Engaging the Hospitalist

Do you have hospitalists in your organization? If so, stop for a moment and make a mental list of what’s going well and not so well in your hospitalist program—I’ll return to that in a moment. But first, I lead a session at the Press Ganey Regional Education Symposiums called “Engaging your Hospitalists.” In the sessions, we discuss concerns, best practices and initiatives that have been implemented at other organizations. I am finding that although much is going well, many organizations share some of the same problems and want to find ways to make things work better for hospitalists, employees and patients. Some of the concerns mentioned are hospitalist buy-in to patient satisfaction, communication with patients and staff, accountability to policies and procedures and the mission of the organization, varying skill levels and practice patterns, coordination of patient care, rounding, discharges and admits from the emergency department. Although it is important to understand common concerns of hospitals, we also need to think about what hospitalists need from their facilities.

In the Hospital Pulse Report 2009: Physician Perspectives on American Health Care, which is based on 2008 physician satisfaction survey information, Press Ganey found that the No. 1 priority of hospitalists is “timeliness of follow-through on written orders,” followed by the “overall degree to which this facility made caring for your patients easier.” That leads to the question of how to address those concerns.

For starters, we should ensure their orders are carried out in a timely manner and that processes are improved to make patient care easier. Look again at your list. I bet it is similar to your peers’. Providers want the same thing: a culture of service excellence where patient care is made easy through efficient and effective processes. The problem is that, in many organizations, nobody asks for any input from hospitalists on quality improvement and patient satisfaction initiatives. They think that planning and decision making is best left to leadership. After all, that saves time and gives leaders more control over initiatives, action steps and timelines, right? But as many of us know from working with hospital employees, the best decisions are those in which there is buy-in from staff members via their direct involvement in planning, design and implementation of process change and quality initiatives.

Unfortunately, we sometimes tend to overlook the top assets in our organizations—our people. Physicians, nurses and other clinical staff are the ones who have created the best practices that can be shared with the rest of the organization. Empowering them to plan and implement change is a critical step toward success.

Put simply, senior leaders and managers must reach out to their hospitalists. Show them the data and create a sense of urgency by making clear the benefits of improved results. For example, tell them that if nosocomial infections and falls are reduced and other quality indicators improve, length of stay will be reduced, hospital net revenue per discharge will rise and patient satisfaction with the hospital will improve. And tie improvement in those areas to compensation, further incentivizing physicians and other members of the clinical team to collaborate.

A lot of this work is communication. Ask for hospitalists’ input via e-mail and during meetings held at their convenience. Also, send data in advance for review; we sometimes forget physicians are scientists, and if they are busy, they need time to study the data.

Want another reason to involve your hospitalists in improvement? One hospital found that hospitalists were involved in 80% of the processes in the organization, so who better to work with to make those processes more efficient and effective?

Let’s go back to the Pulse Report for one final point: Hospitalists’ third-highest priority was   “Responsiveness of hospital administration to ideas and needs of the medical staff.” Hospitalists are a captive audience—if they are working, we can pretty much guarantee we can find them since they don’t have an office full of patients to go see. As your organization increases opportunities for hospitalists to help improve processes, quality and patient satisfaction, make sure you have a system in place to close the loop. Did the hospitalists’ input make it into the final proposal? If not, let them know why. If they contact a senior leader with a concern, take advantage of the fact that you can discuss the concern with them in person. Ask for their help in resolving the issue. If they are involved in the development of the solution, they will see the complexity involved in changing processes in hospitals and the variation seen when dealing with different people and patients. It will help them appreciate the challenges you face as a leader in the organization and improve their willingness to become your partner in improvement