Clinical question: What are the common administrative harms hospitalists experience?
Background: Administrative harm (AH) is a longstanding problem in health care and defined as adverse consequences of administrative decisions that directly influence patient care and outcomes, professional practice, and organizational efficiencies regardless of employment setting. These influences can result in downstream injuries that affect the culture and integrity of healthcare organizations and the broader healthcare system.
Study design: This was a qualitative study using a mixed-methods approach with a 12-question survey and semi-structured virtual focus groups
Setting: Two hospitalist communities—members of the HOMERuN research network and the Society of Hospital Medicine Academic Leaders Special Interest Group
Synopsis: This study included 41 individuals who participated in focus groups, of whom 32 (78%) responded to the brief survey. The majority (91%) of the respondents were physicians and 44% of the participants had leadership roles. The average number of years in practice was 14. After surveys and focus groups, three key themes emerged.
Theme 1: AH Is pervasive and comes from all levels of leadership with a wide-reaching impact. As one can imagine there are multiple people involved in the AH. Interestingly, only 6% of participants were familiar with this term. There was also a perception that AH contributed negatively to patients, workforce, and organizations. These included logistical issues with daily tasks, hospital initiatives like early discharge, and national initiatives including policy decisions.
Theme 2: Organizations lack mechanisms for identification, measurement, and feedback related to AH. There is a power dynamic associated with AHs and only 38% of the participants felt empowered to speak up and raise concerns. Unlike common efficiency metrics, AHs tend not to have dashboards and scorecards to show their effect and hold the decision makers accountable.
Theme 3: Organizational pressures drive AH. Organizational leaders often push for actions regardless of whether they result in the desired outcome. These decisions are sometimes made in silos where the decision maker is removed from the frontline workforce.
Bottom line: AHs were found to be pervasive, have a wide-reaching impact, and were challenging to identify and measure.
Citation: Burden M, Astik G, et al. Identifying and measuring administrative harms experienced by hospitalists and administrative leaders. JAMA Intern Med. 2024;184(9):1014-23.
Dr. Verplanke
Dr. Verplanke is the section chief of hospital medicine at NYU Langone Health and a clinical assistant professor in the department of medicine at NYU Grossman School of Medicine, both in New York.