“There’s no limit to how complicated things can get, on account of one thing always leading to another.”—E.B. White, Charlotte’s Web
E.B. White may not have been talking about hospitalists and their facilities, but he could have been. We are intricately involved in our facilities and, as we begin to make changes for our patients by changing the system and its processes, one thing leads to another.
Why should we bother to have partnerships with our facilities?
Hospitalist medicine has a unique feature: We need a facility to practice in. An ambulatory physician, while maintaining an office, can choose from a number of facilities. Unlike some procedural specialists, we cannot take our patients to an outpatient surgical center or other venue. If our hospital is not performing well, we have a difficult practice situation. It is imperative that we work with our facilities to ensure their success. We can create a rewarding practice environment by creating a highly functioning partnership.
If our goal is to deliver great care to patient populations, we cannot do this alone. In order for us to leverage our specialized knowledge we must leverage and master our partnerships with our facility. Ideally, in a partnership the objectives, values, and approaches are mutually reinforcing. There is agreement on the short-term and long-term goals. By operating with others in this partnership, new levels of unexpected performance are generated.
But partnership is a difficult thing. Though we are intricately entwined with the hospitals in which we practice, often we are not partnering. Partnerships occur at different levels. We may be partnering at a level that does not encourage results. In the dysfunctional partnership, the parties perceive little or no mutual benefit. They apply competitive negotiation skills to get their way regardless of the impact on relationships or outcomes. No one is really committed to anyone. Many times in a partnership, we demand what we want:
- A case manager for our team, seven days a week;
- A better office or computer system;
- Better emergency department procedures; or
- More time off.
Such demands without discussion and without consideration of the other’s point of view occur in a dysfunctional partnership.
But we have the opportunity to move these discussions in a positive manner because there are so many things that we directly control that cause the success or failure of our facilities. Our recognition of these needs can create an opportunity for us to prove our ability to partner. Typically, physicians have not supported administrative initiatives. It is well known that most administrators see the doctors as a project to work around instead of a partner in their success. Indeed for years many doctors established a sport of thwarting administrative plans and ideas; however, we need to proactively establish a new paradigm where we are the partners in improving care for our patient populations. Stuck for ideas on overlapping opportunity? Here are a few thoughts.
Everyone hears about medical record timeliness at their facilities. But why does anyone care about this? Does the Medical Executive Committee like to send out suspension letters? Do the individuals in medical records like to harass doctors? Of course not; this is a matter of vital financial interest to the hospital. The medical record cannot be billed until the record is complete: all consultations, discharge information, admission dictations, and all signatures.