When employees are engaged with their work and organisation, they’re more likely to perform well. This is particularly important in the context of health, where engagement improves the efficiency and effectiveness of services, reduces staff absenteeism and turnover, increases patient satisfaction and improves safety.
Highly engaged doctors, in particular, do much better on a wide range of important measures. These include clinical performance, financial management, safety indicators, patient experience and overall quality standards.
When doctors aren’t engaged, things can go tragically wrong. In the United Kingdom, this was vividly illustrated at the Mid Staffordshire hospital, where a public inquiry found a culture of fear and poor leadership had taken hold in the late 2000s. As a result, between 400 and 1,200 more people died than would have been expected between 2005 and 2008.
Some patients were left hungry, thirsty and in soiled bedclothes, with calls for staff often going unanswered. Other patients received wrong medications. Decisions about who to treat were left to receptionists. And junior doctors were sometimes responsible for critically ill patients they were not sufficiently able to manage.
Since the mid-2000s, a concerted effort has been made to enhance medical engagement in the UK.
The issue hasn’t received the same sort of attention from Australian governments. Initiatives to improve clinician engagement have therefore been piecemeal.
Our research from 12 sites across Australia and New Zealand, involving more than 2,100 doctors, reveals we have lower levels of medical engagement than in the UK. Doctors in Australia feel they aren’t actively and positively contributing to the performance of their hospital.
This doesn’t mean doctors aren’t actively engaged in individual patient care. But they feel they’re making (or are being asked to make) fewer contributions at the organisational level, which has an indirect impact on patients.
We found significant variation between different specialities and types of organisation. There is no consistent national pattern, although engagement is higher in some parts of the country than others.
Hospitals in the UK, where doctors are highly engaged, deliver better patient experiences. This leads to an improved safety and quality culture, resulting in fewer errors, lower infection rates and stronger financial management. Staff have higher morale, less absenteeism and stress.
So, why are Australian doctors less engaged?
Australia has a fragmented health system, which spans the public and private sectors. Funding and responsibilities sit at different levels of government. This means doctors may work across both the public and private sectors and for multiple institutions, making it difficult to engage with each organisation.
Engagement of doctors is also influenced by contracting regimes, education processes and the activities of regulatory regimes. Medical colleges, hospitals and other employers must therefore provide the right training opportunities, supportive and collaborative work environments and development pathways, and give staff purpose and direction.
A recent study found Australia lags behind other countries in setting out pathways for doctors to become more engaged in organisations through, for example, progression to leadership and management roles.
Doctors who move into management often have poorly defined tasks, blurred lines of accountability, no budget and no staff. Yet they are expected to take a leadership role in managing services, quality of care and performance.
Health providers need to involve junior doctors in service-improvement projects, ensure they are involved in meaningful decision-making at all levels of the organisations and provide leadership development programs. They also need to ensure doctors have the time to participate.
The pay-off of a more engaged workforce offers a significant reward that can’t be overlooked: better patient care.
Helen Dickinson receives funding from Federal department of health. Paul W. Long receives funding from health service organisations undertaking medical engagement surveys.
Paul Long was was paid by NSW Health and other funders to survey medical engagement at the 121 sites where this work has been undertaken.
Authors: Helen Dickinson, Associate Professor, Public Governance, University of Melbourne