What Leaders Do
The ideal hospitalist practice leader’s job description will vary from place to place. It includes many things in addition to ensuring the schedule gets created. There are a handful of things that should probably be on every leader’s list. For my money, this leader should:
- Understand where the money comes from, where it goes, and what portion comes from professional fee collections vs. other sources. Also, to ensure all members of the group are updated on financial parameters regularly;
- Put in place mechanisms to ensure the hospitalists provide high-quality care to patients;
- Facilitate communication among hospitalists, hospital personnel, and medical staff to foster effective working relationships and facilitate problem-solving and conflict resolution;
- Proactively identify opportunities for the practice to enhance the service it provides to its constituents and the organization in general, and negotiating a reasonable balance between such opportunities and the practice’s resources and clinical expertise;
- Serve as a point of contact for referring primary care physicians;
- Representing the group when working and negotiating with the hospital administration; and
- Take an active role in recruitment while addressing behavior and performance issues within the practice.
Whether the leader handles these issues alone, delegates responsibility but still provides oversight, or forms a committee with other hospitalists, will vary from place to place. In every case, though, the leader should make sure these things are happening effectively.
Our field is young, and I think tends to attract people who want to avoid managing a complex practice. Perhaps it is no surprise some leaders may not be handling their job optimally. Fortunately, help is available.
Any group leader who wants to function more effectively can do several things. First, start talking to other practice leaders in your hospital. You could ask the lead doctor in another group what he/she regards as the most important components of their leadership role, and strategies that person used to become an effective leader.
Additionally, SHM has a highly regarded Leadership Academy designed to provide group leaders with the skills and resources required to successfully lead and manage a hospital medicine program now and in the future.
Each group leader should periodically step back from the day-to-day work to think about whether his/her time and energy is optimally allocated. Is the mix of clinical and administrative work reasonable? Does the leader devote time to activities (e.g., making the schedule) that could be handed off to others?
The standards used to differentiate between an effective and ineffective leader are hard to pin down and will vary a lot depending on the characteristics of a practice. Still, a comprehensive understanding of the practice’s budget and financial performance should probably be on everyone’s list. I hope the next SHM survey in late 2009 shows a lot more group leaders know things like their group’s annual expenses and revenues. We’ll see. TH
Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He is also part of the faculty for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. This column represents his views and is not intended to reflect an official position of SHM.