Exploring the Connection between Physician Involvement in Quality Improvement and Medical Engagement

Substantial efforts are required to improve the performance of healthcare systems, however, healthcare organizations tend to have structures and cultures that are highly resistant to change. Though such resistance will make significant changes in healthcare challenging there has been a call for reform in Canada’s healthcare system (e.g. Atkinson et al., 2011; CMA, 2012; Clark, 2012; Denis et al., 2013; Dickinson Ham, 2008; Dickson, 2011; Gosfield Reinertsen, 2007; Kirby, 2002; Romanow, 2002; Tuohy, 1999, 2002; Willis et al., 2012).Medical engagement has been suggested as one means of achieving this desired reform and overcoming the challenges of resistance to change (Baker Denis, 2011; Singer Shortell, 2011). Similarly, the involvement of physicians in quality improvement has been purported to contribute to improved health outcomes and decreased costs (Peterson, Jaen Phillips, 2013). Baker Denis (2011) note that many of the growing efforts to engage physicians in leading change are focused on changes in organizational structure and in broader system-wide leadership; however, there have been few studies examining the extent to which these changes have resulted in the enhanced levels of engagement. Similarly absent is empirical work examining the role of physician involvement in quality improvement in building medical engagement, despite suggestions that both will contribute to enhanced organizational and systems outcomes. The role that organizational commitment has on medical engagement is also of interest, given the recognized theoretical links between commitment and engagement. This thesis reports a mixed methods investigation to explore the connection between physician involvement in quality improvement, organizational commitment and medical engagement levels in two healthcare organizations in Ontario. In the first phase of the inquiry, organizational commitment and organizational support for quality improvement were quantified in a survey to determine the relationship among these concepts. The secondary, qualitative phase, allows for a deeper understanding of physicians’ perspectives regarding the connection between quality improvement, organizational commitment and medical engagement while exploring the results of the survey. Overall, this dissertation furthers our knowledge of how Canadian healthcare organizations can effectively work with physicians to drive changes to improve healthcare.Ph.D

Organizational interventions in response to duty hour reforms

Abstract Background Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms. Methods The academic literature was searched through the SCOPUS database using the search terms “resident duty hours” and “European Working Time Directive,” together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome. Results Twenty-five articles were included from the United States (n = 18), the United Kingdom (n = 5), Hong Kong (n = 1), and Australia (n = 1). They all described single-site projects; the majority used post-intervention surveys (n = 15) and audit techniques (n = 4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously. Conclusions Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms

A scoping review on the decision-making dynamics for accepting or refusing the COVID-19 vaccination among adolescent and youth populations

Abstract Background Global COVID-19 vaccinations rates among youth and adolescent populations prove that there is an opportunity to influence the acceptance for those who are unvaccinated and who are hesitant to receive additional doses. This study aimed to discover the acceptance and hesitancy reasons for choosing or refusing to be vaccinated against COVID-19. Methods A scoping review was conducted, and articles from three online databases, PubMed, Wiley, and Cochrane Library, were extracted and screened based on exclusion and PICOs criteria. A total of 21 studies were included in this review. Data highlighting study attributes, characteristics, and decision-making dynamics were extracted from the 21 studies and put into table format. Results The results showed that the primary drivers for accepting the COVID-19 vaccine include protecting oneself and close family/friends, fear of infection, professional recommendations, and employer obligations. Primary hesitancy factors include concerns about safety and side effects, effectiveness and efficacy, lack of trust in pharmaceuticals and government, conspiracies, and perceiving natural immunity as an alternative. Conclusions This scoping review recommends that further research should be conducted with adolescent and youth populations that focus on identifying health behaviors and how they relate to vaccine policies and programs

Additional file 2 of A scoping review on the decision-making dynamics for accepting or refusing the COVID-19 vaccination among adolescent and youth populations

Additional file 2

Engaging patients to improve quality of care: a systematic review

Abstract Background To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. Methods We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients’ experiences of being engaged. Results Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign—discrete products largely derived from low-level engagement (consultative unidirectional feedback)—whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients’ experiences of the engagement process (n = 12; 25%). While most experiences were positive—increased self-esteem, feeling empowered, or independent—some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. Conclusions Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients’ experiences of the engagement process and whether these outcomes translate into improved quality of care. Registration N/A (data extraction completed prior to registration on PROSPERO)

Additional file 2: of Engaging patients to improve quality of care: a systematic review

Figure S1. PRISMA diagram. (DOC 57 kb