Keep Lines of Communication Open
Strong relationships with hospital leadership creates a stable environment where hospitalists feel valued. It also helps ensure a program can weather almost any storm, says Julia Wright, MD, University of Wisconsin Hospital and Clinics hospitalist director and the director of hospital medicine at UW School of Medicine and Public Health in Madison, Wis. “Once you get to the point where you have value, a mission, a system of operations, and a delivery-of-care plan, then that might translate into some personal ownership in the program that could withstand a change in administration,” she says.
Dr. Wright, who took a five-person hospitalist program and has enlarged it to 13, says she understands the value of communication with hospital executives. She also has a game plan, should executive leadership at her hospital change. “The first thing I would do is sit down and discuss what my mission is,” she says. “Continued dialogue after that is really important.” The dialogue would include meeting with hospital administration regularly, as well as talking about objectives and ways to meet them. “I just know what’s worked to keep our program on track,” she says, “and it’s been very successful.”
Leverage a Change in Administration
At Meriter Hospital in Madison, Wis., Cate Ranheim, MD, director of the hospitalist program, found a change in administration actually benefitted her hospitalists. “Our previous administration was essentially a chief operating officer (COO) who approved—or more often—refused, every request for even the simplest things, from sinks to filing cabinets to call rooms,” she explains. “The former CEO was here for 30-plus years, as was the COO, and was virtually invisible within the institution.”
The COO was a strong advocate for the hospitalist group, but Dr. Ranheim says she still had to go through tough negotiations to get what the group needed. When a new CEO came in and announced an open-door policy, Dr. Ranheim jumped at the opportunity to be heard. “Whenever I need something for the group, I go directly to him, and I have never been refused anything because he knows I am not game-playing or negotiating,” she says. “If I say the group needs something, it really does.”
Dr. Ranheim’s experience actually is fairly common. Executive leadership or ownership changes often create “a window of opportunity to further some agendas,” Dr. Wright points out. “If there’s a group that’s been saying, ‘We really want to start this new initiative and just haven’t been able to get there yet,’ this might be the time to do that.”
Whether the transition is a good time can depend on how comfortable a hospitalist group feels with the new executive. “In my own experience, it’s all about personality,” Dr. Ranheim says. “As hospitalist director, I instantly trusted my new CEO, and that trust has never been violated in either direction.” She adds, “Of course, I still do get everything in writing.”
Pay Attention to National Standards
Whether hospitalists can bring about improvements during a hospital change of ownership or leadership isn’t just based on how much the program improves care or reduces costs at the facility. National standards also should come into play, Dr. Bossard says. “The hospitalist negotiator and the administration need to be comfortable with their command of what the data shows and what their standards are,” he cautions.
At Lutheran Medical Center in Colorado, Dr. Krebs felt strongly the change in ownership would cause patients hardship and go against national standards. Though both sides attempted to collect feedback and reach a compromise, neither came up with a solution that satisfied Dr. Krebs. He felt he had no choice but to seek legal action. (Exempla Healthcare, which manages the medical center, also sued to stop the sale).