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Add Mentoring to Your Hospitalist Mix


 

Providing a mentoring program that pairs newly hired hospitalists with more experienced ones is beneficial for several reasons. Mentors can boost the comfort level of new hospitalists and improve likelihood of retention. They can also add continuity of culture and processes to a hospital medicine program.

This month we look at how—and why—Cogent Healthcare maintains its system-wide mentoring program. “Mentoring provides an added dimension to a traditional management structure,” explains Russell L. Holman, MD, senior vice president and national medical director, Cogent Healthcare, and president-elect of SHM. “Mentors can put a very personal, subjective, human element to learning. There’s almost an emotional component, as opposed to being more didactic.”

Case Study in Brief

Cogent’s mentoring program has evolved over time, but the organization tries to keep the program’s structure loose and informal. “In the world of mentoring research—which is largely the business world, not the healthcare world—it’s clear that mentoring relationships that develop naturally are more effective than those that are assigned,” says Dr. Holman.

Cogent teams mentor new programs, rather than individual hospitalists. However, their broad outline of the mentor/mentee relationship can be applied to a one-on-one scenario. At Cogent, an experienced hospitalist will visit a new facility at set times.

“With all programs, we schedule visits at certain intervals,” says Dr. Holman. “But there’s a fair amount of informal contact with the mentors on an as-needed basis.”

Each site visit lasts one to two days. “When a mentor is on-site, their only responsibility is to spend time with the physicians,” explains Dr. Holman. “And typically, at the end of each visit we look forward to evaluating it, getting feedback from the physicians as well as the mentor.”

During the site visit, all physicians in the program have complete, open access to the mentor. “It’s a group dynamic, but there’s as much one-on-one time as possible,” says Dr. Holman.

The intervals at which a mentor visits a program are standard, as are the topics covered—at least at first. “We look at critical phases in the life cycle of our programs,” says Dr. Holman. “When a program first starts, people are concerned with the nuts and bolts of operations, such as the use of guidelines, information systems, decision support tools, coding/billing, and even scheduling suggestions. A mentorship visit at this stage provides useful tips on operational implementation that are highly pragmatic.”

The next visit takes place within three to six months of the program’s implementation. At this point, says Dr. Holman, “there’s a comfortable workflow established but it’s likely that none of the physicians have worked together before. A mentor can talk about teamwork, including tips to bring consistency to the practice style.”

Next, after the program has been up and running for nine to 12 months, Dr. Holman says, “there’s enough experience in the program to speak more specifically to efficiency issues. An experienced hospitalist can provide focused mentorship on time-management skills, ways to extend your clinical reach, and ways to expand the number of patients you’re caring for. Most hospitalists are relatively young—many are within a year or two of completing their residency—so they’re still building these skills.”

At 12 months and beyond, the mentoring becomes much more customized to the specific needs of the individual program. “Maybe a program is trying to establish good working relationships with key departments within the hospital … or they want advanced clinical tools,” speculates Dr. Holman. “It may be that our hospitalists have been asked to lead an initiative, and they don’t have experience in leading hospital-wide initiatives. At this point, mentorship can reach a new level.”

Meet the Mentors

A mentor should be well versed in organizational processes, have clinical expertise and—if not an experienced teacher—should have well-honed people skills.

“Our mentors come from a profile of different folks, including the founding group of Cogent, a large practice in Los Angeles comprised of experienced hospitalists,” explains Dr. Holman. “Another group of mentors is our entire slate of medical directors, who have individual expertise in different areas. When mentors go on site visits, there’s no direct reporting, but they bring their expertise and facilitate networking.”

Cogent continues to widen its pool of available mentors, and is working to include physicians with special expertise. “We’re trying to build a diverse team [of mentors],” says Dr. Holman. “We look for clinical expertise in physicians who may not necessarily hold leadership roles. We try to predetermine which available mentor we think will be the best fit for a program, including personality, culture, and expertise.”

You Can Introduce Mentoring

You many not have the resources or number of physicians that Cogent has, but you can still start your own mentoring program. “Any program can look at a variety of resources to build a stable of mentors, or at least have a couple of mentors they can draw on,” insists Dr. Holman. “Look at other members of the medical staff that are experienced and role models for desirable qualities. Mentors can be within the healthcare field, but they don’t have to be physicians. One of my personal mentors for years was a director of human resources. You can even look outside healthcare.

“SHM is constantly looking at how to facilitate mentorship through venues like the Mentorship Breakfast at the Annual Meeting, and I still keep in touch with people I’ve met there,” he continues. “The SHM Annual Meeting is a terrific venue in general if you’re looking to connect members of your group (or yourself) with others from around the country.”

Implementing and maintaining a mentoring program may add to your workload, but it will pay off immediately. Just remember not to plan it out too carefully. “Mentoring is a constant work in progress,” concludes Dr. Holman. “We never want to see it as a static or inflexible entity. It’s a dynamic process driven by physician needs.” TH

Jane Jerrard writes “Career Development” each month for The Hospitalist

Hospitalists Make Better Teachers

A study in the September 2004 Archives of Internal Medicine reported that hospitalists who train students do a better job than traditional attending physicians. In staff and student evaluations at two teaching hospitals, students reported more effective teaching from hospitalists, as well as more satisfying inpatient rotations when supervised by hospitalists. This analysis suggests that hospitalists may possess or accrue a specific inpatient knowledge base and teaching skill that distinguishes them from other physicians.

How’s Your Staffing?

SHM provides some general advice for hospital medicine groups to estimate how many full-time equivalent physicians (FTEs) they need:

  1. What does the practice want to accomplish? Does it want to provide 24-hour coverage, 365 days a year? Or does it just plan to cover days? Or nights? Or weekends and holidays?
  2. How well do you know your community? Know your referral sources and your competition? Who else sees hospitalized patients at your hospital? How are emergency department admissions handled?
  3. Will the hospitalists have duties other than seeing patients, such as teaching, taking outpatient rotations, or doing hospital administration?
  4. What seasonal issues in your community affect demand for hospitals?
  5. What are your scheduling preferences?
  6. How will salaries be determined? If not simply by the individual's billings, how much are you willing to pay, including benefits?

Find more information on www.hospitalmedicine.org under “Resource Center,” then “Practice Resources.”

Beam Me Up, Scotty

The Royal Cornwall Hospital in Truro, Great Britain, is testing a new communications system that could eventually replace pagers, walkie-talkies, and mobile phones. Hospital workers are wearing tiny, voice-activated badges that allow instant communication between staff by simply speaking a person’s name or department.

The BT Managed Vocera system is specifically designed for environments where key staff need to be contacted urgently and are often away from desk phones.

The Salary Wizard Speaks

According to the online “Salary Wizard” at http://swz.salary.com, the median expected salary for a typical hospitalist in the United States is $157,317. Compare this with SHM findings on p. 19.

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