Engaging medical staff in clinical governance: introducing new technologies and clinical practice into public hospitals.

INTRODUCTION: To enhance patient care, medical staff at major tertiary teaching hospitals are encouraged to innovate through introducing new technologies and clinical practices. However, such introduction must be safe, efficient, effective and appropriate for patients and the organisation, and actively lead by engage medical staff. METHOD: This study outlines the development, implementation and evaluation of a framework for introducing new technologies and clinical practice to a major tertiary health service. Evaluation includes survey of medical Heads of Units (HOUs) for framework's effectiveness, and comparison of level of medical staff engagement against a best-practice model. RESULTS: Over 2-year period: 19 applications, 7 approved. Successful external funding of $1.993 million achieved. Survey of HOUs in June 2009: response rate 59% (25 of 42 HOUs), with 11 of 25 respondents utilised the committee. Of those 14 of 25 who had not utilised the committee, low awareness of the committee's existence (2 respondents). Most elements of the best-practice model for engaging medical staff were achieved. Recommendations include improvements to committee process and raising profile with medical staff. DISCUSSION: This study demonstrates an effective and successful clinical governance process for introducing new technologies and clinical practice into a major tertiary teaching hospital, supported by moderate levels of medical staff engagement.

Distressed doctors: a hospital-based support program for poorly performing and "at-risk" junior medical staff.

Despite "safe-hours" campaigns and doctors health programs, "at-risk" behaviour and suicides still occur in junior doctors. A recent national survey found that 46% of junior doctors believed that their hospital administration was not supportive. The Royal Melbourne Hospital has developed a comprehensive program for preventing and identifying at-risk behaviour and supporting junior doctors, tailored to the individual's needs. Patient and individual doctor safety is paramount, and confidential collaboration between medical workforce and medical education structures, clinical supervisors and the Victorian Doctors Health Program is required. The boundaries of the hospital's "duty of care" for those who do not want assistance is unclear, and balancing increased supervision within a limited workforce is challenging.

Roles, attributes and career paths of medical administrators in public hospitals: survey of Victorian metropolitan Directors of Medical Services.

AIM: To document the roles, the perceived skills and attributes and experience required of Medical Administrators in contemporary public hospitals. METHOD: Interviews with Directors of Medical Services (DMS) from Victorian metropolitan public hospitals between March 2005 and May 2005. RESULTS: A total of 14 of the 21 DMS in Victoria were interviewed. Key roles: Managing Medical Staff; Clinical Governance and Quality Improvement; Strategy and Service development; and Medical advisor to CEO. Key attributes and skills aligned with roles. Most respondents hold Fellowship of Royal Australasian College of Medical Administrators (FRACMA) with over half employed for less than 2 years. DISCUSSION: Core roles identified mirrored in key international literature. Recommendations for further study includes systematic review of literature; the influence of the medically-trained Chief Executive on roles; and further analysis of high turnover. CONCLUSION: This study clarifies the roles undertaken and skills required by Medical Administrators in contemporary public hospitals, providing: (1) role benchmarking for Chief Executives; (2) reduced ambiguity among the broader medical staff of the roles, to assist those who may need Medical Administrator assistance with providing patient care; (3) assisting the Medical Administration profession and RACMA to provide tailored education and training; and (4) to inform aspiring future Medical Administrators of the broad nature of such roles.

Medical managers in contemporary healthcare organisations: a consideration of the literature.

OBJECTIVES: To consider the literature supporting the evolution of the roles of a Medical Manager within contemporary healthcare organisations. DESIGN: Consideration of available literature. RESULTS: Limited dedicated literature available. Consideration of available studies and expert opinion reveals benefit of doctors in management positions within healthcare organisations. The roles of Medical Managers arise from: organisational structure-theory of healthcare's 'professional bureaucracy'; clinical directorate models; clinical governance, legislative and public health requirements; and the duality of combining medical knowledge with business and healthcare management training. Roles identified are: (1) leadership and management of medical staff including appointments and credentialing, and mentoring of medical staff in Clinical Directorate roles; (2) strategy development including Medical Advisory Role to Executive; (3) clinical governance including quality and risk management and legislative requirements; and (4) operational areas that benefit from clinical and management skills. DISCUSSION: Strengths of this review include considering contexts of Medical Managers in medical and healthcare management literature. Weaknesses include drawing inferences from theory. Future recommendations include formal studies and systematic reviews of available literature of the subject. CONCLUSIONS: In light of falling Medical Management trainee numbers, this study highlights the value to the health system of a dwindling Medical Management profession, the urgent need to encourage more medical practitioners into management and for organisations to further embrace Medical Managers in key leadership roles.