Improving Physician’s Practices

Hospitalists as Physician Leaders: The Facts

A 1999 survey (3) conducted by the National Association of Inpatient Physicians (NAIP, now SHM) documented the medical staff leadership roles of hospitalists. Of the survey respondents, 53% held responsibility for quality assurance and/or utilization review; 46% were responsible for practice guideline development; 23% had administrative responsibilities; and 22% were charged with information systems development.

There are several different types of hospitalist programs and, as shown by the examples below, each model offers opportunities for hospitalists to play a medical staff leadership role.

Academic Medical Centers

The hospitalists that practice at University of California at San Francisco Medical Center (UCSF) are making a significant impact on many critical hospital issues. Robert Wächter, MD, chief of the hospitalist program at UCSF and a former president of SI IM says, while it is still important to have other specialists serve on medical staff committees, UCSF hospitalists participate on all committees, chairing some of the crucial ones, such as patient safety. “The structure of the medical staff won’t change, but the doctors who participate will,” Wächter says. “They [hospitalists] will be more invested in the hospital, so the nature of the committee work will change. It will become more effective” (4). Selected QI projects led by UCSF hospitalists include:

• Medical Service Discharge Planning Improvement Project
• Collaborative Daily Bedside Rounds— a program to improve physician-nurse communication
• Protocol for Management of Alcohol Withdrawal
• Protocol for Prevention and Management of Delirium
• Medical Service Intern Signout— an educational program to enhance physician signout in the setting of new resident duty hours requirements
• Perioperative Performance Improvement Project— assessing the use of beta-blockers, glucose management surgical site infection and DVT prophylaxis
• DVT Treatment and DVT Prophylaxis Protocols
• JCAHO Core Measures in community acquired pneumonia and smoking cessation
• Post-Discharge Home Visits— a collaborative pharmacy-hospitalist project for patients at high risk for readmission

UCSF hospitalists are also leaders and key participants in many interdisciplinary medical center performance improvement committees including the Patient Safety Committee, Clinical Performance Improvement Committee, Physicians Advisory Group for Clinical Information Systems, Patient Satisfaction Committee, Pharmacy and Therapeutics Committee, and the Patient Flow Committee (4).

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Community Hospitals

At Mercy Medical Center in Springfield, MA, 10% of the hospitalist’s bonus is based on participation in “good citizenship” activities for the hospital. To earn his bonus, Winthrop Whitcomb, MD, director of the Mercy Inpatient Medical Service (MIMS), organizes the hospital’s CME accredited medical education series, which is offered to the entire medical staff. Every month, Whitcomb is responsible for developing learning objectives, identifying speakers, and coordinating the program logistics.

Other MIMS hospitalists have chosen the following good citizenship activities:

• Chairperson of the Medication Reconciliation Committee, a statewide initiative designed to assure medication information is consistently communicated across different care settings
• Leadership of a tribunal that evaluated a physician for ethical issues and made a decision whether or not medical staff privileges should be revoked
• Clinical expert and resource for the implementation of a new hospital information system

Medical Groups

Harvard Vanguard Medical Associates (HVMA) is a 550-physician group practice with 14 practice locations in the greater Boston area. Joseph L. Dorsey, MD, director of the medical group’s hospitalist program, described the following medical staff leadership roles that HVMA hospitalists execute at their six affiliated hospitals:

• Quality Improvement Committee
• Interdepartmental Committee, which reviews cases for possible reporting to state healthcare agencies
• Medical Executive Committee
• Clinical and Education Planning Task Force, which is preparing plans to move approximately 60 medical inpatients off the house staff covered service onto a Physician Assistant-supported alternative
• Advisory Committee to the Department of Medicine Chairperson, consisting of all sub-specialty Chiefs
• Credentialing Committee
• Clinical Teaching Initiative