Dr. Kisuule
We are living in disruptive times. We are amidst national and global conflict, we survived a pandemic that changed many aspects of our lives permanently, and many of our health systems are working through financial challenges with unprecedented operating and net losses. These disruptive forces require equal and opposite forces … remember high school physics and Newton’s third law? How do we reclaim this word “disruptive” as a force for good? According to the Oxford Dictionary, disruptive is, “causing radical change in an existing industry or market through being innovative.” Healthcare disruptors are hospitalists who are shifting the healthcare industry by making big changes that significantly define the way care is delivered. That means integrating new technologies, streamlining processes, and simply refusing to do things the way they’ve always been done!
Hospitalists are in the thick of things, shaking things up. SHM’s mission and vision call for us to be disruptive and advocate for change—inside and outside the hospital walls—and our members are actively helping us do both.
Vision: To be the professional home of hospitalists dedicated to exceptional and equitable care for acutely ill patients.
Mission: As the home for hospitalists, SHM activates and engages our community to:
- Advocate for our specialty, our members, and the diverse patients we serve
- Promote high-value care and optimal outcomes for acutely ill patients
- Meet the evolving educational needs of a dynamic specialty
- Cultivate an inclusive community for hospitalists and support career growth and well-being
- Advance the research and innovation of healthcare delivery, quality, safety, and experience across the care continuum
Here are some examples of how hospitalists are “disrupting” healthcare and making meaningful changes:
1. Hospitalists are developing new models of care. From unique partnerships with payors to “street medicine on the floors,” hospitalists at Boston Medical Center and Allegheny Health Network in Western Pennsylvania are developing innovative models for providing care to complex patients with extensive healthcare needs. They are creatively working to provide person-centered care to those patients who are more medically and socially complex than the average population.
2. Hospitalists are “shaking things up” in Washington, D.C., lifting our voices and advocating for our field and diverse constituents. For example, we can now provide comprehensive care to our patients suffering from addiction because of the hard work of members of our public policy committee. Are you worried about school safety? Well, Dr. Ilan Alhadeff, who received SHM’s Award of Excellence for Humanitarian Services in 2023, is honoring his daughter’s memory, advocating all the way to the White House for laws that can make our schools safer.
3. Hospitalists have made it their life’s work to address structural racism and eliminate unnecessary barriers to access to healthcare. A notable example is Dr. Lilia Cervantes, who is recognized for spearheading the change in the Medicaid payment rule so undocumented patients with kidney failure can access life-saving maintenance dialysis. Dr. Cervantes was the recipient of SHM’s Award of Excellence for Diversity, Equity, and Inclusion in 2021. She says, “I have learned that every problem can be an opportunity. The fight is not always won by the loudest voice. It is won by those who do not give up.” The Society of Hospital Medicine is working with industry partners to invest monetarily in a diverse and equitable culture through pipeline development through the Hospital Medicine Diversity, Equity, and Inclusion Scholarship Fund.
4. Hospitalists are at the forefront of leveraging technology, such as generative artificial intelligence (AI), to improve the provision of care. Generative AI is about two important simultaneous breakthroughs: a human-language interface and a reasoning engine beyond a database that recognizes complex patterns to produce accurate insights and predictions. If you love ChatGPT, you will love what hospitalists like Dr. Subha Airan-Javia are doing, working to build the technological infrastructure to facilitate interactions between hospital clinicians and their smart technology. Hospitalists were using telemedicine before COVID-19 made it mainstream, and hospitalists like Dr. Nilam Soni, are leading the way in point-of-care ultrasound training, equipping us to weave this technology into the fabric of our daily practice.
5. Hospitalists are leading the way in promoting humanism and “personomics” in medicine. Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.” Personomics, a term coined by Dr. Roy Zielgelstein at Johns Hopkins in Baltimore, is defined as the influence of the unique circumstances of the person—the “personome”—on disease susceptibility, how that disease will reveal itself phenotypically, and the way that the person with the disease will respond to treatment.1 We are practicing medicine in an era of precision medicine where biologic variability is being used to identify treatments that are uniquely tailored to the individual. However, individuals are not only distinguished by their biologic variability, but they also differ in terms of how disease affects their lives. People have different personalities, resilience, and resources that influence how they adapt to disease. Hospitalists like Dr. Janet Record, at Johns Hopkins, are re-writing the medical training curriculum at her institution so that there is an emphasis on teaching residents to know their patients as individuals. Other hospitalists like Dr. Kimberly Manning, at Emory in Atlanta, are using the power of storytelling and social media to explore the human side of medicine.
6. Hospitalists are “disruptive” leaders. Tom Ziglar, in his book, “10 Leadership Virtues for Disruptive Times,” writes, “Those who embrace change are the ones who will create the future, serve their people, and solve problems in the best ways.”2 Disruptive leaders are those who see the future, opportunities disguised as problems, the potential in every person, and are those with the ability to understand who we need to become to create the future we want.2 Disruptive leadership is a team sport that involves engaging all stakeholders and recognizing the power of diversity. Key virtues of disruptive leadership are: willingness to challenge the status quo; thinking outside the box; having a positive mindset; embracing failure; and thinking and dreaming big. Dr. Nasim Afsar, past SHM president, is an example of disruptive leadership. She is leading in new spaces, as Cerner’s (in Kansas City) first chief health officer, promoting “techquity” (using technology and data insights to deliver more equitable patient care).
7. Hospitalists are reaching beyond borders to ensure access to care and are spreading the ethos of hospital medicine. From Dr. Lisa Kaufmann, practicing in the Blue Ridge Mountains of North Carolina, to Dr. Khaalisha Ajala, traveling to Thailand to ensure access to care, hospitalists are practicing global health. Furthermore, hospitalists are also reaching across borders to share best practices for inpatient care with partners in countries such as Spain, Japan, Argentina, and Brazil. As we build bridges through global health and extend a hand to like-minded international colleagues, we expand our community and strengthen the big tent. These connections build our collective cultural intelligence, bridging different values, norms, and preferences, allowing us to focus on the commonality of our love for hospital medicine and turn our differences into complementary strengths.
On a more personal note, positive disruption has been a part of my life even before my time as a hospitalist. It has been 33 years since I arrived in the U.S., a long tortuous journey that got me from a small Eastern African country to a riveting meeting (Converge) with a few thousand of my favorite people. Along the way I have encountered remarkable disruptors who have helped me break down barriers, opened doors, and got me to today: my mother, the original disruptor, who believed, way before her time, that an African woman, a black woman, a woman, could be anything she dreamt of being, and raised me to dream big; incredible philanthropists who made scholarships available to a foreign student and made medical school feasible; and my peer and senior mentors as well as sponsors who, as disruptive leaders, saw my potential and believed in me even before I believed in myself. I channel this energy, and that of our collective community, when I consider what being a healthcare disruptor means in 2024.
I am so honored to serve you all, our discipline, and our society as president this year. I look forward to meeting many of you and brainstorming with you on how to push the boundaries in care delivery both within and beyond our borders. Disruptive times require disruptive forces. Hospitalists are shaking things up and expanding their scope of practice. Innovation in hospital medicine, and the expanded roles of hospitalists, are increasing value in healthcare and benefiting humans, especially the acutely ill, across the globe.
Are you a healthcare disruptor?
References
- Ziegelstein RC. Personomics. JAMA Intern Med. 2015;175(6):888-9.
- Ziglar, Tom. 10 Leadership Virtues For Disruptive Times. Nashville: Nelson Books; 2021.
Dr. Kisuule is director of the division of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore and president of SHM.