Orthopedist involvement in the management of clinical activities: a case study

André Côté,Célia Lemaire,Kassim Said Abasse,Marie-Hélène Gilbert,Maude Laberge,Mylaine Breton

doi:10.1186/s12913-021-06299-2

Abstract

BackgroundThe rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists’ level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement.MethodsWe selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview.ResultsOur findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed.ConclusionsBeyond simply identifying the underlying dynamics of orthopedists’ involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.

Highlights

The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery
Study setting For the purposes of this study, we considered the care pathways of the three orthopedic surgeries—hip fractures (HF), total knee replacements (TKR), and total hip replacements (THR), at the Centre Hospitalier Universitaire
We analyzed orthopedists’ involvement in management, explained variations according to the activities carried out during the five episodes of the care pathway, and determined the impact of such involvement on the flow of clinical activities

Summary

Introduction

The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists’ level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. Physicians have a significant impact on the allocation of resources and, Physicians’ involvement in the management of clinical activities in health care institutions is of high importance, as the cost, quality, and relevance of patient care depend on the attitude, actions, and level of their. Research shows that physician involvement in the management of hospital clinical activities is critical to the safety and quality of care [7, 8]. For Turner, interactions are a way of showcasing actors’ resources so that the exchange will result in a mutually beneficial situation [10]

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