Encouraging participation in health system reform: is clinical engagement a useful concept for policy and management?
Dimitra Bonias A , Sandra G. Leggat B C and Timothy Bartram AA Department of Management, La Trobe University, Bundoora, VIC. 3086, Australia. Email: d.bonias@latrobe.edu.au; t.bartram@latrobe.edu.au
B School of Public Health, La Trobe University, Bundoora, VIC. 3086, Australia.
C Corresponding author. Email: s.leggat@latrobe.edu.au
Australian Health Review 36(4) 378-383 https://doi.org/10.1071/AH11095
Submitted: 5 October 2011 Accepted: 19 April 2012 Published: 15 October 2012
Abstract
Objective. Recent health system enquiries and commissions, including the National Health and Hospital Reform Commission, have promoted clinical engagement as necessary for improving the Australian healthcare system. In fact, the Rudd Government identified clinician engagement as important for the success of the planned health system reform. Yet there is uncertainty about how clinical engagement is understood in health policy and management. This paper aims to clarify how clinical engagement is defined, measured and how it might be achieved in policy and management in Australia.
Methods. We review the literature and consider clinical engagement in relation to employee engagement, a defined construct within the management literature. We consider the structure and employment relationships of the public health sector in assessing the relevance of this literature.
Conclusions. Based on the evidence, we argue that clinical engagement is similar to employee engagement, but that engagement of clinicians who are employees requires a different construct to engagement of clinicians who are independent practitioners. The development of this second construct is illustrated using the case of Visiting Medical Officers in Victoria.
Implications. Antecedent organisational and system conditions to clinical engagement appear to be lacking in the Australian public health system, suggesting meaningful engagement will be difficult to achieve in the short-term. This has the potential to threaten proposed reforms of the Australian healthcare system.
What is known about the topic? Engagement of clinicians has been identified as essential for improving quality and safety, as well as successful health system reform, but there is little understanding of how to define and measure this engagement.
What does this paper add? Clinical engagement is defined as the cognitive, emotional and physical contribution of health professionals to their jobs, and to improving their organisation and their health system within their working roles in their employing health service. While this construct applies to employees, engagement of independent practitioners is a different construct that needs to recognise out-of-role requirements for clinicians to become engaged in organisational and system reform.
What are the implications for practitioners? This paper advances our understanding of clinical engagement, and suggests that based on research on high performance work systems, the Australian health system has a way to go before the antecedents of engagement are in place.
Additional keywords: clinician participation, health policy, health reform, medical engagement.
References
[1] National Health and Hospital Reform Commission. A Healthier Future For All Australians - Final report, June 2009. Canberra; Australian Government; 2009.[2] Garling P. Final report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals. Sydney: NSW Government; 2008.
[3] Australian Government. A national health and hospitals network for Australia’s future. Delivering the reforms. Canberra: Australian Government; 2010.
[4] Australian Medical Association. Doctors’ engagement in the management of hospitals - 2010. Australian Medical Association; 2010. Available at http://ama.com.au/node/6285 [verified 03 January 2011].
[5] Thallon J. Clinical engagement strategy, Action Plan, National Health Service. West Kent: Primary Care Trust; 2008.
[6] Parvin S. The Medical Engagement Scale survey. Bournemouth: The Royal Bournemouth and Christchurch hospitals NHS foundation trusts; 2009.
[7] Committee on Quality of Healthcare in America. Crossing the quality chasm. A new health system for the 21st century . Institute of Medicine, editor. Washington, D.C.: National Academy Press; 2001.
[8] NHS Centre for Reviews and Dissemination. Undertaking systematic review of research on effectiveness . York: University of York; 2001.
[9] Leiter M, Day A, Harvie P, Shaughnessy K. Personal and organisational knowledge transfer: implications for work-life engagement. Hum Relat 2007; 60 259–83.
| Personal and organisational knowledge transfer: implications for work-life engagement.Crossref | GoogleScholarGoogle Scholar |
[10] Roberts DR, Davenport TO. Job engagement: why it’s important and how to improve it. Organ Dev J 2002; 29 21–9.
[11] Harter JK, Schmidt FL, Hayes TL. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: a meta-analysis. J Appl Psychol 2012; 87 268–79.
[12] Bamruk R. The missing link: the role of employee engagement in business. Workspan 2004; 9 48–52.
[13] Kahn WA. Psychological conditions of personal engagement and disengagement at work. Acad Manage J 1990; 33 692–724.
| Psychological conditions of personal engagement and disengagement at work.Crossref | GoogleScholarGoogle Scholar |
[14] Little B, Little P. Employee engagement: conceptual issues. J Organ Cult. J Organ Cult Commun and Conf 2006; 10 111–120.
[15] May DR, Gilson RL, Harter LM. The psychological conditions of meaningfulness, safety and availability and the engagement of human spirit at work. J Occup Organ Psychol 2004; 77 11–37.
| The psychological conditions of meaningfulness, safety and availability and the engagement of human spirit at work.Crossref | GoogleScholarGoogle Scholar |
[16] Saks AM. Antecedents and consequences of employee engagement. J Manag Psychol 2006; 21 600–19.
| Antecedents and consequences of employee engagement.Crossref | GoogleScholarGoogle Scholar |
[17] Vandenberg RJ, Scarpello V. A longitudinal assessment of the determinant relationship between employee commitments to the occupation and the organization. J Organ Behav 1994; 15 535–47.
| A longitudinal assessment of the determinant relationship between employee commitments to the occupation and the organization.Crossref | GoogleScholarGoogle Scholar |
[18] Shortell SM. Physician involvement in quality improvement: issues, challenges, and recommendations. In: Blumenthal D, Sheck AC, editors. Improving clinical practice: total quality management and the physician. San Francisco: Jossey-Bass; 1995. pp. 207–17.
[19] Berwick DM. Eleven worthy aims for clinical leadership of health care reform. JAMA 1994; 272 797–802.
| Eleven worthy aims for clinical leadership of health care reform.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2czlvV2lsA%3D%3D&md5=9d312e1dd098c5a3ce96f6b1238a72f4CAS | 8078145PubMed |
[20] Reinersten JL, Gosfield AG, Rupp W, Whithington JW. Engaging physicians in a shared quality agenda . Cambridge, Massachusetts (United States of America): Institute for Healthcare Improvement; 2007.
[21] Denis J-L, Langley A, Cazale L. Leadership and strategic change under ambiguity. Organ Stud 1996; 17 673–99.
| Leadership and strategic change under ambiguity.Crossref | GoogleScholarGoogle Scholar |
[22] Doolin B. Narratives of change: discourse technology and organisation. Organization 2003; 10 751–70.
[23] Ellins J, Ham C. NHS Mutual: engaging staff and aligning incentives to achieve higher levels of performance. London: The Nuffield Trust for Research and Policy Studies in Health Services; 2009.
[24] Loughman TP, Snipes RL, Pitts JP. The effects of physicians’ communication, satisfaction and their perceptions of empowerment on their likelihood to recommend a hospital to their peers: a mixed method study. Manag Research Rev 2009; 32 354–70.
| The effects of physicians’ communication, satisfaction and their perceptions of empowerment on their likelihood to recommend a hospital to their peers: a mixed method study.Crossref | GoogleScholarGoogle Scholar |
[25] Buchanan D, Jordan S, Preston D, Smith A. Doctor in the process: the engagement of clinical directors in hospital management. J Manag Med 1997; 11 132–56.
| Doctor in the process: the engagement of clinical directors in hospital management.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2svnsFSiuw%3D%3D&md5=f95eb9ea55a45e448f917c7f591992a7CAS | 10173243PubMed |
[26] Katz D. The motivational basis of organizational behavior. Behav Sci 1964; 9 131–46.
| The motivational basis of organizational behavior.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaF1c7lvVensA%3D%3D&md5=4df95d46800671853c11ef017cbbd294CAS | 5888769PubMed |
[27] Smith AC, Organ DW, Near JP. Organizational citizenship behavior: its nature and antecedents. J Appl Psychol 1983; 68 653–63.
| Organizational citizenship behavior: its nature and antecedents.Crossref | GoogleScholarGoogle Scholar |
[28] Podsakoff PM, MacKenzie SB, Paine JB, Bachrach DG. Organizational citizenship behaviors: a critical review of the theoretical and empirical literature and suggestions for future research. J Manage 2000; 26 513–63.
| Organizational citizenship behaviors: a critical review of the theoretical and empirical literature and suggestions for future research.Crossref | GoogleScholarGoogle Scholar |
[29] Hamilton P, Spurgeon P, Clark J, Dent J, Armit K. Engaging doctors. Can doctors influence organisational performance? London: NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges; 2008.
[30] Leggat SG, Bartram T, Casimir G, Stanton P. Nurse perceptions of the quality of patient care: confirming the importance of empowerment and job satisfaction. Health Care Manage Rev 2010; 35 365–371.
| Nurse perceptions of the quality of patient care: confirming the importance of empowerment and job satisfaction.Crossref | GoogleScholarGoogle Scholar |
[31] Scotti DJ, Harmon J, Behson SJ. Links among high-performance work environment, service quality and customer satisfaction: an extension to the healthcare sector. J Healthc Manag 2007; 52 109–25.
| 17447538PubMed |
[32] Harmon J, Scotti DJ, Behson S, Farias G, Petzel R, Neuman JH, et al Effects of high-involvement work systems on employee satisfaction and service costs in veterans healthcare. J Healthc Manag 2003; 48 1–14.
[33] Spurgeon P, Mazelan PM, Barwell F. Medical engagement: a crucial underpinning to organizational performance. Health Serv Manage Res 2011; 24 114–20.
| Medical engagement: a crucial underpinning to organizational performance.Crossref | GoogleScholarGoogle Scholar | 21840896PubMed |
[34] Leggat SG, Bartram T, Stanton P. High performance work systems: the gap between policy and practice in health care reform. J Health Org Manage 2011; 25 281–297.
[35] Nadler DA, Tushman ML. Beyond the charismatic leader: leadership and organizational change. Calif Manage Rev 1990; 32 77–97.
[36] Cropanzano R, Mitchell MS. Social exchange theory: an interdisciplinary review. J Manage 2005; 31 874–900.
| Social exchange theory: an interdisciplinary review.Crossref | GoogleScholarGoogle Scholar |
[37] Horsburgh M, Perkins R, Coyle B, Degeling P. The professional subcultures of students entering medicine, nursing and pharmacy programmes. J Interprof Care 2006; 20 425–31.
| The professional subcultures of students entering medicine, nursing and pharmacy programmes.Crossref | GoogleScholarGoogle Scholar | 16905490PubMed |
[38] Felstead A, Gallie D. For better or worse? Non-standard jobs and high involvement work systems. Warwick: University of Warwick; 2002 Contract No.: No. 29.
[39] Butler P, Felstead A, Ashton D, Fuller A, Lee T, Unwin L. et al. High performance management: a literature review. Leicester: University of Leicester; 2004 Contract No.: No.1.
[40] Leggat SG. Operations management: the search for value in healthcare organisation and performance . In: Sorenson R, Iedema R, editors. Managing clinical processes in health services. Sydney: Mosby Elsevier; 2008. pp. 21–34.
[41] Glouberman S, Mintzberg H. Managing the care of health and the cure of disease - Part 1: differentiation. Health Care Manage Rev 2001; 26 56–69.
| Managing the care of health and the cure of disease - Part 1: differentiation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3ksFShuw%3D%3D&md5=73e65143146cd753b3b6f43ef968c031CAS | 11233354PubMed |
[42] Harley B, Allen BC, Sargent LD. High performance work systems and employee experience of work in the service sector: the case of aged care. Br J Ind Relat 2007; 45 607–33.
| High performance work systems and employee experience of work in the service sector: the case of aged care.Crossref | GoogleScholarGoogle Scholar |
[43] Laschinger HKS, Shamian J, Thomson D. Impact of magnet hospital characteristics on nurses’ perceptions of hospital burnout, quality of care and work satisfaction. Nurs Econ 2001; 19 209–19.
[44] Leggat SG, Bartram T, Stanton P. Exploring the lack of progress in improving patient safety in Australian hospitals. Health Serv Manage Res 2008; 21 32–9.
| Exploring the lack of progress in improving patient safety in Australian hospitals.Crossref | GoogleScholarGoogle Scholar |
[45] Stanton P. The politics of healthcare – the industrial relations climate . In: Sorenson R, Iedema R, editors. Managing clinical processes in the health services. Sydney: Elsevier Australia; 2008.
[46] Bartram T, Stanton P, Leggat SG, Casimir G, Fraser B. Lost in translation: making the link between HRM and performance in healthcare. Hum Resour Manage J 2007; 17 21–41.
| Lost in translation: making the link between HRM and performance in healthcare.Crossref | GoogleScholarGoogle Scholar |
[47] Leggat SG, Bartram T, Stanton P. Performance monitoring in the Victorian health care system: an exploratory study. Aust Health Rev 2005; 29 17–24.
| Performance monitoring in the Victorian health care system: an exploratory study.Crossref | GoogleScholarGoogle Scholar | 15683351PubMed |
[48] Leggat SG, Bartram T, Stanton P. People management in Victorian Community Health Services: an exploratory study. Aust J Primary Health 2006; 12 59–65.
| People management in Victorian Community Health Services: an exploratory study.Crossref | GoogleScholarGoogle Scholar |
[49] Forster P. Queensland Health System Review. Final report. Brisbane: Queensland Health; 2005.
