But what if the hospital and the hospital medicine group engage in a true partnership—a proactive joint venture in which each fully appreciates the other’s value proposition? What if each seeks to deliver something greater than the mere sum of hospital resources and hospitalist resources? Suppose the hospital embraces the idea of helping build structure and processes to maximize the number of patients seen by a hospitalist. Suppose the hospital medicine program embraces this but also embraces the goal of high-quality care in all its dimensions. What results is true synergy, where both parties benefit tremendously and the real winner is the patient. This won’t happen just by tweaking to make improvements at the edges; only wholesale change will take patient care delivery to a new level.
This will require hospitalists to embrace new methods of patient care. When I speak of this concept to hospitalists, I ask them to imagine doubling the amount of patients they currently see. If your census is 15 patients a day, imagine seeing 30. Most hospitalists immediately push back and say it isn’t possible because they can’t envision a new way of patient care. But what if by engaging in this partnership, the hospital brought to bear all its potential resources to help you—maybe a scribe, or several midlevel providers? What if there were zero barriers to finding data? What if the pharmacist took such a reliable medication history that you could fully depend on it? How about before you see a patient, a history and physical was already done so all you had to do was review the findings?
Many of you are still skeptical. Some of you struggle just getting approval for a part-time administrative person. You can’t ever imagine the hospital providing additional resources. Trust me when I tell you times are changing. One of the chief concerns all hospital executives have is the imperative to change the hospital-physician relationship. Much has been written on this topic, and the prevailing wisdom among hospital leaders is that the old medical staff leadership concept is dead. New types of leadership are necessary if hospitals and physicians are to survive.1
Because I am a hospitalist and a hospital executive, I feel the hospital part is the easy one. As chief medical officer, my main goal is to improve the quality of care delivered. The chief constraint I encounter is the number of engaged physicians. Much of my day is spent working with physicians to engage them in a hospital-physician partnership. The No. 1 thing preventing engagement is clinical workload. From the hospital perspective, I know I need to mobilize hospital resources to help physicians and remove time as the constraint. But for me to take them away from seeing patients may also hurt the hospital.
Now don’t misunderstand me. I am not advocating an improvement in efficiency just for the sake of it or just to improve our recruiting problems. The vision must be the delivery of higher quality care.
Change is not over. SHM’s responsiveness to change will greatly enhance your ability to promote change from within your hospital. Physician leadership is essential.2 We have much more to accomplish, but SHM is well positioned to continue to help you and your patients. We will continue to be nimble. We will continue to respond to the many changes on the road ahead. Even the road we can’t quite see yet. TH
Dr. Cawley is president of SHM.
References
- Petasnick WD. Hospital-physician relationships: imperative for clinical enterprise collaboration. Front Health Serv Manage. 2007;24(1):1:3-10.
- Porter M, Teisberg EO. How physicians can change the future of healthcare. JAMA. 2007;297(10):1103-1111.