Physician Involvement in Healthcare Reform: How Physician Professional and Organizational Identification Relate to Physician Work Engagement in Clinical and Organizational Work Settings in Ontario
Bibliographic record
Abstract
Hospital physicians play a vital role in healthcare systems, and their engagement in leadership and organizational activities—such as planning, decision-making, and quality improvement—is known to enhance hospital performance and support system-level change. Despite this, hospitals continue to face challenges engaging physicians in these non-clinical roles. These challenges are partly rooted in structural issues within the health system and are further complicated by the dual identity hospital physicians experience—balancing clinical responsibilities with organizational expectations that may conflict with their professional values. This study aimed to advance understanding of these challenges by exploring the concepts of physician work engagement and physician identification (with both their profession and their organization) in the context of the multiple roles physicians perform. A comprehensive literature review informed the development of the Physician Work Engagement and Identification Conceptual Framework (PWEICF) and a corresponding survey instrument—the Physician Work Engagement and Identification Survey (PWEIS). The PWEIS was distributed electronically to physicians (n=264) across five academic and community hospital sites. Data were analyzed using descriptive statistics, t-tests, factor analysis, and path analysis. Findings provided good support for the PWEICF and several hypotheses. Results revealed that physicians identify more strongly with their profession than with their organization and report higher engagement and fulfillment from clinical work compared to organizational work. Path analysis further demonstrated that professional fulfillment, perceived organizational support, and burnout are significant antecedents of physician work engagement. Additionally, alignment between physicians’ professional values and those of their organization was associated with stronger organizational identification, which in turn was significantly related to physicians’ engagement as members of the organization. This research offers a novel conceptualization of physician work engagement and provides new insights into the mechanisms of physician work engagement and identification by highlighting the contextual factors that shape how physicians engage and identify with their organizations. The findings contribute to the limited literature on physician engagement and offer practical insights for healthcare leaders aiming to foster more meaningful physician involvement in organizational life.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.006 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".