Areas in which the hospitalist program needs to play a stronger or increased role include quality improvement and patient safety, non-internal medicine services, clinical education, research, and leadership within the health system. There was no major variation among hospital administrator and chair of medicine responses. Program directors of three years or less identified quality improvement and standardizing care as areas that need more emphasis. Program directors of more than three years identified quality, research, and health system leadership as areas they’d like to gain a more significant role.
The most common impediment to the continuation and growth of hospitalist programs: attracting and retaining physicians, given the ratio of salary to workload, the level of burnout, and the lack of a defined career path. Attracting quality candidates with academic skills and/or the ability to lead and manage change was identified as a major impediment.
Challenges included:
- Cultural and political issues;
- Inadequate commitment or support for the program;
- Lack of understanding with regard to the role of the hospitalist and the true value of the program;
- Lack of organizational clarity of program goals, expectations, and measures of success; and
- Improvement of academic and scholarly aspects of the program.
Conclusions
The “Role of the Hospitalist 2006 Benchmarking Project Performance Scorecard.” reported on the need to proactively manage the program direction and growth by developing and expanding lines of business, which may include:
- Non-internal medicine services such as co-management models, pre-operative clinics, and anticoagulation clinics;
- Palliative care services;
- Quality and safety improvement efforts;
- Facilitation of admissions from the emergency department and transfers both within and outside the network; and
- Care of extended care facility patients.
Hospitalist program satisfaction in academic models may be enhanced by increasing the academic and research presence and by supporting the role of the hospitalist in quality improvement. In addition, the project identifies the need to effectively manage increasing demand for hospitalists for other service lines.
Articulating the hospitalist program’s value is the first step in obtaining the resources to proactively manage the program’s direction and growth. UHC recommends clearly defining the hospitalist program goals, expectations, and measures of success. This requires obtaining input and buy-in from all key stakeholders and developing measures for all key aspects of the program, including intangible contributions. Key stakeholders should meet regularly with hospitalists to discuss program accomplishments. Hospitalist program representatives should assume leadership roles within the hospital and medical staff. For example, hospitalists should become members of the medical staff executive committee and the hospital’s operational committee, interwoven into the fabric of the hospital. It is also important to identify and monitor measures to support program funding and support, as well as to create a business case for new program roles.
Enhancing hospitalist career development and advancement is central to the recruitment and retention of experienced hospitalists. Development of effective recruitment and retention strategies includes creating a hospitalist career path, offering protected time for non-direct patient care activities, implementing innovative strategies to manage night and weekend coverage, defining and monitoring workload indicators, building reward and recognition programs, and implementing incentive programs. Training and education curriculum should focus on the needs of hospitalists and should include modules in areas of program growth such as palliative care and surgical co-management. TH