Journal of Hospital & Medical Management

Keywords

Medical field; Multidisciplinary; Clinicians

Introduction

In our present and fast-changing world, practitioners especially the ones in the medical field, are exploring different roles amidst their credentials and accomplishments. One of the most affected settings in this concern is the practitioners working in the hospital. Because of the rapid and changing health care environment, clinical practitioners are accepting administrative roles and shift to the management path instead of the clinical ones. As a result, the hospitals are the ones being responsible on how to support and facilitate the role transitions of the practitioners. However, one concern in this activity is on how will the organization increased its benefits from the practitioners if they let them shift to advanced practice settings and leave the clinical practice [1].

In an article made by the university of wisconsin extended campus, four reasons were stated on how transitioning from clinical role to administration role can be beneficial. First is that working from direct patient care can give you the motivation to make a change in the organization, therefore, it will also develop your leadership and management skills. In this way, you will not only be able to help the patients, but also provide efficient service from the administrative level. Another point is the consistent work schedule that will liken to increase having a hands-on experience to improve the hospital care. It was also stated in the discussion that investing on growth and variety of duties can also be the reasons as to because even if less clinical work duties, still clinicians can still pursue a specific area of their profession as well as maintaining the leadership duties [2].

It can be argued that these factors will imposed an impact in developing an understanding of what factors should be involved in the transition process. As proposed by Schumacher and Meleis, there are five factors that can influence role transitions which were:

• Personal meaning of transition, relating to identity crisis.
• Degree of planning, relating to the anticipation of change.
• Environmental barriers and supports.
• Level of knowledge and skill, relating to prior experience and education.
• Expectations, relating to role models, literature and media.

While in our country, it is seen in that the health care system is the less evident on the multidisciplinary collaboration when a clinician started to accept higher positions. This is because of the idea of “seniority” and other “lower level” employees should collaborate and communicate. This is also a reason on somehow clinicians accept the upgraded duties to lessen their workload and have consistent duties at the hospital. Senior and junior doctors conveyed wide differences for their clinical and professional approaches in the use of theoretical knowledge, use of prior experience of cases, use of ethical and moral values, collaboration with the patient, and being led by the organization. This situation relates on why do some clinicians tend to shift to advanced roles and duties [3].

Literature Review

The study predominantly categorized as systematic review as it used a synthesized level of evidence to understand the social and behavioral dimensions of the needed outcome. The study incorporated Arksey and O’Malley’s framework as the study suggests to develop concepts and elements that utilize the understanding of a situation based on the thought, experiences, and views of the participants. Through this framework, the data gathered were documented, collated, and summarized appropriately. Additionally, as it was evaluated and was already approved, it will be registered under the holy angel university [4].

Preliminary search

The researcher conducted a review about clinicians on understanding the impact of role transition from clinical practice to advanced practice roles. As of the current, there are less number of existing reviews about the topic which is why using the research questions of “What is the impact of role transition of Filipino health practitioners to their practice from clinical to advanced roles?” was utilized to identify the possible related articles to answer the question. Specific questions such as, “What are the effects for a clinician’s professional status when they accept the administrative duties and leave the clinical roles?” and “Is there a flexible transition process when shifting from one practice to another?” were incorporated to classify related reviews. The researcher applied related articles with full text and open access available and using the steps following the search strategy [5].

Search strategy

Electronic searching was done to identify the related literature regarding the described research question. Most of the literatures are from google scholar, pubmed, sage journals, and BMJ Open wherein the time frame chosen is from 2012 up to present. Studies were identified using the key terms initially “transition”, “advanced practice”, “role transition”, “transition and advance practice”. All literature related to the key terms used in searching were included during the selection of literature. The studies that did not describe mostly the research question will be excluded in the study. All the related data such as country, date of publication, relatedness of abstract to the main question and level of administrative tasks were tabulated to properly create a clear connection of the literature [6].

The key terms “role transition” and “advanced practice” were used in Google scholar and it resulted to 107,000 articles, while in PubMed, using the same procedure, it resulted to 441 articles. However, to practically limit the studies related to the study, abstract screening was done [7-10].

Abstract Screening

The main search keywords were “transition”, “advanced practice”, “role transition”, “transition and advance practice”. The researcher conducted a literature search using MeSH and free text terms and then compiles the correct and applicable searches in a one document [11].

In this section, PubMed and sage journals were mainly the application used to identify the relevant studies. Upon searching and using the filters applicable, there were 22 articles related to the topic, and 4 of them are found by citation matching for PubMed, and 16 articles were identified in Sage Journals [12].

Inclusion and exclusion criteria

Criteria for considering studies

• Studies that mention role transition/or shifting to advanced practice roles such as administrative and management roles.
• Studies that mostly done in the Philippines or at least in Southeast Asia.
• Studies published from 2010 until present. • National and/or international locale using the English language.

Criteria for excluding studies

• Studies published more than 10 years ago.
• Studies that are not done in the Philippines or at least in Southeast Asia.
• Studies published as case reports only, and not journal indexed.
• National and/or international locale with language other than English.

Results

Initial search from PubMed and Google scholar resulted into a large number of articles. After which, given the key terms to search, the Google scholar resulted to 107,000 articles, while in PubMed, using the same procedure, it resulted to 441 articles. The inclusion and exclusion criteria were then applied to limit the possible related studies wherein it resulted to 22 articles related to the topic, and 4 of them are found by citation matching for PubMed, and 16 articles were identified in sage journals. However, after carefully checking the data, only 2 articles were included as they are applicable with at least 3 of the criteria; the criteria of the locale was not checked as there were no mentioned setting in the 2 articles seen in PubMed, while in sage journals, 0 articles were found upon using the f ilters of the criteria. Because of this result, the researcher used the Google search instead using the terms “role of advanced practice in the Philippines” and it resulted to 1 published study from penn libraries of university of Pennsylvania. This article fulfilled the inclusion criteria of the study, thus, it was included in the review.

Discussion

The articles simply discuss that practitioners mostly transition to more advanced practice roles as because of lack of clear understanding of the competencies in the profession. Because of the vast changing world, professionals also seek for personal and professional development, thus, attending to promotion or change of line of practice. Furthermore, the lack of opportunities and desire for progress are seen to be overlooked in the clinical setting. The common desire of everyone is to seek higher quality of service and practice which pertains to being an administrator. On the other hand, a policy is important for this undertaking state the standards, regulations, legislations, and solutions to the queries and concerns of the professionals, wherein the Philippines still lacks a concrete and clear policy reform regarding the impact of role transition to the members of the hospital specifically for the health care practitioners.

Conclusion

A professional can choose whatever path or career he may take in his professional journey. However, especially for the health professionals practicing in the clinical field, this may be difficult because of many substantial reasons wherein one of these is the lack of number in the country. Because of the lacking number, many reasons arise which results to others shifting career specifically attending to administrative positions. However, while some hospitals do not easily allow this, it is also important to define what might be the advantages and disadvantages of the hospitals and its members to these decisions. More specifically, the need to understand the clear benefits, effects and outcomes of this transition should be recognized, thus, to be discussed to the hospital members. Overall, as the Philippine health care system is developing, there should also be a clear provision and understanding of the roles of the other settings, specifically the hospital administration and management in the system.

Ethical Considerations

The study should report only articles with quality and enough relevance of evidence in line with the purpose of the study. The institutional review board of holy angel university will evaluate and approve the contents and objectives of the study to initiate the research.