Tyrone Perreira - Academia.edu (original) (raw)

Papers by Tyrone Perreira

Journal of Healthcare Leadership

Background: Physicians are essential in health-care delivery. Physician engagement, defined as ac... more Background: Physicians are essential in health-care delivery. Physician engagement, defined as active participation in administrative and leadership activities in their organization, is a useful metric for hospital leaders to evaluate as they develop and implement strategy. The purpose of this study was to gain insight into the perspectives of senior hospital physician leaders on factors impacting physician engagement. Methods: Semi-structured interviews were conducted virtually. A purposive sample was used. Hospital physician senior leaders were recruited from Ontario public hospitals in Canada. The interviews were recorded, transcribed verbatim, and analyzed. Results: Ten participants in senior hospital physician leadership positions were interviewed. Seven themes were identified as impacting physician engagement: being seen and being heard, accountability, trust, leadership engagement, intercommunication, organizational stability, and discord within the organization. Saturation of themes was achieved. Conclusion: Two-way communication is essential to physician engagement. Physician input in decision-making processes is a vital way to improve engagement. For this to work, leadership must also be engaged. Trust and accountability are critical attributes for senior hospital physician leaders, especially during times of organizational instability. For physicians whose remuneration model is fee-for-service, new compensation models are required for them to actively participate in hospital decision-making.

ABSTRACTBackgroundTo confirm the reliability of a survey investigating physician engagement in qu... more ABSTRACTBackgroundTo confirm the reliability of a survey investigating physician engagement in quality improvement (QI) among Ontario physicians. We conducted a pilot study to test the survey on physicians, evaluate a recruitment strategy, and assess preliminary data.MethodsAll Ontario physicians were invited to participate in the survey through province-wide online physician and hospital organization newsletters.ResultsResults indicate a need for solutions and standards for training physicians interested in participating in QI initiatives. Study objectives were reached, but recruitment remains challenging.ConclusionThis pilot study supports conducting a full-scale survey that would result in more robust results.

Digital health, Oct 15, 2022

The Toronto prehospital hypertonic resuscitation-head injury and multi organ dysfunction trial (T... more The Toronto prehospital hypertonic resuscitation-head injury and multi organ dysfunction trial (TOPHR HIT)- Methods and data collection tools

Background: A standard of prehospital care for patients presenting with ST-segment elevation myoc... more Background: A standard of prehospital care for patients presenting with ST-segment elevation myocardial infarction (STEMI) includes prehospital 12-lead and advance Emergency Department notification or prehospital bypass to percutaneous coronary intervention centres. Implementation of either care strategies is variable across communities and neither may exist in some communities. The main objective is to compare prehospital care strategies for time to treatment and survival outcomes as well as cost effectiveness. Methods/Design: PREDICT is a multicentre, prospective population-based cohort study of all chest pain patients 18 years or older presenting within 30 mins to 6 hours of symptom onset and treated with nitroglycerin, transported by paramedics in a number of different urban and rural regions in Ontario. The primary objective of this study is to compare the proportion of study subjects who receive reperfusion within the target door-toreperfusion times in subjects obtained after ...

The implementation and change management literatures support the importance of leadership at all ... more The implementation and change management literatures support the importance of leadership at all organizational levels to achieve meaningful change. Recent scholarship on strategic change processes has highlighted leadership of middle management, in particular. This chapter aims to better understand middle management’s contribution to strategic change processes in health care. The extant literature is synthesized and mapped out in order to better understand how middle managers contribute to and engage in strategic change processes and further explores current and future contributions of middle managers to these processes. Middle managers may be able to meaningfully influence all aspects of the strategic change process, but risk becoming barriers to the strategic change process without sufficient access to resources and an empowering environment from senior leadership.

Journal of health and human services administration, 2016

BACKGROUND: The Workplace Affective Commitment Multidimensional Questionnaire (W ACMQ) measures a... more BACKGROUND: The Workplace Affective Commitment Multidimensional Questionnaire (W ACMQ) measures affective commitment towards eight work-related targets. While this questionnaire was developed in the business sector, we believe that the multi-target conceptualization of affective commitment has applicability to complex health care contexts where providers of care, in the production and delivery of care, likely develop commitment toward a multiplicity of targets. Affective commitment is a strong predictor of extra-role workplace behavior; indispensable behaviors which enable health systems to function. OBJECTIVE: The aim of this psychometric exercise is to content validate the WACMQ questions for use in health care. METHODS: Two focus groups were conducted, consisting of nurses working in acute care and emergency hospitals in Ontario. Linguistic validation and cognitive debriefing were used. RESULTS: A total of 14 modifications to the wording of items on the original WACMQ questionnai...

Academy of Management Proceedings, 2016

Work motivation has been associated with work productivity. In health care, low motivation levels... more Work motivation has been associated with work productivity. In health care, low motivation levels are associated with low productivity and linked to poor performance, decreased patient safety, and overall poor quality care. Hence the importance, ascribed in the literature, to clearly identifying the relationships between and among factors associated with work motivation, including work attitudes, and behaviours linked to work performance such as extra-role behaviours. Despite their importance to performance in health care, these relationships are understudied and poorly understood. The purpose of this study is to better understand work attitudes and their relationships to one another and to extra-role behaviours amongst nurses working in hospitals, the community, and long-term care settings in Ontario. This study comprises two stages: first, a scoping review focused on identifying individual-, unit-level, and organization-level characteristics that influence work motivation in health service organizations. The findings from the scoping review, augmented by a more in-depth review of the literature, aided in the development of a conceptual framework that guided the second stage of the study, to examine relationships amongst a specific set of nurses' work attitudes-including perceptions of organizational justice, perceived organizational support, and affective commitment-and extraiii role behaviours-specifically, organizational citizenship behaviours-in Ontario health care settings. In the second stage of the study, a survey was developed and administered to frontline nurses actively working in hospitals, the community, and long-term care settings in Ontario. Relationships amongst the constructs of interest were examined using structural equation modeling and path analysis. Examining the relationships of these concepts in a single model is novel, and offers insights regarding their complexity. The analyses further suggest that prior studies may be under-nuanced, and approaches to conceptualizing the concepts of perceived organizational justice and affective commitment in particular may have led to erroneous conclusions regarding their associations with perceived organizational support and organizational citizenship behaviours. This study further addresses four significant gaps previously identified in the work motivation and work behaviour literature: (1) how affective commitment relates to behavioural efforts, specifically organizational citizenship behaviours; (2) utilization of reliable and validated instruments to study work motivation; (3) use of a sufficiently large sample to have empirical support for generalizability; and (4) examination of these phenomena, among nurses, across diverse health care settings.

Journal of Healthcare Leadership, 2019

The term "physician engagement" is used quite frequently, yet it remains poorly defined and measu... more The term "physician engagement" is used quite frequently, yet it remains poorly defined and measured. The aim of this study is to clarify the term "physician engagement." This study used an eight step-method for conducting concept analyses created by Walker and Avant. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on February 14, 2019. No limitations were put on the searches with regard to year or language. Results identify that the term "physician engagement" is regular participation of physicians in (1) deciding how their work is done, (2) making suggestions for improvement, (3) goal setting, (4) planning, and (5) monitoring of their performance in activities targeted at the micro (patient), meso (organization), and/or macro (health system) levels. The antecedents of "physician engagement" include accountability, communication, incentives, interpersonal relations, and opportunity. The results include improved outcomes such as data quality, efficiency, innovation, job satisfaction, patient satisfaction, and performance. Defining physician engagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.

Journal of Clinical Nursing, 2018

What does this paper contribute to the wider global clinical community?  Insight into the relati... more What does this paper contribute to the wider global clinical community?  Insight into the relational complexity between work environment, attitudes and behaviours which impact clinical practice  Results identify areas leadership might leverage to meet organizational and clinical practice goals such as quality of care, patient safety, and patient outcomes  The importance of interpersonal justice to clinical staff

Journal of Vocational Behavior, 2018

Although it has long been recognized that employees' workplace affective commitment can be direct... more Although it has long been recognized that employees' workplace affective commitment can be directed at a variety of foci, theory and research on this multifocal perspective remain underdeveloped, possibly due to the lack of a short, yet comprehensive measure. The purpose of the present study was to assess the psychometric properties of a newly developed short (24-item) version of the Workplace Affective Commitment Multidimensional Questionnaire (WACMQ-S), covering affective commitment directed at the organization, supervisor, coworkers, customers, tasks, profession, work, and career. Using two independent samples of English-(N = 676, including 648 females) and French-(N = 733, including 593 females) speaking healthcare professionals and the newly developed bifactor-ESEM framework, the present study supported the factor validity, composite reliability, test-retest reliability, linguistic invariance, and criterion-related validity (in relation to turnover intentions, in-role performance, and organizational citizenship behaviors) of the WACMQ-S ratings. The results also demonstrated the superiority of a bifactor-ESEM representation of WACMQ-S ratings, confirming the importance of taking into account employees' global levels of commitment to their work life. Finally, the results also proved to be fully generalizable to subsamples of hospital and community healthcare professionals, as well as of nurses and beneficiary attendants.

BMJ open, Jan 5, 2018

Literature on healthcare reforms highlights the importance of physician engagement, suggesting th... more Literature on healthcare reforms highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. As a result, many hospitals have adopted physician engagement as a top strategic priority, but little is known about the actual evidence, making it difficult for hospital leadership to identify relationships between true physician 'work engagement' and work outcomes. The aim of this scoping review is to identify factors associated with, and tools used to measure, physician engagement. This scoping review will be conducted as per Arksey and O'Malley (2005). The electronic databases that will be searched from inception onwards include MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Grey literature will be searched via websites of relevant agencies such as Agency for Healthcare Research and Quality. Conferences and a...

Human resources for health, Jan 22, 2018

Our overarching study objective is to further our understanding of the work psychology of Health ... more Our overarching study objective is to further our understanding of the work psychology of Health Support Workers (HSWs) in long-term care and home and community care settings in Ontario, Canada. Specifically, we seek novel insights about the relationships among aspects of these workers' work environments, their work attitudes, and work outcomes in the interests of informing the development of human resource programs to enhance elder care. We conducted a path analysis of data collected via a survey administered to a convenience sample of Ontario HSWs engaged in the delivery of elder care over July-August 2015. HSWs' work outcomes, including intent to stay, organizational citizenship behaviors, and performance, are directly and significantly related to their work attitudes, including job satisfaction, work engagement, and affective organizational commitment. These in turn are related to how HSWs perceive their work environments including their quality of work life (QWL), their...

Journal of applied gerontology : the official journal of the Southern Gerontological Society, 2017

Health Support Workers (HSWs) provide up to 80% of care to residents and clients in the long-term... more Health Support Workers (HSWs) provide up to 80% of care to residents and clients in the long-term care (LTC) and home and community care (HCC) sectors but have received little research attention compared with the regulated professions. The authors explore similarities and differences in the work psychology of HSWs employed in LTC and HCC settings. Data were collected via survey from 276 LTC and 184 HCC HSWs. Descriptive statistics and path analyses were conducted. HSWs in LTC and HCC settings have significant, positive associations between organizational citizenship behaviors directed toward the organization (OCB-Os) and psychological empowerment, as well as intention to stay (ITS) and job satisfaction. For LTC sector HSWs, there are significant relationships between OCB-Os and quality of work life (QWL), ITS and work engagement, and individual performance and both job satisfaction and QWL. For the HCC sector, OCB-Os and ITS are significantly and directly related to organizational c...

Health Care Management Review, 2017

International Journal of Evidence-Based Healthcare, 2016

The aim of this scoping literature review was to examine and summarize the factors, context, and ... more The aim of this scoping literature review was to examine and summarize the factors, context, and processes that influence work motivation of health care workers. Methods: A scoping literature review was done to answer the question: What is known from the existing empirical literature about factors, context, and processes that influence work motivation of health care workers? This scoping review used the Arksey and O'Malley framework to describe and summarize findings. Inclusion and exclusion criteria were developed to screen studies. Relevant studies published between January 2005 and May 2016 were identified using five electronic databases. Study abstracts were screened for eligibility by two reviewers. Following this screening process, full-text articles were reviewed to determine the eligibility of the studies. Eligible studies were then evaluated by coding findings with descriptive labels to distinguish elements that appeared pertinent to this review. Coding was used to form groups, and these groups led to the development of themes. Results: Twenty-five studies met the eligibility criteria for this literature review. The themes identified were work performance, organizational justice, pay, status, personal characteristics, work relationships (including bullying), autonomy, organizational identification, training, and meaningfulness of work. Conclusion: Most of the research involved the use of surveys. There is a need for more qualitative research and for the use of case studies to examine work motivation in health care organizations. All of the studies were crosssectional. Longitudinal research would provide insight into how work motivation changes, and how it can be influenced and shaped. Several implications for practice were identified. There is a need to ensure that health care workers have access to training opportunities, and that autonomy is optimized. To improve work motivation, there is a need to address bullying and hostile behaviours in the workplace. Addressing the factors that influence work motivation in health care settings has the potential to influence the care that patients receive.

International Journal of Evidence-Based Healthcare, 2015

The aims of this scoping literature review are to examine and summarize the organizational-level ... more The aims of this scoping literature review are to examine and summarize the organizational-level factors, context, and processes that influence the use of evidence-based practice in healthcare organizations. Methods: A scoping literature review was done to answer the question: What is known from the existing empirical literature about factors, context, and processes that influence the uptake, implementation, and sustainability of evidence-based practice in healthcare organizations? This review used the Arksey and O'Malley framework to describe findings and to identify gaps in the existing research literature. Inclusion and exclusion criteria were developed to screen studies. Relevant studies published between January 1991 and March 2014 were identified using four electronic databases. Study abstracts were screened for eligibility by two reviewers. Following this screening process, full-text articles were reviewed to determine the eligibility of the studies by the primary author. Eligible studies were then analyzed by coding findings with descriptive labels to distinguish elements that appeared relevant to this literature review. Coding was used to form categories, and these categories led to the development of themes. Results: Thirty studies met the eligibility criteria for this literature review. The themes identified were: the process organizations use to select evidence-based practices for adoption, use of a needs assessment, linkage to the organization's strategic direction, organizational culture, the organization's internal social networks, resources (including education and training, presence of information technology, financial resources, resources for patient care, and staff qualifications), leadership, the presence of champions, standardization of processes, role clarity of staff, and the presence of social capital. Conclusion: Several gaps were identified by this review. There is a lack of research on how evidence-based practices may be sustained by organizations. Most of the research done to date has been cross-sectional. Longitudinal research would give insight into the relationship between organizational characteristics and the uptake, implementation, and sustainability of evidence-based practice. In addition, although it is clear that financial resources are required to implement evidence-based practice, existing studies contain a lack of detail about the cost of adopting and using new practices. This scoping review contains a number of implications for healthcare administrators, managers, and providers to consider when adopting and implementing evidence-based practices in healthcare organizations.

Strategic HR Review, 2015

Purpose– The purpose of this paper is to describe the development of a coherent conceptual framew... more Purpose– The purpose of this paper is to describe the development of a coherent conceptual framework that could guide research that enhances our understanding of the factors that influence extra-role workplace behaviors and work performance in health care. In health-care settings, work performance is dependent upon worker’s extra-role behaviors.Design/methodology/approach– The authors draw upon theory and current research in the field of organizational behavior and work motivation to explain the relationships between extra-role behaviors (ERBs), commitment, perceived organizational support (POS) and justice. These behaviors are related to a number of factors, including one’s affective commitment, POS and organizational justice. The influence of most of these concepts on work outcomes has been established in disparate studies, but their precedence in terms of influencing extra-role behaviors is not well understood.Findings– An augmented framework is produced, incorporating concepts o...

Journal of Nursing Management, 2015

This paper describes the development of a coherent framework that develops nursing knowledge and ... more This paper describes the development of a coherent framework that develops nursing knowledge and guides research in workplace behaviours, work performance, and the factors that influence behaviours and performance. Work performance is dependent upon behaviours that are related to one&amp;amp;amp;amp;amp;#39;s commitment towards their workplace and leadership interactions. The influence of these concepts on work outcomes has been established in disparate studies, but their precedence in terms of influencing workers&amp;amp;amp;amp;amp;#39; behaviours, is not well understood. A scientific realism approach is applied, where theory and current research in the field of organisational behaviour and work motivation are drawn upon to identify validated constructs and explain their relationships. An augmented framework is produced, incorporating concepts of relevance to work motivation and work attitudes. Propositions, predicated on research evidence, are offered. Conclusions A novel comprehensive framework is developed, extending the range of behaviours important to workers and the organisation. Focusing on targets for which nurses are affectively committed can prove useful to managers. The developed framework can be informative to managers by increasing awareness of the relationships between concepts, such that they are mindful of these constructs while interacting with staff.

Prehospital Emergency Care, 2007

ABSTRACTS FOR THE 2007 NAEMSP SCIENTIFIC ASSEMBLYS FOR THE 2007 NAEMSP SCIENTIFIC ASSEMBLY 1. THE... more ABSTRACTS FOR THE 2007 NAEMSP SCIENTIFIC ASSEMBLYS FOR THE 2007 NAEMSP SCIENTIFIC ASSEMBLY 1. THE TORONTO PREHOSPITAL HYPERTONIC RESUSCITATION HEAD INJURY AND MULTI-ORGAN DYSFUNCTION TRIAL (TOPHR HIT) Laurie J. Morrison, MSc, Sandro Rizoli, Brian Schwartz, Shawn Rhind, Sandra Black, Donald T. Stuss, Andrew Baker, Merita Simitciu, Tyrone Perreira, Russell D. MacDonald, Jennifer Shield, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada Goal: To evaluate the feasibility of a prehospital randomized controlled trial (RCT) comparing 250 mL of hypertonic saline and dextran (HSD) to normal saline (NS) for head-injured adult trauma patients GCS < 9. Specific objectives were to evaluate the protocol-related logistical issues; randomization, HSD safety, followup rates, and to define the best primary outcome. Methods: Double-blind randomized trial with paramedic administration of a 250-mL solution within 4 hours of the incident. The primary outcome was survival to 30 days; secondary outcomes were Disability Rating Scale (DRS) and Glasgow Outcome Score Extended (GOSE) at 4 months. The study was conducted with waiver of consent for the primary outcome. Patients consented for telephone follow-up of neurofunctional outcomes. Results: Of 132 eligible patients, 113 were randomized. Nineteen eligible patients were missed: lack of time (9 [22%]); paramedic discretion (3 [7%]); forgot (6 [15%]); refused (1 [2%]). Randomization compliance was 96% (109/113). Four randomized cases met exclusion criteria: one penetrating trauma, cardiac arrests, and one fall from standing. Three randomized patients were excluded from the final analysis; two patients received <50 mL of study solution because of an interstitial intravenous line and one lost randomization identification. Fifty patients (47%) were randomized to HSD and 56 (53%) to NS. Mean ISS was 32.7 for HSD and 32.6 for NS. Initial head scans scored ≥3 by Marshall Classification for 12 HSD and 11 NS patients. Zero adverse events occurred, and follow-up for the primary outcome was 100%. Alive at 30 days for HSD PREHOSPITAL EMERGENCY CARE 2007;11:94–136 doi: 10.1080/10903120601026365 and NS was 70% (35/50) and 75% (42/56) and at discharge was 34/50 (68%) and 41/56 (73%), respectively. Only 49.3% (37/77) of surviving patients consented to follow up at 4 months and 89% (33/37) completed the assessment; DRS (median, interquartile range) for HSD; 3 (0,6) and NS 0 (0,6); GOSE > 4 for HSD 12/12 (100%) and NS 15/21 (72%). Conclusions: It is feasible to conduct a prehospital RCT with HSD for treatment of blunt trauma patients with head injuries. Acquiring consent for neurofunctional outcomes in this cohort is problematic and threatens the feasibility of definitive trials using these potentially meaningful endpoints. 2. PAMPPER: A NOVEL PEDIATRIC PAIN MANAGEMENT EDUCATIONAL PROGRAM FOR EMS PROVIDERS Halim Hennes, Deborah Simpson, Ronald Pirrallo, Judith Rehm, Kenneth Sternig, Del Szewczuga, Michael K. Kim, Medical College of Wisconsin, Wauwatosa, Wisconsin Purpose: Evaluate the effect of PAMPPER (Pain Assessment & Management for Prehospital Pediatric EmeRgencies), a two-part educational intervention on EMS providers’ knowledge of pediatric pain management and determine its impact on prehospital pain management of children with extremity fracture or burn. Hypothesis: The intervention will improve EMS providers’ knowledge of pediatric pain management and increase the proportion of eligible children receiving prehospital analgesia. Methods: The setting was an urban EMS system with 234 paramedics serving a population of 1 million. Part one consisted of a 1-hour online PowerPoint presentation with accompanying audio narration on pediatric pain physiology, assessment, and management. Part two, presented 9 months after part one, involved 1-hour small group facilitator led discussion centered around six short video triggers scripted to portray real-life prehospital pain assessment and management scenarios. EMS providers completed a 26-item validated multiple-choice test before (pre) and after (post) participating in each part. Prehospital patient care records of children aged 5–17 years transported during the study period with extremity injury or burn were reviewed and data on demographics and