Australian doctors are more engaged than UK doctors: why is this the case?

BACKGROUND: Despite reports highlighting the need for greater medical engagement and the benefits of being widely understood, very little information is available on the status of medical engagement in Australia, and how this compares to the UK. Answering this question will no doubt assist training bodies, curriculum designers and policy makers better understand relevant issues. METHODS: The medical engagement questionnaire (MES) was emailed to all medical staff working at 159 UK National Health Service Trusts and 18 health service organisations in Australia. The questionnaire consists of 30 predetermined items seeking responses using a 5-point Likert scale. RESULTS: Overall, doctors in the Australian dataset are slightly more engaged, or more positive, than their UK colleagues. Good interpersonal relationships was the only variable that UK doctors scored more positively than their Australian counterparts. At the lower end of the responses, that is the least engaged, we found this even more apparent. Where doctors in Australia are less disengaged, that is still more positive than the UK colleagues. CONCLUSION: While the profiles of medical engagement vary at the sites and also across the MES and subscales, the data illustrate that overall doctors in Australia feel valued and empowered, and they have purpose and direction and work in a collaborate culture. At the most disengaged end of the scale, Australian doctors are markedly less disengaged than their UK counterparts. There may be numerous factors that influence and change how engaged doctors are in both countries. The most prominent of these are appear to be working conditions and lifestyle, driven by funding and other economics issues. This research is likely to be of great interest to regulators and training bodies in both countries.

The Relationships Between Use of Quality-of-Care Feedback Reports on Chronic Diseases and Medical Engagement in General Practice.

BACKGROUND: There is a limited knowledge on how medical engagement influences quality of care provided in primary care. The extent of the use of feedback reports from a national quality-of-care database can be considered as a measure of process quality. This study explores relationships between the use of feedback reports and medical engagement among general practitioners, general practitioner demographics, clinic characteristics, and services. METHODS: A cross-sectional combined questionnaire and register study in a sample of 352 single-handed general practitioners in 2013. Logistic regression analysis was used to explore associations between the use of feedback reports for diabetes and chronic obstructive pulmonary disease and medical engagement. RESULTS: For both diabetes and chronic obstructive pulmonary disease, a higher degree of medical engagement was associated with an increased use of feedback reports. Furthermore, we identified positive associations between using feedback reports and general practitioner services (spirometry, influenza vaccinations, performing annual reviews for patients with chronic diseases) and a negative association between usage of quality-of-care feedback reports and the number of consultations per patient. CONCLUSION: Using feedback reports for chronic diseases in general practice was positively associated with medical engagement and also with the provision of services in general practice.

Medical engagement and organizational characteristics in general practice.

BACKGROUND: Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale (MES) was developed by Applied Research Ltd (2008) on the basis of emerging evidence that medical engagement is critical for implementing radical improvements. OBJECTIVES: To study the importance of medical engagement in general practice and to analyse patterns of association with individual and organizational characteristics. DESIGN AND SETTING: A cross-sectional study using a sampled survey questionnaire and the official register from the Danish General Practitioners' Organization comprising all registered Danish GPs. METHOD: The Danish version of the MES Questionnaire was distributed and the survey results were analysed in conjunction with the GP register data. RESULTS: Statistically adjusted analyses revealed that the GPs' medical engagement varied substantially. GPs working in collaboration with colleagues were more engaged than GPs from single-handed practices, older GPs were less engaged than younger GPs and female GPs had higher medical engagement than their male colleagues. Furthermore, GPs participating in vocational training of junior doctors were more engaged than GPs not participating in vocational training. CONCLUSION: Medical engagement in general practice varies a great deal and this is determined by a complex interaction between both individual and organizational characteristics. Working in collaboration, having staff and being engaged in vocational training of junior doctors are all associated with enhanced levels of medical engagement among GPs.

The organizational stress measure: an integrated methodology for assessing job-stress and targeting organizational interventions.

This paper briefly describes the OSM (Organizational Stress Measure) which was developed over a decade ago and has evolved to become a well-established practical method not only for assessing wellbeing at work but also as a cost-effective strategy to tackle workplace stress. The OSM measures perceived organizational pressures and felt individual strains within the same instrument, and provides a rich and subtle picture of both the organizational culture and the personal perspectives of the constituent staff groups. There are many types of organizational pressure that may impact upon the wellbeing and potential effectiveness of staff including skill shortages, ineffective strategic planning and poor leadership, and these frequently result in reduced performance, absenteeism, high turnover and poor staff morale. These pressures may increase the probability of some staff reacting negatively and research with the OSM has shown that increased levels of strain for small clusters of staff may be a leading indicator of future organizational problems. One of the main benefits of using the OSM is the ability to identify 'hot-spots', where organizational pressures are triggering high levels of personal strain in susceptible clusters of staff. In this way, the OSM may act as an 'early warning alarm' for potential organizational problems.

Medical engagement: a crucial underpinning to organizational performance.

Medical Engagement has long been advocated as a critical component relating to organizational performance. Relatively little data though existed to support this contention. Using the Medical Engagement Scale (MES) This study demonstrates a persuasive linkage between assessed levels of Medical Engagement in secondary care organizations and independently gathered performance measures. Implications of executive leaders in promoting engagement are explored.

A management control approach to monitor large-scale change: an illustration in the context of reconfiguration.

The paper describes how Hospital Episode Statistics (HES) data can be retrospectively analysed over a number of years to evaluate and monitor organizational change in National Health Service (NHS) trusts. A methodology based on joinpoint regression analysis and management control theory has been developed which is able to represent in a framework (called an 'activity map') the complexity of HES data in a more user-friendly way than the unwieldy and often overwhelming tables or spreadsheets that are typically utilized. The 'activity map' has been designed to provide a common frame of reference for health professionals from different backgrounds to visualize and interpret the actual patterns of hospital activity changes that have occurred over the years. The aim is to facilitate a more effective, faster and more intuitive exploration of very large and unwieldy HES data-sets to assist health-care staff in monitoring planned and unplanned activity changes. It is hoped that making HES data more easily assimilated will encourage a greater sense of meaningful engagement in creatively contributing to service innovation.

Development and psychometric properties of a self report measure to assess clinicians' practices in self management support for patients with long term conditions.

OBJECTIVE: This paper presents a process of developing practices in self management support (PSMS) - a measure assessing clinicians' self reported use of self management support practices in clinical consultations for patients with long term conditions (LTCs). METHODS: The development process comprised the following steps: literature review to define what skills clinicians need to effectively support patients to self manage, review of existing measures of SMS practices, construction of an initial pool of items, E Delphi study pilot survey to select items for final measure, data collection to confirm the factor structure and internal consistency of the final measure. RESULTS: The PSMS comprises three subscales: Clinical SMS (14 items), Patient Centeredness (4 items) and Organizational SMS (7 items). All subscales have very good internal reliability (Cronbach α: 0.94, 0.78 and 0.85; all item-total correlations above 0.50). CONCLUSIONS AND PRACTICE IMPLICATIONS: We believe PSMS measure is suitable for both research and programme evaluation in UK clinical settings. To complete the process of measure development we are now planning to conduct further analyses to establish the validity of PSMS measure in UK and non UK healthcare settings and test the validity of PSMS measure on a wider range of other LTC groups.

Organizational interventions to promote risk management in primary care: the experience in Warwickshire, England.

Primary care organizations are under-represented in research on quality improvement and risk management (RM), yet the potential for improving patient safety is possibly greater given the extent that clinical judgement is required to achieve a service tailored to the individual's personal health and lifestyle. This paper examines how a health authority in England promoted interventions to improve RM in General Practice that included the practices' own initiatives, significant event audit (SEA) and the Medical Defence Union's workshops which included SEA. All 75 practices were approached before the programmes and when they were finished, eight months later. The practice manager from each practice completed an audit of RM activities, from which a RM competence score was derived. Up to six staff per practice completed the Learning organization Culture Questionnaire (LCQ) at both times. There was evidence of improved competence in RM over the period of the study, particularly through a widening breadth of staff involved and in formal recording systems. There was little evidence that these improvements were mediated by organizational culture. It is argued that future interventions should more closely target specific competences (e.g. recording systems for adverse events, root cause analysis to understand error generation) and enable staff to see tangible personal and organizational benefits for the extra effort involved.

The new GMS contract: impact and implications for managing the changes.

BACKGROUND: In February 2003, a new General Practitioner (GP) contract was agreed between the profession's leaders and the government, which was later accepted following a national ballot of GPs. However, the ballot simply required respondents to vote for or against the proposal; it did not provide any opportunity to identify which aspects of the new contract were more or less acceptable. Since the proposed changes were far reaching, the implications of implementing and managing these were considerable. Consequently, some information about how GPs viewed various components of the new contract would enable a more targeted and effective management strategy to be developed that would facilitate the introduction of all aspects of the contract. OBJECTIVES: To survey GPs working within the West Midlands region regarding their opinions on each of the key features of the new contract. METHOD: A postal survey of 360 GPs was undertaken, using a specially devised questionnaire. RESULTS: Four factors emerged as the most acceptable aspects of the contract: option to opt out of out-of-hours work, flexibility in the services provided, prediction of future income levels and linking practice to performance targets. Least acceptable were: performance monitoring systems, the new financial formula for calculating income, greater patient involvement in service development and 24/48 hour access. With regard to potential outcomes of the contract, the most positive were considered to be increased proportion of salaried GPs, increased salaries, appropriate quality standards for care, earlier retirement; the factors least likely to be of potential benefit were: reduction in occupational stress, simplification of the regulatory framework, improved equity of workload and improved staff retention. Further analysis of the results using inferential statistics revealed a range of subgroup differences in reaction to the contract. CONCLUSION: Overall, those aspects of the new contract that are perceived to reduce workload and enhance salary were supported, while those that increase targets and bureaucracy were not. Generally, there was only moderate support for the changes, which could be explained by a general scepticism about any top-down modifications, the practicality and power of the changes to impact upon practice and/or a genuine belief that the modifications are unacceptable. Taken together, these results provide an indicative focus for managing the implementation of the new contract, especially with regard to its least acceptable components and the emerging differences between subgroups of GPs.

Changing Childbirth: a pilot project.

OBJECTIVE: To compare the outcomes of an adapted pilot Changing Childbirth initiative providing continuity of care by a group of known midwives with traditional maternity care. DESIGN: Between-groups trial to compare levels of satisfaction and clinical outcomes for two groups of women, cared for either under this Changing Childbirth scheme or the traditional model of care. METHOD: Of the 200 women who agreed to participate in the project, 100 were randomly allocated to the pilot scheme and 100 to the traditional care package. During the postpartum period, information was collected via a questionnaire about participants' levels of satisfaction with a variety of aspects of care provided during the antenatal, delivery and postpartum periods. Data about clinical outcomes for the two groups were also obtained. RESULTS: Women in the pilot group had significantly more continuity of care throughout each of the three periods, were generally more satisfied with their care, felt that they had more choice over a variety of aspects of care and experienced no compromise in clinical outcomes (P = 0.05 or less in each case). IMPLICATIONS FOR PRACTICE: Many previous attempts to introduce the Changing Childbirth initiative have revealed significant problems, particularly with regard to the continuity of carer requirement. Taking account of local health care needs and existing provision, the present study adapted this concept to continuity of care. This did not apparently affect any of the guiding principles contained in the original document, and yet enhanced satisfaction. It would appear that the Changing Childbirth agenda can be adapted and integrated with local health care situations without sacrificing any of the overarching principles.

Staff attitude surveys. The morale majority.

Since April 2000, it has been mandatory for all NHS organisations to conduct annual surveys of staff morale. Analysis of staff attitude surveys in 18 trusts and 20 health authorities in 2001 showed that most staff groups were not happy with their pay or the recognition they received. Managers were happy with all aspects of their jobs. Doctors and nurses were concerned about their safety. All employing organisations must act on these results to improve employment practice and help to develop motivation.