‘If clinicians are engaged in management and leadership then organisational performance will improve and if there is good organisational performance there is likely to be high levels of clinician engagement’ *
Of the three critical ‘engagements’ in healthcare, patient, clinician and community, we hear much about the first and less about the second and third. Increasingly over the coming decade, we will be forced to engage more with the community as the changing (ageing) demographics of the world’s population begin to push institutionalised healthcare out into communities and cause it to evolve into other manifestations. More will be said of community engagement at the ISQua Innovations Workshop at the Cape Town Conference.
Here, let me focus on CLINICIAN ENGAGEMENT.
While the literature supports the benefits of clinician engagement, it comes at a cost, so cost-benefit considerations are important to those looking at setting out on this journey. The benefits are improved outcomes, clearly a benefit for patients and, consequently, the bottom line on the balance sheet. The costs are system disruption and increased financial costs of implementation, but these costs will continue if the implementation is botched.
Engagement of clinicians has been linked to indicators such as reduced mortality, fewer adverse events and improved patient experience and outcomes, both within and without hospitals. In particular, clinicians need to be leading, contributing and promoting the improvement agenda. But managers are also a key to successful clinician engagement and teamwork is essential. Unfortunately, the two groups are not always in agreement about how improvement through clinician engagement can be achieved.
In general, managers support greater systematisation of clinical work through the use of such tools as clinical guidelines, yet clinicians often remain suspicious of such initiatives seeing them as ineffective and a waste of scarce resources….in particular, money and time…. and that such cooperation will erode clinical/clinician freedoms and cede power to managers. On the other hand, managers have argued that the way in which clinicians (especially doctors) are trained and the traditional environment in which they work can encourage a failure to recognise the value of change and therefore they are likely to resist it.
Leading healthcare organisations such as the Institute for Healthcare Improvement and The Health Foundation have undertaken and/or commissioned work on the benefits of clinician engagement, how to effectively introduce it to healthcare workplaces and what to avoid in order to achieve the benefits with minimal pain.
In short, clinician engagement requires cultural change and cultural change may have structural change as a prerequisite. Once we recognise this, the following are seen as some of the essential considerations for successful clinician engagement:
- A common purpose
- Regular and open dialogue between all parties
- Shared values and beliefs
- Making it easy
- Courage
- Commitment – the whole organisation and especially leaders
- Resourcing -- money and time
- Formal and informal networking and communications
- Multiple approaches
- Direction and control yet flexibility
- Realistic goals and goal consistency
- Staff recruitment and induction to include ‘engagement’ as a skill or attribute
- Expansion of the clinician role and assistance to make the transition
- ‘Unlearning’ of old ways
- Communication of evident cost-benefit
- On-going professional development
- Sustainability - review/refine/monitor
On the other hand, inhibitors to clinician engagement include:
- Cost-benefit case not made
- Failure of leadership
- Under resourcing – time and money
- Consultation overload/information overload
- Sustainability
- Tribalism
- Hidden agendas
- Lack of inclusion
- Unrealistic timelines
- Ambition excess
- Communication inadequacies
Clinician engagement is a high priority for the Australian Health District of which I am a Board member and with 5,500 staff across eight hospitals, four multi-purpose medical centres and 20 community health centres, the challenge is daunting, but the rewards are potentially enormous.
Is it worth the effort? We think so.
Peter Carter
ISQua Board member
Board member Northern New South Wales Local Health District, Australia
REFERENCES
- The Health Foundation
Healthcare Professionals’ views on clinician engagement in quality improvement.
Huw Davies: Alison Powell: Rosemary Rushmer
Universities of Dundee and St Andrews: 2007
- Institute for Healthcare Improvement
Strategies for academic and clinician engagement in community: participatory partnered research
Loretta Jones: Kenneth Wells
JAMA. 2007; 297 (4); 407-410. doilo. 1001/jama 297.4.407
- Northern New South Wales Local Health District and NSW Ministry of Health
Report to the Northern New South Wales Local Health District (N NSW LHD) on Improving Clinician Engagement from the N NSW LHD Executive September 2013; and
*Medical Engagement and the NSW Whole of Hospital Program: Sally McCarthy, June 2013
- Journal of Health Services Research Policy
Why don’t clinicians engage with quality improvement?
Huw Davies: Alison Powell: Rosemary Rushmer
Journal of Health Services Research Policy: Volume 12 Number 3 July 2007
- Investigating apparent variation in quality of care: the critical role of clinician engagement.
Andrew L L Clarke: William Shearer: Alison J McMillan: Paul D Ireland
The Medical Journal of Australia 2010 https://doi.org/10.5694/j.1326-5377.2010.tb040.x
- British Medical Journal
Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature.
Mary Dixon-Woods: Sarah McNicol: Graham Martin
British Medical Journal Volume 21, Issue 10 2011