Encouraging participation in health system reform: is clinical engagement a useful concept for policy and management?
OBJECTIVE
Recent health system enquiries and commissions, including the National Health and Hospital Reform Commission, have promoted clinical engagement as necessary for improving the Australian healthcare system. In fact, the Rudd Government identified clinician engagement as important for the success of the planned health system reform. Yet there is uncertainty about how clinical engagement is understood in health policy and management. This paper aims to clarify how clinical engagement is defined, measured and how it might be achieved in policy and management in Australia.


METHODS
We review the literature and consider clinical engagement in relation to employee engagement, a defined construct within the management literature. We consider the structure and employment relationships of the public health sector in assessing the relevance of this literature.


CONCLUSIONS
Based on the evidence, we argue that clinical engagement is similar to employee engagement, but that engagement of clinicians who are employees requires a different construct to engagement of clinicians who are independent practitioners. The development of this second construct is illustrated using the case of Visiting Medical Officers in Victoria.


CONCLUSIONS
Antecedent organisational and system conditions to clinical engagement appear to be lacking in the Australian public health system, suggesting meaningful engagement will be difficult to achieve in the short-term. This has the potential to threaten proposed reforms of the Australian healthcare system.
Department of Management, La Trobe University, Bundoora, VIC. 3086, Australia. d.bonias@latrobe.edu.au
Dimitra
D
Bonias
Sandra G
SG
Leggat
Timothy
T
Bartram
D001315:Australia; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D018166:Health Care Reform; D006291:Health Policy; D008503:Medical Staff