We are in the financial crosshairs, as well. Administrators want to see value—that is, money saved. But the fact that we see and manage patients does not generate savings per se because insurance companies do not allow reimbursement as such for our services. “Prove your value,” they say. “Show us the money.” That translates into driving down length of stay, cutting nursing expenses, and reducing pharmacy costs though better quality control and more coordinated care.
But administrators also know that to accomplish these goals and bring other physicians on board, their best ally is the hospitalist.
Our patients demand more of us, too. In “Zen and the Art of Physician Autonomy Maintenance” in Annals of Internal Medicine in 2003, author Jim Reinertsen clearly stated the public’s perspective. “You claim that your profession is based on science … now show us that you can use all the science you know, for our benefit,” he writes. He asks us to “join together—as a profession—with our colleagues, in venues large and small to decide on and apply the best science.”
It is the least we can do as physicians. But in practice, working together to apply the best science is difficult.
All of which brings me to my final point: SHM’s commitment to our members. In October, SHM sponsored two summits, the first on healthcare quality, the second on leadership development. Two themes emerged. First, it takes an unwavering commitment to teamwork to accomplish anything of substance. Second, the educational needs of our workforce are tremendous. SHM’s focus on acquiring skills and applying knowledge are the society’s greatest accomplishment and greatest ongoing opportunity. To that end, we are working on four fronts.
First, we are developing alliances with other like-minded organizations such as the Case Management Association of America, the American Nursing Association, the American Hospital Association, and the Institute for Healthcare Improvement. Through these alliances we hope to foster the teams that will improve the monitoring of parameters of hospital care, and the care itself.
Second, we are committed to creating the tools to equip hospitalists to make the changes that will lead to improvements in the front lines of hospital medicine. We have taken several such steps. SHM has developed a discharge checklist for physicians to use before sending patients home or to other facilities. The checklist, somewhat like those used by pilots, ensures nothing is forgotten or overlooked upon discharge. We believe it will become an invaluable tool.
SHM has also added Resource Rooms to our Web site (www.hospitalmedicine.org). Here, our members can look up and download information on disease states like heart failure or venous thromboembolism.
Third, SHM is funding a group of quality-control mentors available to visit hospitals. These mentors will evaluate and advise on quality-control programs at SHM’s expense.
Finally, SHM wants to train its next generation of leaders. Quality control is a never-ending quest; it can always be better. That is what we at SHM strive for. That is what we owe our patients.
All these tools have one goal: Make quality easy. With so many other pressures of physicians and hospital staff, making it easy is also the key to making it work.
“Knowing is not enough,” Goethe said. “We must apply.” I say: “Willing is not enough. We must do.” TH
Dr. Holman is president of SHM.