Safely Practicing in a New Environment: A Qualitative Study to Inform Physician Onboarding Practices

摘要

Background: Physicians are frequently asked to practice in hospitals different from their home institution, often undercontracts called professional service agreements (PSAs). With highly variable onboarding processes, traveling physicians areoften left to “figure out” the available resources, processes of care, crucial relationships, and culture of the new institution.This research aimed to understand the current practices of onboarding for the purpose of informing future improvementsin practice.Methods: Two physicians conducted semistructured, in-depth interviews with physicians working at hospitals beyondtheir home institution. A thematic qualitative analysis was performed.Results: The sample included 20 physicians from six specialties. Key findings include (1) the basic logistics of providingcare in a new environment are often not incorporated into physician onboarding and can limit physicians’ ability to providecare efficiently and effectively; (2) the strength of interpersonal relationships greatly influences the ability of physicians toget help when working in new environments; and (3) managing clinical emergencies in unfamiliar settings can result insignificant perceived risk to patient safety due to delays in providing care.Conclusion: The onboarding process, for physicians working in new institutions, provides significant opportunity forimprovement. In the future, more work is needed to ensure that the most notable differences between institutions are clarified,physicians have the necessary information and professional relationships to handle emergencies, and they know whichpatients they can safely care for in their new institution.