EDITORIAL: Engagement in the health system
Johny Van Aerde, MD, PhD
This issue of our Canadian Journal of Physician Leadership is about engagement. Physician engagement takes place at two levels: the independent, individual level and the interdependent, systemic level. At the independent level, physicians act as disease experts and as advocates for each patient, all on a one-to-one basis. In contrast, the interdependent level of engagement consists of two-way interactions, relationships if you will, with all the elements in the health care system: patients, physicians, health care workers, and all other stakeholders, each with their own needs and contributions.
The different types of relationships at these two levels require different mental models of health, wellness, and disease, as well as different sets of leadership skills. One important skill is the ability to zoom in and out: zoom into the detailed, individual elements and zoom out to see the overview and the connections between all those elements.
This issue of the CJPL offers material that deals with both levels of physician engagement. The book review — of three related books — gives us a glimpse into the one-on-one level, the relationship between the patient and the physician or the health care team. What is unusual about these books is the people who wrote them. They entered the health care system from different angles, as mothers, patient advocates, physicians. The physicians ended up as patients in their own units and disliked the world they themselves had helped create. All three books make us pause and reflect on our professional relationships, our understanding of how and what we communicate, our mental models, compassionate care and empathy, and what these constructs mean at the individual, independent level of engagement. Top
The seven articles in this issue apply mainly to the interdependent, systemic level, although some deal with both levels. Brian Goldman’s writing on the mental model of “us and them” (pages 95-98) leans closely toward the books reviewed, with an ER story that describes the empathy gap created by different social identities inside and outside our health care system. Duncan Rozario (pages 99-103) weaves Plato’s seven virtues into both levels of engagement, starting with our own mental models and how they relate to the values we hold.
Tyrone Perreira and colleagues (pages 111-122) have developed a short, easy survey to measure physician engagement at the systemic level and describe how it can enable engagement in quality initiatives. Dawn Hartfield (pages 104-110) looked retrospectively at systemic engagement from a practical angle. A new physician leader, she structured the domains of the LEADS framework to guide a new quality management program. Figure 5 in her paper shows a new way to look at the LEADS framework within the context of the Stacey complexity model. Top
Malcolm Ogborn (pages 83-88) illustrates time management in a new light that can be used at all levels of engagement. The same applies to Nancy Merrow’s third article in a series on coaching competencies (pages 90-94). This time she explains how to ask appropriate questions that turn a problem into a goal and move intentions into actions. David Mador (pages 123-127) shows us what else is possible as physician leaders transition through the phases of their professional life. How do they re-engage with the system, and how do physicians who used to have leadership roles re-adjust when they rewire and re-engage differently?
We hope that this issue stimulates you to reflect on how best to engage in our health care system at all levels to make the world around us a better place for each (individual level) and for all (systemic level).
Johny Van Aerde, MD, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and executive medical director of the Canadian Society of Physician Leaders.