Home The Quarterly 2017 RACMA Literature Review Update

The Quarterly

RACMA Literature Review Update Print E-mail
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As at July 2017
 
 

Competency : Medical Leader

Patient engagement: catalyzing improvement and innovation in healthcare|
Baker, G. R., Judd, M. & Malka, C. Eds. (2016)
## Book published by: Longwoods Publishing: Toronto

This book is designed to provide compelling examples of healthcare organisations in Canada, the US and England that have advanced patient-centred care and patient engagement.  These selected healthcare organisations have demonstrated that patient engagement contributes to improving care, outcomes, and the experiences of patients and families. By illustrating these organisations’ strategies, investments and experiences, the authors intend to illustrate pathways to increased engagement for innovation and improvement. They describe important common themes and approaches to patient engagement that can be adapted for different types of organisations and environments. Almost all developed countries emphasize a shift to patient centred care as the cornerstone of “better health” in the future. Practical cases and examples of how patients can be engaged for innovation and improvement, in order to create such a system, is valuable to Australia’s medical leaders. People in formal positions of leadership within healthcare must generate the conditions for patient engagement and involvement. If that leads to better health, the approaches described in this book are valuable for those leaders.

Medical doctors in healthcare leadership: theoretical and practical challenges
Denis, J., & van Gestel, N. (2016)
## Article available online

Research on health system reform and improvement has recognised the importance of physician leadership, but has not fully articulated how policies shape or limit opportunities for physician engagement. The authors use two contrasting case studies from Canada and the Netherlands to examine strategies to engage medical doctors and develop their leadership for health system improvement. The findings suggest that deliberate policy initiatives to engage the medical profession and governments in some form of joint or collaborative policy-making is needed to achieve healthcare improvement. Both appear to face similar policy challenges, which may need facilitate conditions at the health system level, including clarity and stability of policy orientations and openness to local experimentation in order to achieve alignment between soft (trust, collaboration) and hard (financial incentives) levers. The results have important implications for better understanding policies that enable and hinder physician engagement and leadership development for health system improvement and transformation.

Leading Across the Health and Care System
The King’s Fund. (2017)
## Grey Literature available online

This paper offers those who are leading new systems of care some guidance on how to address the challenges they face. It draws on the King’s Fund’s work on the development of new care models, sustainability and transformation plans, and accountable care organisations. It is also informed by the experience of people who have occupied system leadership roles and draws on case studies from our research and organisational development work.

National leaders in the NHS are seeking to move away from competition as the guiding principle of the NHS toward collaboration. Integration is being favoured in place of fragmentation. And leadership is conceived as shared and collective rather than heroic. The development of new care models, sustainability and transformation plans (STPs), and accountable care systems are all examples of where these shifts are taking place.

In this context, it can be tempting for organisations to look after their own interests and performance rather than to work in partnership with others. However, the paper argues that this would be a major missed opportunity to transform the delivery of care to meet the changing needs of the population. Doing this requires NHS organisations and their partners to work together to improve services and make the best use of limited resources.

This paper offers those who are leading new systems of care some practical ways in which to work together to address the challenges they face.  The practical examples of how people build collaborative initiatives to improve services, based on cases in the NHS, are relevant to Australia. It is interesting to note that in a unitary system—such as the NHS—the challenges of fragmentation and dispersion are challenging for them; and even more so in Australia, of course, because of its unique constitutional model of health service delivery.

Caring to Change: How compassionate leadership can stimulate innovation in health care
West, M., Eckert, R., Collins, B., & Chowla, R. (2017 May)
## Grey literature available online

Improvement efforts are widespread within the National Health Service (NHS) in the UK: stimulated and supported by a variety of organisations and initiatives. However, examples of radical and sustained innovation are exceptions in the NHS landscape. There are examples that offer hope and direction from local systems that have triumphed over adversity through:
• whole-system redesign • radical rethinking of organisational roles
• empowering teams to innovate
• persistently nurturing continuous improvement.

The authors argue that enabling leadership and cultures are essential for ensuring that innovation spreads and becomes a cultural norm within the NHS. However, without innovation generally, and quality improvement specifically, attempts to meet the challenges of modern health care are less likely to succeed. Leadership is central to this and compassionate leadership is a fundamental enabling factor that will create a culture of improvement and radical innovation across health care. The paper also presents case studies of how compassionate leadership has led to innovation. 

Evidence-based management in practice: Opening up the decision process, decision-maker and context
Wright, A. L., Zammuto, R. F., Liesch, P. W., Middleton, S., Hibbert, P., Burke, J., & Brazil, V. (2016)
## Article.  Abstratct available online.  Full text article can be purchased

The authors of this article propose a conceptual model of evidence-based management (EBM) within the context of healthcare. Research on decision making has recognised the importance of systematic analysis of best available evidence to improve decision processes within organisations, but has not examined how the decision-maker and the context shape EBM decision processes in practice.

The authors used a case study approach in a large metropolitan Australian emergency department. Interviews were conducted with 24 emergency physicians and registrars, four hospital executives and one nurse who had been involved in solving a four-year operations management problem. Findings reveal an evidence-base process involves five stages: (1) problem recognition and assigning a mandate; (2) assembling literature and internal evidence; (3) cross-pollinating evidence and reformulating the problem; (4) engaging stakeholders and generating evidence-based alternatives; and (5) commitment to an evidence-based solution and implementation.

Four personal characteristics of the decision-maker were prominent. These included self-belief; a preference for rationality; expertise in tailoring communication; and determination. Finally, in relation to the context, three factors were identified: a recognized need for change; insider (only) trust; and stakeholder regard for the art of judgement.

The article sheds light on the concept of EBM decision processes and the role of person-context fit in engaging with evidence and stakeholders to reach an implementable and effective decision. From a managerial perspective, it suggests that managers-to-be develop situated expertise to enact EBM in useful and meaningful ways.
 

Competency : Health Advocate

Leadership Development Programs for Physicians: A Systematic Review
Frich, Jan C., Brewster, Amanda L., Cherlin, Emily J., & Bradley, Elizabeth H. (2014)
## Article is available through the RACMA eLibrary

Physician leadership development programs typically aim to strengthen physicians’ leadership competencies and improve organisational performance. In this article, the authors profiled the results of a systematic review of medical literature on physician leadership development programs in order to characterize the setting, educational content, teaching methods, and learning outcomes achieved.

Articles were identified through a search in Ovid MEDLINE from 1950 through November 2013.

The authors identified 45 studies that met eligibility criteria, of which 35 reported on programs exclusively targeting physicians. The majority of programs focused on skills training and technical and conceptual knowledge, while fewer programs focused on personal growth and awareness. Half of the studies used pre/post intervention designs, and four studies used a comparison group. Positive outcomes were reported in all studies, although the majority of studies relied on learner satisfaction scores and self-assessed knowledge or behavioral change.

Only six studies documented favorable organisational outcomes, such as improvement in quality indicators for disease management. The leadership programs examined in these studies were characterized by the use of multiple learning methods, including lectures, seminars, group work, and action learning projects in multidisciplinary teams.

This synthesis of the literature suggests important gaps, including a lack of programs that integrate non-physician and physician professionals, limited use of more interactive learning and feedback to develop greater self-awareness, and an overly narrow focus on individual-level rather than system-level outcomes.

Physician-organisation collaboration reduces burnout and promotes engagement: The Mayo Clinic experience
Swensen, S., Kabcenell, A., Shanafelt, T., (2016)
## Article can be accessed  through the RACMA eLibrary

This article examined strategies adopted by a health care organisation to foster physician engagement and reduce burnout. The authors use the Mayo Clinic, the first and largest physician-led, integrated, multispecialty medical group practice in the world, as a case study. In mitigating environmental drivers of burnout and enhancing individual resiliency, the Mayo Clinic introduced the Listen-Act-Do model which aims to provide physicians some degree of choice (choice over their lives), camaraderie (social connectedness) and an opportunity for excellence (being part of something meaningful). In fostering healthy physician-organisation relationships, the Mayo Clinic committed to organisation-sponsored practice improvement initiatives, including: 1) the Quality Academy; 2) Safety Team-based Engagement Model; 3) Institutional Burnout-Engagement Initiative; and 4) Office of Leadership and Organisation Development. Three principles which support the strategy are identified, including: 1) addressing the psychological needs of people; 2) developing constructive organisation-physician relationships; and 3) sponsoring physician leadership development. The authors suggest that these elements, collectively, raise organisational effectiveness and meet patients’ needs. The results have important implications for better understanding physician engagement and the relationship that health service organisations can develop to mitigate burnout and strengthen resiliency.

Accepting our responsibility: A blueprint for physician leadership in transforming Canada’s health care system
Van Aerde, J., & Dickson G. (2017)
## Grey literature available online

The authors of the white paper examine the role of physician leadership in generating and implementing sustainable health system reforms and improvement. Central elements impeding health care reform in Canada are identified, including: capacity challenges, mindset challenges, collaborative leadership challenges, educational challenges, and alignment challenges.

In the absence of physician engagement and leadership, the development and implementation of effective reform and transformation efforts will be compromised. Physician engagement is conceptualised as active and willing participation of physicians in local, regional, and provincial efforts to improve health in Canada. Physician leadership, which is the assumption of responsibility to influence others to work together to create the health care system of the future, is needed both formally and informally.

The paper identifies four arenas in which to systematically and strategically improve physician engagement and leadership, including: 1) physicians, individually and collectively; 2) health service organisations; 3) provinces and medical associations; and 4) national level. Specific recommended actions for effecting structural, cultural, political, and personal change in each arena are identified. The paper sheds light on physician engagement and leadership needed to operate as true partners in efforts to achieve meaningful large-scale change for health services delivery and health care reform.

Competency : Communicator

Physician engagement strategies in care coordination: Findings from the Centers for Medicare & Medicaid Services’ Health Care Innovation Awards Program
Skillman, M., Cross-Barnet, C., Friedman Singer, R., Ruiz, S., Rotondo, C., Ahn, R., Page Snyder, L., Colligan, E. M., Giuriceo, K., & Moiduddin, A. (2017)
## Article can be accessed  through the RACMA eLibrary

This article examined strategies adopted by health service organisations and programs to foster physician engagement for program implementation and to achieve innovation success. The successful implementation of new methods of service delivery or enhanced patient experience efforts need physician support.

The authors used a qualitative approach to gain data from 21 Health Care Innovation Award (HCIA) programs in the US which involved interviews and direct observations with 672 individuals, including 95 physicians.

The findings suggest that targeted communication and education that (1) involved physician champions, and (2) promoted program aspects valued by physicians as an innovation-values fit, were the most widely used successful strategies to promote an innovation climate that engaged physicians. The article sheds light on innovation success and the role that physician values play in interacting and shaping implementation policies and practices. By integrating physicians into care teams in which values are considered as components of policy and process, organisations can accelerate adoption of innovations. 

Creating a patient-centered health care delivery system: A systematic review of health care quality from the patient perspective
Mohammed, K., Nolan, M. B., Rajjo, T., Shah, N. D., Prokop, L. H., Varkey, P., & Murad, M. H. (2016)
## Article can be accessed  through the RACMA eLibrary

In the United States the Centers for Medicare and Medicaid Services are the US Federal Agency which administers Medicare, Medicaid, and the State Children’s Health Insurance Program. These Centers fund hospitals on a formula that includes a 30% score for the quality of patient experience. The authors contend that the measures used to determine patient experience may or may not be an appropriate way to gauge the quality of patient experience. They believed that other factors--not measured by surveys of patient satisfaction or experience—can affect how patients view the quality of a health care system and how they choose where to receive their care.

The research team conducted a systematic review of the published literature to better understand the factors that affect patient perceptions of health care organisations. The aims of the study are to explore patient perceptions of quality of health care and to understand how patient perceptions may differ by settings and condition.
Health care quality indicators, in descending order of importance, were:  quality of communication; access to health care; shared decision making; provider clinical quality; the physical environment of health care delivery; pain control; patient education; existence of an electronic medical record; the discharge process, and preventative services. The 10 dimensions identified can be used in the planning and evaluation of health care delivery. 

It should be noted that when compared to studies in other countries, the results for other countries did differ significantly from those in the US. Readers from Australia will have to identify elements that they believe are applicable in the Australian environment.

This systematic study suggests that the use by leaders of patient satisfaction surveys on their own to determine overall patient satisfaction with the quality of care is not an accurate determination of that quality. More robust measures including multiple factors may be more reliable in decision making.
 

Competency : Collaborator

Developing Canadian physicians: The quest for leadership effectiveness
Comber, S., Wilson, L., & Crawford, K. C. (2016)
## Article can be accessed  through the RACMA eLibrary

Physician leadership is recognised as key skill for the success of physicians and others working in collaborative and integrated healthcare environments. Research has recognised its importance, but has not fully articulated what physicians and physician leaders need to become more effective leaders and made it actionable.

The authors used quantitative data gathered from Canadian physicians who attended conferences and courses to identify clinical and non-clinical physicians’ perceptions of leadership effectiveness through the lens of political skills. Political skills are defined as ‘ability to understand others at work and to use that knowledge to influence others to act in ways that enhance one’s personal and organisational agenda’.

Survey data was collected from 209 physicians from 2012 to 2014 along four dimensions, including: 1) social astuteness; 2) interpersonal influence; 3) networking ability; and 4) apparent sincerity.

The analysis reveals that physicians in clinical roles assessed their leadership effectiveness scores in all four dimensions as significantly lower when compared to all other physicians in non-clinical roles. This article has important implications for better understanding the explicit, pragmatic behaviours needed by physicians to enact leadership in clinical and non-clinical roles at different points in their careers and in affecting organisational change.

Making time for learning-oriented leadership in multidisciplinary hospital management groups
Singer, S. J., Hayes, J. E., Gray, G. C., & Kiang, M. V. (2015)
## Article can be accessed  through the RACMA eLibrary

This article examined why some interdisciplinary groups foster quality and safety improvements in healthcare through collaborative leadership while others do not.

The authors identified a sample of 12 groups, consisting of 6 to 12 members which included physicians, nurses, and other clinical and administrative managers, from one Boston area academic medical centre that participated in a 15-month safety leadership team training program.

A mixed methods approach used observation, interview, and archival data along with survey scores to identify groups with high results--i.e., they showed improvement and were successful in achieving improvement project goals. They then compared them to lower performers. The findings indicate that high performers purposefully invested in capacity building to act as a multi-disciplinary learning team and gained long term benefits.

In contrast, the low performers were not intentional about learning and engaged in a vicious cycle which impeded open discussion, input seeking, and listening and limited achievement of project improvement goals.

 

Further reviews and articles are available through the RACMA eLibrary - http://racma.edu.au/index.php?option=com_content&view=article&id=787&Itemid=103&utm_medium=banner&utm_campaign=elibrary&utm_source=racmahomepage



Bibliography

Baker, G. R., Judd, M. & Malka, C. Eds. (2016). Patient engagement: catalyzing improvement and innovation in healthcare. Longwoods Publishing: Toronto.

Comber, S., Wilson, L., & Crawford, K. C. (2016). Developing Canadian physicians: The quest for leadership effectiveness. Leadership in Health Services, 29(3), 282-299.

Denis, J., & van Gestel, N. (2016). Medical doctors in healthcare leadership: theoretical and practical challenges. BMC Health Services Research, 16(Suppl 1): 158, 45-56.

Frich, Jan C., Brewster, Amanda L., Cherlin, Emily J., & Bradley, Elizabeth H. (2014). Leadership Development Programs for Physicians: A Systematic Review. J Gen Intern Med 30(5) 656–74.

Mohammed, K., Nolan, M. B., Rajjo, T., Shah, N. D., Prokop, L. H., Varkey, P., & Murad, M. H. (2016). Creating a patient-centered health care delivery system: A systematic review of health care quality from the patient perspective. American Journal of Medical Quality. 31(1), 12 –21.

Singer, S. J., Hayes, J. E., Gray, G. C., & Kiang, M. V. (2015). Making time for learning-oriented leadership in multidisciplinary hospital management groups. Health Care Management Review, 40(4) 300-312.

Skillman, M., Cross-Barnet, C., Friedman Singer, R., Ruiz, S., Rotondo, C., Ahn, R., Page Snyder,L., Colligan, E. M., Giuriceo, K., & Moiduddin, A. (2017). Physician engagement strategies in care coordination: Findings from the Centers for Medicare & Medicaid Services’ Health Care Innovation Awards Program. Health Services Research, 52(1), 291-312.

Swensen, S., Kabcenell, A., Shanafelt, T., (2016). Physician-organisation collaboration reduces burnout and promotes engagement: The Mayo Clinic experience. Journal of Healthcare Management, 61(2), 105-128.
The King’s Fund. (2017). Leading Across the Health and Care System. The King’s Fund: London. Accessed on May 11 @ https://www.kingsfund.org.uk/publications/leading-across-health-and-care-system.

Van Aerde, J., & Dickson G. (2017). Accepting our responsibility: A blueprint for physician leadership in transforming Canada’s health care system. Canadian Society of Physician Leaders: Ottawa, ON.

West, M., Eckert, R., Collins, B., & Chowla, R. (2017 May). How compassionate leadership can stimulate innovation in health care.  King’s Fund: London. Accessed on May 10, 2017 @ https://www.kingsfund.org.uk/publications/caring-change

 

Last Updated on Friday, 15 September 2017 16:08