“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”—Maya Angelou
When SHM surveyed its members last year about why they had attended the annual meeting, the single most common response was to “be part of the hospital medicine movement.”
In the first three of my presidential columns, I talked about what that meant for the first 15 years of our specialty. HM’s rise occurred in the mid 1990s, during a time of despair in medicine, when pressures from rising costs and the new managed care industry upended the usual way of doing things, and then, around the turn of the century, amid a growing awareness that the care we had been delivering was wildly variable in quality—and often unsafe. Our field, created by members of the Baby Boomer generation, ultimately proved highly attractive to Generation X’ers, and our growth was accelerated by this new supply of young doctors. Fueled by the influx of dollars and attention brought on by the patient safety and quality movement, HM became the fastest growing medical specialty in history.
So, now we know what being part of the hospitalist movement meant before, but what does it mean today? Are the issues and drivers the same? I left my last column in 2006, with the partnership between the Institute for Healthcare Improvement (IHI), SHM, and six other key organizations to create the 5 Million Lives Campaign. It was an important year in several other ways, as what it meant to be a hospitalist began to change.
Enter the Millenials
In 2006 a new generation, the Millenials, born between 1985 and 2000, began entering medical schools across the country. This group, raised on a diet of positive reinforcement and cooperation, is characterized by confidence and a desire to work in teams. Born after the introduction of the Macintosh computer, Millenials are not just tech savvy; they have grown up in the world of social media and are digital media savvy. Even more than Gen X, Millenials strive for work-life balance. It almost seems this was a generation born and raised to be hospitalists!
Not only is their life philosophy different than the Boomers and X’ers before them, but their medical training has been unlike any before. From the moment they entered medical school, they were taught about patient quality and safety. To them, doctors aren’t the isolated pillars of strength and sole possessors of sacred knowledge that they used to be. They intuitively get that medicine is a team sport. In fact, most of the attendings on their ward rotations have been hospitalists.
Rise of Experience
In the early days of medicine, we as physicians understood that patients might not have the best experience, but that was just part of the deal, right? It’s just not supposed to be fun to be hospitalized—and sometimes you had to go through hell to get better. Those were the days of pure, unadulterated paternalism. We did things to patients to make them get better.
In the late 1970s, Irwin Press, PhD, began to study and lecture on patient satisfaction. In 1985, he joined forces with statistician Rod Ganey, PhD, to found Press Ganey Inc.1 Patient experience as a concept began to enter the conversation of hospital administration, especially around the one-dimensional idea that better experience could contribute to the better financial health of an organization.
During the rise of the patient safety and quality movement in the late 1990s and early 2000s, our zeal to improve care led us to begin doing many things for patients. But a collateral idea began to rise in importance, too—the idea that a patient’s experience was critical to improving quality, not just a tool to attract more patients.
The entire national quality infrastructure I described in my last column (CMS, JCAHO, AHRQ, NQF) began to work on adding experience to the suite of measurements being developed. In 2006, CMS introduced the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This was a set of questions designed to be used at all hospitals nationwide, a significant development, because there was now a national standard for patient experience that could be compared over time and across hospitals anywhere in the country.2
In 2007, all hospitals subject to the Inpatient Prospective Payment System—pretty much all hospitals except critical access hospitals—were required to submit their HCAHPS survey data or face up to a 2% penalty. In 2008, this experience data was released publicly for the first time.2
And, of course, the Patient Protection and Affordable Care Act of 2010 (ACA) included HCAHPS results in calculating Hospital Value-Based Purchasing payments.3
The Institute of Medicine, in laying out a vision for better healthcare in 2012, called for more involvement of patients and families.
We are even seeing organizations creating leadership positions solely focused on patient experience. The Cleveland Clinic created the first physician leadership position dedicated to patient experience in the country, appointing Bridget Duffy, MD, a hospitalist, as its first chief experience officer in 2010. In 2012, Sound Physicians became the first hospitalist company to create such a position, to which it appointed Mark Rudolph, MD. Who would have imagined this 10 years ago?
Life for hospitalists has changed dramatically from the early 1990s to the Millenials now entering our workforce. The forces guiding our work and stimulating our growth have evolved, but the overarching theme of the last twenty years has been improvement. When the medical world took a cold hard look at the care being delivered, we suddenly saw a world of opportunities for improvement.
I talked before about how the rise of the patient safety and quality movement coincided perfectly with the emergence of hospitalists. Here I told you about how patient experience emerged in prominence as we, collectively, in becoming aware of our quality deficits, gained newfound empathy for what patients were going through. This focus on patient experience again plays into our strength and the opportunity we have as a specialty.
In the December issue of The Hospitalist, the final column in this five-part series will examine how to put it all together as we move toward the future of the field. But first I’ll introduce one last factor, a problem that helped launch our field and is now the greatest threat to our success.
Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.
- Press Ganey Associates, Inc. A spark ignited nearly three decades ago. Available at: http://www.pressganey.com/aboutUs/ourHistory.aspx. Accessed August 31, 2014.
- Centers for Medicare and Medicaid Services. HCAHPS Fact Sheet. Available at: www.hcahpsonline.org. Accessed August 31, 2014.
- American Hospital Association. Inpatient PPS. Available at: http://www.aha.org/advocacy-issues/medicare/ipps/index.shtml. Accessed August 31, 2014.