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• Filed under: President’s Column, Columns, Trends

• Keywords: leadership, quality, decision-making

Face the Future

From: The Hospitalist, February 2007

by Mary Jo Gorman, MD, MBA

We need not be afraid of the future, for the future will be in our own hands.
—Thomas E. Dewey

Your SHM board recently spent some time on the most comprehensive strategic planning that we have undertaken. Our last strategic planning meeting was almost three years ago. It is reassuring to review those minutes and see that we have accomplished a number of things that we set out to do. We have:

• Enhanced our chapters by making more resources and staff assistance available to them;
• Expanded our leadership training offerings;
• Established relationships with other organizations, such as the American Hospital Association, the Joint Commission on Accreditation of Healthcare Organizations, the Society of Critical Care Medicine, and many others; and
• Explored a credential for the hospitalist that distinguishes our work from other practitioners.

Planning to Plan

In these exciting times, however, we decided it was important to stop and take stock to either confirm that we are on the right track or adjust our direction. To prepare for the meeting, we hired an outside facilitator. We invited all board members and our staff from Philadelphia. Our staff has grown from several people to more than 20. They are a diverse group with a tremendous amount of talent. Their perspective and input remain crucial to our success.

We included some of our key committee chairs as well. These individuals have regular contact with other agencies, our members, and their employees. We surveyed our membership and hospitalist leaders to determine their perspective on the dilemmas that they face. We interviewed 13 “futurists” to obtain their opinions about key trends that will affect hospitalists, including:

• The current environment for hospitalists;
• The implications of future trends in patient populations;
• The regulatory and political environment;
• The competitive forces; and
• Advancements in science, technology, and pharmaceuticals.

Bang for the Buck

The SHM board, when surveyed, expressed a strong interest in better understanding SHM’s customer groups, what they value, and what we can offer to them. We conduct many activities and support many projects through our staff, our volunteer leadership, and our members. We need to know if we are spending our resources in a way that optimizes our impact on our members and our field. Each participant spent two to three hours reviewing materials in preparation for the meeting.

When we gathered for two days, our facilitator worked us hard. We began by reviewing what we are doing and checking that against the needs and directions identified by our members and others. We then attempted to prioritize new initiatives so that we could focus on “bang for the buck.”

As we continued the process of refining our findings and designing our action plans, a few things become apparent. Among them:

• There is and will continue to be a shortage of qualified hospitalists;
• The demands of an aging population, in conjunction with the expectations of healthcare givers, will be a source of pressure;
• It will take more time to deliver care to our incoming group of patients than it did for their grandparents;
• The technology and options that are available continue to expand, as does the need to stay abreast of ongoing changes; and
• There will be more medical information to absorb and more to communicate and organize.

As this pressure increases, the facilities’ search for solutions to the impact on cost will increase. In addition, the transparency of hospital results, as well as pay for performance, will drive a desire to improve quality results. The process improvement changes that will be needed cannot be accomplished without a committed medical staff. Hospitalists are uniquely positioned to take on this role. Thus, the demands on hospitalists for participation and leadership will increase.

Labor Shortage a Key Issue

It appears from our membership survey that the labor shortage is a key worry. Because we have no control over demand and we expect demand to increase, we will need to be creative about impacting supply. SHM may be able to address this issue. One approach is to increase supply in the following ways:

1. Design programs that attract individuals who want to be hospitalists into the primary residencies for hospitalists: internal medicine, pediatrics, and family medicine.

An example:

• Influencing training programs and educators to develop positive experiences for residents.

2. Create a model that includes nursing and physician assistants, as well as others, who can extend physicians’ capabilities

Another approach is to improve retention, a goal that might be accomplished by:

• Educating hospitals on their roles in creating a good working environment with excellent support systems for their hospitalists;
• Training group leaders to manage their programs for success;
• Creating alternative delivery models that enhance the physician lifestyle and practice experience; and
• Training individuals to matching their career goals with the right program.

Leadership Gap

Our members and their leaders seem to feel adequately prepared for clinical decision-making to deliver high quality care, but they see a gap when it comes to how they are equipped to provide leadership in a number of areas. These areas include transitions and coordination of care, resource utilization, and collaboration with multidisciplinary teams. SHM can respond to this need with training and mentoring. Perhaps we can also influence training programs and their curriculum.

Caring for the Uninsured

As many of you experience, hospitalists are increasingly called on to provide care for those without funds. When caring for the uninsured, physicians experience special challenges that create job dissatisfaction and affect the sustainability of the practice. In many cases, hospitals are willing to pay for this care because they are required by government regulation to provide it. As they see their profit margins erode, however, they are reluctant to compensate this work. It is important for SHM to be positioned to participate in these discussions as the payment and care of the uninsured gets increasing attention. Our public policy committee will continue to try to identify our best opportunities to impact this issue. How their mission will change is unclear, but this issue continues to be identified by our members as an important one.

This article only touches briefly on the many topics that SHM continues to explore as we try to see the future and take it into our hands. TH

Dr. Gorman is the president of SHM.