Harnessing the Hospitalist Movement (Part 4 of 4): Scheduling and Leadership

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Wrapping up our weeklong look at various strategies healthcare organizations can use to effectively implement a hospitalist program, we move on to the third and fourth strategies discussed in Joe Cantlupe’s HealthLeaders Media article: scheduling and leadership.

One of the problems hospitals often face with their hospitalist programs is unit scheduling. Instead of having their duties focused on one floor in one unit, hospitalists will find themselves scurrying across several floors and several units. Not only is this unproductive, it’s a squandering of time and resources, Cantlupe points out.

St. Mary’s Health Center in St. Louis, Mo., confronted this problem by redesigning their program, Philip Vaidyan, M.D., FACP, director of hospital medicine in the department of internal medicine, said. St. Mary’s made it so one hospitalist would see 80 percent of their patients in the same unit.

He explained, “The idea is that the hospitalist can stay in that unit for an extended time to build a relationship with the nursing staff and multidisciplinary team members. The process has led to improved patient satisfaction.”

In its HCAHPS survey, patient satisfaction increased from 41 percent to 55 percent over two years. As Cantlupe notes, “Moving the hospitalists to be nearer the patients had a psychological advantage: Suddenly patients saw the hospitalists as physicians who were right there, caregivers who would be mindful of their needs.”

Using this method can also impact the patient volume an organization is able to handle, he added.

The fourth strategy goes hand-in-hand with the previous three. Cantlupe observes, “Hospitalists are becoming pivotal players in carrying out team-based care. They are involved in admissions and discharges of patients, especially when patients don’t have a primary-care physician. In some cases, hospitals are characterizing hospitalists as ‘captains’ of teams to coordinate care as they take leadership positions.”

In fact, hospital leaders are now giving hospitalists “a place at the table,” realizing that they play significant roles in care coordination, managing patient-safety data, and the ever-present core measures. St. David’s Round Rock Medical Center in Texas has found this to be an effective strategy.

“We’re having a permanent seat [on the medical executive committee], and it’s rotated after two years,” Louis J. Lux, M.D., chief of hospital medicine, explained. “We have become the universal admitters to hospitals, and we’re admitting patients and assigning them to other specialists. It’s important there is regular interface with other medical disciplines.”

The quality, pharmaceutical, and cancer committees also have hospitalists on hand. It’s a method of collaboration that many hospitals around the country have embraced, realizing just how much of the workload hospitalists take on, with many hospitalists being overtaxed, according to a 2013 Johns Hopkins University study.

Bringing them into team decision-making not only impacts the overall workflow of an organization, but it also helps healthcare leaders decide how to best delegate duties among its hospitalists.

“We determined that a team of unit-based physicians could improve not only patient flow but also patient and staff satisfaction, as well as physician efficiency,” Larry Spratling, M.D., chief medical officer at Banner Baywood Medical Center, in Mesa, Ariz., said. “With all the patients in one location, travel and communication delays were removed. That was what we wanted.”

What scheduling issues have you had with your hospitalists? Have you started to incorporate them more into executive decision-making? After reading these last few postings, what are some strategies you would offer to effectively harness the hospitalist movement?

-by Pete Fernbaugh

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