Leadership

Building a Practice that People Want to be Part Of

As those of you who have followed my posts on this blog know, I’ve been spending a lot of time mulling over issues related to hospitalist job satisfaction and career sustainability. I’ve written about concrete things like re-thinking hospitalist work schedules and minimizing low-value interruptions, as well as more abstract concepts like assessing your group’s “gross happiness index.” My fascination with these issues and my concern about their potential impact on the specialty of hospital medicine eventually led John and me, as course directors, to the theme of this year’s practice management pre-course at HM17 – Practice Management Success Strategies: Building a Practice That People Want to Be Part Of. Perhaps, like me, you are interested in digging deeper into matters of career satisfaction and sustainability. Or perhaps you are simply focused on the more mundane struggle just to recruit and retain enough qualified providers for your group. In either…

Does Your Onboarding Process Really Get Folks On Board?

Not long ago, I had a conversation with a good friend who is the hospitalist medical director for a five-hospital health system in the northeast. We were commiserating about how hard it is to recruit new hospitalists to rural and small-town settings and the high risk of rapid turnover despite all the energy invested in recruiting and onboarding them. As we discussed how new hospitalists are oriented into his organization, I learned that like most hospitalist groups, my friend’s group focuses onboarding efforts on making sure that new providers know how to find their way around the hospital and use the EHR, complete required training modules, are credentialed with payors, and are aware of applicable policies and procedures. They also see this time as a probationary period to ensure the new group member has adequate clinical skills and behavioral competencies. This conversation got me thinking about the crucial relationship between…

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…

Equal Time for Hospital Execs

Last month, I wrote a letter to hospital executives, urging them to deliberately invest their own personal time and effort in fostering hospitalist wellbeing. I suggested several actions that leaders can take to enhance hospitalist job satisfaction and reduce the risk of burnout and turnover. Following publication of that post, I heard from several hospital executives and was pleasantly surprised that they all responded positively to my message. Several execs told me that they gained valuable new insights about their hospitalists’ challenges and needs or that they planned to take action on one or more of my suggestions that had never occurred to them before.  Especially useful to them was the idea of a hospitalist “hierarchy of needs,” in which basics such as well-designed work (including adequate staffing), belonging, and esteem must be addressed before expecting hospitalists to undertake “self-actualizing” work, such as engagement in organizational performance improvement initiatives. Their…

Count Me – and My Intuition – In

In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation? Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have an 8.0-gram hemoglobin drop from her baseline. Further questioning by the night admitting MD revealed that the patient had been having melena for several days. GI was consulted, but the lab was considered to be spurious. A stat repeat CBC and type and crossmatch was ordered. The EMR system was down, though this was not apparent at first. Because of this, it was not immediately evident that the lab could not see the order entered into the EMR system.…
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