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. Implications. 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. What is known about the topic? Engagement of clinicians has been identified as essential for improving quality and safety, as well as successful health system reform, but there is little understanding of how to define and measure this engagement. What does this paper add? Clinical engagement is defined as the cognitive, emotional and physical contribution of health professionals to their jobs, and to improving their organisation and their health system within their working roles in their employing health service. While this construct applies to employees, engagement of independent practitioners is a different construct that needs to recognise out-of-role requirements for clinicians to become engaged in organisational and system reform. What are the implications for practitioners? This paper advances our understanding of clinical engagement, and suggests that based on research on high performance work systems, the Australian health system has a way to go before the antecedents of engagement are in place.