Macquarie University
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Measuring Medical Doctor Activation in Academic Medicine in Australia and the USA

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posted on 2023-01-23, 04:05 authored by Natalie Sequeira

Despite general acceptance that clinician engagement delivers positive outcomes for healthcare organisations, uniform understanding of the concept and ability to effectively measure and link it to outcomes remains limited. Drawing on the literature and the concept of the valid and reliable Patient Activation Measure, this study conceptualises a defined and measurable concept of ‘doctor activation’. Doctor activation was defined for this purpose as the ability and motivation of medical doctors in regularly and actively contributing to sustaining or improving the delivery of high value, patient-centred care. The study developed - through an evidence-based, co-production process - a new, purpose-designed survey, the Measure of Doctor Activation (MD-A). The MD-A was implemented at two academic health systems in Australia and the USA and evaluated for validity and reliability as a tool. Finally, the results were analysed in concert with semi-structured interview findings to provide a two-country and site comparison of doctor activation. The MD-A was shown to be a valid and reliable, 18-item scale for measuring activation of medical doctors. Differences were demonstrated in predictors and detractors of activation at the two sites, given their different contexts and levels of maturity as academic health systems. The study demonstrated a correlation between doctor activation and tangible results being delivered for the organisation (as measured by initiation and leadership of new model of care, quality improvement or strategic initiatives). In summary, the MD-A is a valid, reliable, and potentially high utility tool to measure the activation level of doctors across organisations, countries, and contexts, with a view to continuous improvement.


Table of Contents

Chapter 1. Introduction -- Chapter 2. Narrative Literature Review -- Chapter 3. Methods -- Chapter 4. Qualitative Leadership Interview Results -- Chapter 5. Doctor Activation Survey Development & Validation -- Chapter 6. Doctor Activation Survey Results -- Chapter 7. Discussion and Conclusion -- References -- Appendix A. Semi Structured Interview Schedules -- Appendix B. Original Md-A Item Mapping -- Appendix C. Factor Loadings for EFA (All Items) -- Appendix D. Final MD-A Model Fit

Awarding Institution

Macquarie University

Degree Type

Thesis MRes

Department, Centre or School

Australian Institute of Health Innovation

Year of Award


Principal Supervisor

Jeffrey Braithwaite


Copyright: The Author Copyright disclaimer:




Australia United States


87 pages

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