality, the QPHP does not interact with those professionals once a physician has been referred to them and thus can- not be sure that they meet the needs of their clients. This raises the question of whether a physician help program
reporting mechanism creates workflow burden and is not feasible for most primary care clinics. Therefore, we developed an innovative and inexpensive physician ILI reporting program, which was integrated into our exist- ing EMR system. In doing so, we were able to ensure that our needs and those of HPH were met by delivering real-time ILI surveillance data electronically to HPH with minimal disruption to our practice workflow, while mini- mizing the risk of a manual transcription error.
Hamilton family physicians identified 4 dynamic ele- ments for building resilience: attitudes and perspec- tives; balance and prioritization; practice management; and supportive relations. Attitudes and perspectives include valuing the physician role, maintaining inter- est in one’s career, accepting career demands, develop- ing self-awareness, and accepting personal limitations. Balance and prioritization of work and personal life include setting limits to work, scheduling time off, and maintaining healthy relationships. Despite varied prac- tice management styles, common contributors to resil- ience are identifiable: efficient organization, trusted and experienced office staff, supportive group practices with good on-call systems, and effective communica- tion with colleagues and patients. Positive personal relationships protect against stresses of busy medical practices.
Physicians can have a professional relationship with schools in many ways, such as a full- or part-time employee, an independent contrac- tor, or a volunteer on a school health advisory group. Where feasible, a school physician does not serve as a private physician for a child in that school district, however, because it can create a potential con ﬂ ict of in- terest between the physician as
addictive behavior and other mental health issues in physicians with the term “ sick ” rather than “ disciplinary problems ” that The Federation for State Physician Health Programs was de- veloped. The Journal of the American Medical Association article offered a rare public glimpse into the closed medi- cal community and acted as a power- ful catalyst for change. By 1980, 51 of the 54 medical societies of all states and jurisdictions had authorized or implemented impaired physician pro- grams, mandated to identify, treat, and rehabilitate physicians struggling with burnout-related drug and alcohol ad- diction. 33 Although these programs have
The American Academy of Pediatrics acknowl- edges the importance of pediatric profiling. If ap- plied properly, profiling has the potential to improve quality of care, physician performance, and patient outcomes. It is important that the information col- lected regarding physicians and/or physician groups is accurate, interpreted appropriately, and only released to the public under controlled situa- tions. Pediatric profiling can be a successful venture when there is ongoing communication and coopera- tion between pediatricians and evaluators.
This section presents the interview protocols extracted from the questions presented to the participants to find out their reactions to CF. The responses were coded based on three dimensional engagement models as well as language learning. The following table illustrates samples of interview extracts categorized based on the afore-mentioned dimensions (Table13). To facilitate the coding process, the researchers went through the transcripts and extracted the themes that appeared to be relevant. Then, they employed MAXQDA software to identify and categorize recurrent codes.
The present study provides a thorough analysis of phys- ician population in Portugal, and showed that the physi- cians registered in the country are almost equally male and female, mostly Portuguese and between 41 and 55 years of age. Spanish, Brazilian, PALOP and other European nationalities are also a significant presence among foreign physicians. A considerable unbalance was detected in the physician-to-population ratio between metropolitan areas and the rest of the country, favouring particularly those municipalities in the proximity of a teaching hospital. Among the variables considered, population, nurses and purchasing power per capita were the most important municipality characteristics associated with physician distribution in Portugal. For national doctors, the Municipality Development Index was significant too, and so was for international doctors the proportion of foreigners applying for residence. For- eign physicians resulted, in proportion, more likely than the Portuguese to be found outside metropolitan areas. However, such effect appeared to be mostly due to the Spanish cohort, as other nationalities – especially the African PALOP - displayed location preferences similar to those of the Portuguese. Among foreigners, males and over-50s were more likely to reside outside the Lisbon and Oporto areas. Being able to speak Portuguese or Table 4 Logistic regression for probability to reside outside metropolitan areas for foreign physicians
SEPT-OCT, 2015, VOL-I, ISSUE-III www.srjis.com Page 186 engagement. These elements are a combination of the background of students, the influence and expectations of family and peers, schoolwide and classroom practices which will be helpful for effective teaching and learning.
These are examples where employers are deepening their relationship with the organisation managing the existing engagement. In some cases involvement in an employer engagement activity can encourage an employer to broaden their involvement in several ways. It is possible the employer broadens the range of activities on which they engage with the organisation to achieve new objectives. The employer could also engage with different organisations to achieve the same or fresh objectives. For example many members of the Northamptonshire County Employer Engagement Group (case study 12) and the Hampshire and Isle of Wight Local Skills for Productivity Alliance (case study 10), both run by the LSC, had previously participated in employer engagement activities with either the local Business Link or Chamber of Commerce. However successive engagements of this type still require a clear rationale and establishment of the most appropriate form of engagement.
satisfaction with care, physical and mental health, and preferences regarding seeking care and making medical decisions. Satisfaction was measured in two ways: a single item on patients' satisfaction with their physicians and a 12-item scale on patients' satisfaction with the healthcare that they have been receiving from all sources during the past few years. Two validated trust scales were used [12,22], each using a 5-point Likert scale [a 10 item phy- sician trust scale (Cronbach's α = 0.93), and an 11 item medical profession trust scale (Cronbach's α = 0.92)]. The physician trust scale asked mainly about trust in primary care physicians. Items in both the scales represent four dimensions of trust (fidelity, competence, honesty, glo- bal). Physician trust was measured by the sum of 10 items scores, ranging from 10 to 50, with a higher score indicat- ing more trust. Trust in the medical profession was meas- ured by 11 item scores ranging from 11 to 55, with a higher score indicating more trust. Patient satisfaction with health care was measured using a previously vali- dated 12-item 60 point scale.  Other variables thought to be related to physicians trust were measured as follows: whether one had enough choice in selecting a physician (yes/no); number of years with physician; willingness to recommend to friends (strongly agree to strongly disagree; past disagreement or dispute with the physician (yes/no); desire to switch physicians (strongly to strongly disagree). Due to interview length (25 minutes), only half of the subjects that were randomly selected were asked about trust in the medical profession.