Senior Hospital Physician Leaders' Perspectives on Factors That Impact Physician Engagement: A Qualitative Interview Study.

Background: Physicians are essential in health-care delivery. Physician engagement, defined as active participation in administrative and leadership activities in their organization, is a useful metric for hospital leaders to evaluate as they develop and implement strategy. The purpose of this study was to gain insight into the perspectives of senior hospital physician leaders on factors impacting physician engagement. Methods: Semi-structured interviews were conducted virtually. A purposive sample was used. Hospital physician senior leaders were recruited from Ontario public hospitals in Canada. The interviews were recorded, transcribed verbatim, and analyzed. Results: Ten participants in senior hospital physician leadership positions were interviewed. Seven themes were identified as impacting physician engagement: being seen and being heard, accountability, trust, leadership engagement, intercommunication, organizational stability, and discord within the organization. Saturation of themes was achieved. Conclusion: Two-way communication is essential to physician engagement. Physician input in decision-making processes is a vital way to improve engagement. For this to work, leadership must also be engaged. Trust and accountability are critical attributes for senior hospital physician leaders, especially during times of organizational instability. For physicians whose remuneration model is fee-for-service, new compensation models are required for them to actively participate in hospital decision-making.

Determinants Present in the Receptor Carboxy Tail Are Responsible for Differences in Subtype-Specific Coupling of beta-Adrenergic Receptors to Phosphoinositide 3-Kinase.

An agonist-occupied beta(2)-adrenergic receptor (beta(2)-AR) recruits G protein receptor kinase-2 (GRK2) which is recruited to the membrane. Thus, the physical proximity of activated beta(2)-AR and PI-3K allows the activation of the latter. In contrast, it has been observed that the beta(1)-AR is unable to activate the PI-3K/Akt pathway. We hypothesized that the difference might be due to molecular determinants present in the carboxy termini of the two beta-AR subtypes. Using transiently transfected HEK 293 cells expressing either beta(1)- or beta(2)-AR, we also observed that in presence of an agonist, beta(2)-AR, but not beta(1)-AR, is able to activate the PI-3K/Akt pathway. Switching the seventh transmembrane domain and the carboxy tail between the two receptors reverses this phenotype; that is, beta(1) x beta(2)-AR can activate the PI-3K/Akt pathway whereas beta(2) x beta(1)-AR cannot. Pretreatment with pertussis toxin abolished the activation of PI-3K by beta(2)- or beta(1) x beta(2)-AR stimulation. Ligand-mediated internalization of the beta(2)-AR induced by a 15-minute stimulation with agonist was abolished in the presence of a dominant negative of PI-3K or following pertussis toxin pretreatment. These results indicate that the subtype-specific differences in the coupling to PI-3K/Akt pathway are due to molecular determinants present in the carboxy tail of the receptor and further that beta(2)-AR activates PI-3K via a pertussis toxin-sensitive mechanism.