5) Make “hospitalist” a specialty. Dr. Ford would like to see “hospitalist” recognized as a medical sub-specialty in 2008. As specialists, hospitalists would have specific training requirements and other benefits, he says.
“Right now, we’re a big black box,” Dr. Ford says. “There are no clearly defined guidelines for what we can and can’t do.”
A formal credential for hospitalists is closer to reality. The American Board of Internal Medicine (ABIM) has officially approved the creation of a Focused Recognition for Hospital Medicine through its Maintenance of Certification (MOC) system. The ABIM’s formal proposal to the American Board of Medical Specialties (ABMS) is expected to be approved by September 2008. SHM began pursuing certification three years ago and intends to reach out to the pediatric and family medicine boards so certification can be available to all hospitalists.
The move would help make “hospitalist” a more recognizable term in the medical community and in the public arena, says Dr. Ford. “We’re not just your stereotypical general practice doctor. I think we’re more than that. I’d like to promote more of a global perspective of what hospitals are: We make the best use of resources as well as provide the most up-to-date care.”
6) Break down silos and collaborate more. “Medicine in general really is traditionally a siloed field, and at our institution there has been a lot of effort to break down those silos and work collaboratively,” Dr. Howell says.
In 1999 and 2000, the Johns Hopkins Bayview Medical Center, where Dr. Howell works, addressed a major patient throughput issue by bringing together two large groups for negotiation: the emergency department (ED) and the department of medicine. Together they reduced ED waiting time by 90 minutes, Dr. Howell says. The collaborative process received national recognition and resulted in joint publications. They did it again seven years later, this time bringing five large groups to the negotiating table and reducing the wait time even more.
“Each of those groups had to give up something,” such as control over the process, and they had to agree to greater transparency, Dr. Howell concedes. “But in return, they got a lot more.”
Bayview used collaboration again to tackle the issue of ambulance diversion, known as Red Alert, to dramatic effect. In fiscal year 2006, the campus had 2,025 Red Alert hours. The following year, it was 503. Fiscal year 2008 had, as of October, zero Red Alert hours.
“For years, we had been trying to solve the problems individually,” Dr. Howell says. “Imagine if everybody were approaching problems from the teamwork perspective right away. This is a cultural shift that’s going to have to change, and I think it’s going to take a long time. But for hospitalist medicine, these things are already happening.”
7) Improve staffing and retention rates. It almost doesn’t matter how sophisticated hospital culture is overall if the institution still battles one crucial weakness: burnout.
“There is a true burnout factor to hospitalists,” Dr. Amin says. “A lot of institutions are challenged with having the appropriate staffing of hospitalists. Part of that boils down to economics.”
Dr. Amin understands that bumping up staffing is tough to promote when the additions don’t correspond with increased revenue. An appropriate staffing model takes into account a number of variables, including patient load, vacation schedules, and non-clinical duties such as teaching, academics, research, administration, and quality-improvement efforts, he says.
Hiring hospitalists is not like hiring a new primary care doctor or another specialist who might attract new patients to the institution, he says. “A hospitalist program will have the same volume of patients that need to be covered regardless. If a hospitalist goes on vacation, one can’t close the hospital.”