What’s on your wish list for 2008? For many hospitalists, the list is full of cultural changes they’d like to see sweep through their institutions, prying loose old, entrenched habits and replacing them with new, efficient methods and practices. They’re changes that would improve patient safety and care and create better working conditions for physicians.
Those ideas don’t have to remain wishes. We’ve compiled a list of some of the top changes hospitalists say they’d like to see in the coming year, including ideas for how to implement them and some success stories to prove change is possible. Of course, it’s not easy.
“We had to work, and we had to work hard,” says Dr. William Ford, MD, director of the hospitalist program at Temple University in Philadelphia. It took major collaboration and a lot of face-to-face talks to create the cultural shifts he wanted to see at Temple, which partnered with Cogent Healthcare in 2006. But the work paid off, winning support for an observation unit from key stakeholders, such as residency program leaders and nurses.
Dr. Ford’s experience might inspire hospitalists who wish to improve the following critical facets of how hospital medicine is done:
1) Integrate hospitalists into policy-making bodies of institutions. Hospitalists work right in the thick of things, yet don’t often have a voice in their institution’s strategic planning, says Alpesh Amin, MD, MBA, FACP, professor and chief, general internal medicine, executive director and founder of the hospitalist program at the University of California, Irvine. Bringing hospitalists onto major committees would benefit everyone, he says.
Hospitalists have a vested interest in their institutions and a deep knowledge of it. They should be involved in operations, business development, and growth, Dr. Amin notes. That can mean growing the surgical business, increasing referrals, or meeting joint commission goals and requirements of the Accreditation Council for Graduate Medical Education (ACGME).
“Many of the bylaws of an institution have been created 10, 20 years ago, when there wasn’t such a thing as hospitalists,” so they don’t automatically get a seat at the table, Dr. Amin says.
But that should change, he argues, because today hospitalists affect every part of an institution. Hospitalists should sit on medical executive committees and contribute to discussions about bylaws, planning, business strategy, and more.
“The hospitalist is integral to helping a hospital improve operations and patient safety,” Dr. Amin says. “Having a permanent seat on the medical executive committee seems like a natural role for the hospitalist director to have.”
2) Reduce paperwork. Mark Thoelke, MD, clinical director of the hospitalist program and associate professor of medicine at Washington University School of Medicine in St. Louis, would love to put down his pen.
“I’ve been doing this job for 15 years now,” he says. “When I started, there was one piece of paper I’d fill out for admissions. [Now] we have to fill out 15 separate pieces of paper when we admit a patient to the hospital.”
Worthwhile and well-meaning patient process improvement groups tend to generate more paperwork for physicians, he points out.
“Nobody seems to want to complain about this because you’re going to be perceived as someone who’s against patient safety,” Dr. Thoelke says. “I feel very strongly about providing excellent patient care. But it makes it harder for me to take care of patients if I’m concerned about filling out multiple pieces of paper.”
To combat the paper flood, his institution has been using Lean Six Sigma, a business improvement strategy that addresses speed and quality. Admission forms are now in a single large packet available in one spot. Dr. Thoelke would like to see even more improvements.