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Posted February 27, 2015

5 Essentials for a Successful Hospitalist Program

By Richard Rubin, MD, MBA, CPHQ

I have had the opportunity to be involved with hospitalists since the specialty began almost 2 decades ago. In my previous role, I managed a hospitalist service as a chief medical officer and as a practicing physician, I worked closely with hospitalists that cared for my patients. Now, as a Studer Group physician coach, I’m fortunate to work with hospitalists on improving communication and patient experience. These experiences have offered insight into some of the issues hospitalists and hospitalist programs can face, and have uncovered five essentials that can make a hospitalist program successful.

1) Recognition (mostly) and reward

We often say that the emergency department is the “front door” of the hospital in terms of patient experience. Continuing that metaphor, hospitalists are the lobby! Recognizing hospitalists for the vital role they play in caring for patients is a crucial step that is often missing. It is critically important and very difficult for hospitalists to assume the care of someone they have never met before, explain their role, and answer the question “Where is my regular doctor?” This is a critical competency for the hospitalist.

Also, because of their defined role of caring for inpatients, hospitalists are sometimes asked to assume care of patients not originally assigned to them. This often occurs because they are “on-site” and accessible. This is one of the reasons why specific recognition and thanking them, not only for their skill, but for the work that goes “above and beyond” is so meaningful.

Senior leader rounding is an important process that allows for communication and connection with Hospitalists. Not only can we ensure that they have the tools and processes to do their job well, but we can take the opportunity to recognize purpose and worthwhile work. A hand-written thank you from a senior leader goes a long way in sustaining loyalty and conveying appreciation.

2) Define scope and rules

It’s important to have a shared understanding between the Hospitalists, the medical staff and the hospital. Defining scope and expectations through clear guidelines will remove subjectivity and interpretation. In turn, hospitalists will have clarity of standard work and feel less resentment and pressure to complete the additional tasks.

A good rule of thumb is that any issue that raises a question or creates disagreement should be addressed and defined to avoid ambiguity on the next occurrence. Some examples include:

  • Define the age that differentiates a pediatric from an adult patient
  • Decide who admits subspecialty patients and who consults
  • Set and agree on times for standing meetings

3) Align the goals of the hospitalists and the ED

This step is critical for many reasons. The “first impression” of the hospital is a major influence on overall patient experience, and the admission process is a key component of the comfort and confidence of patients and families. We recommend the emergency department and Hospitalists develop joint standards and expectations of each other. These standards should be focused on safe, effective and efficient patient-centered care in a way that serves the needs of both departments. The transfer of care between the emergency department and Hospitalist is also critically important and should also be clearly addressed within the standards.

4) “Manage Up” the Hospitalists

Hospitalists are not new to medicine, however, patients may not know of the concept, and particularly the value that Hospitalists bring to the care of the patient and the family. We find that most office-based practices do not provide information on Hospitalists and their role, thus, it becomes critical early in the admission process that we share information regarding the Hospitalists. Information should reassure the patients and families regarding the Hospitalist’s role, “manage up” the advantages of Hospitalists and clarify questions. We can proactively anticipate these questions and provide answers by using adjuncts like photo business cards/biocards (larger than normal to help with visual impairment), brochures, notepads on which to write questions for the doctor, and white boards/communication boards.

5) Provide training and development

Training and education on communication and patient experience is as important as mainstay clinical education in this era of increasing transparency regarding performance (HCAHPS). Best-in-breed hospitals and groups provide the education and training that physicians need to effectively care for patients while connecting and communicating with them. Additionally, we should identify future physician leaders and enroll them in leadership development so that they possess the necessary skill to lead and guide physicians and work collaboratively within the organization to achieve excellence.

While there are certainly more than the five essentials outlined above, we feel this is a strong and attainable starting place for developing a more successful hospitalist program. What would you add? I’d love to hear from you. Feel free to contact me at richard.rubin@studergroup.com

Additional Resources:

  • Studer Conferences offer a roadmap to achieve measurable results across the organization. Attendees can choose sessions based on their learning objectives, including evidence-based leadership, physician partnership, emergency department excellence and senior executive & board. Learn more at www.studergroup.com/conferences.
  • “Advance your Emergency Department: Leading in a New Era” offers high impact tactics to improve the ED experience and set the entire organization up for success. Read an overview and access chapter tools.

 

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