Managing Your Practice

Business Blueprint

Identify Core Leadership Requirements

Dr. Silversin

There are various ways to categorize the leadership skills that a hospitalist needs, including these: financial and business literacy, technical savvy for projects like quality and patient safety improvement, planning acumen to identify external trends and implement appropriate change in one’s department or group, and emotional intelligence to engineer cooperative relationships, says Jack Silversin, DMD, DrPH, president of Amicus.

Indeed, the ability to manage the relationships with myriad stakeholders is a hospitalist leader’s central requirement, according to “Hospitalists: A Guide to Building and Sustaining a Successful Program.”1 Stakeholders include patients, families, referring physicians, medical subspecialists and surgeons, the hospital executive team (C-suite), the clinical team (nurses, case management, therapy departments, and others), the HM group itself, and the public.

The hospitalist leader is responsible for many tasks, the authors write, including:

  • Blending marketplace needs with those of these various stakeholders;
  • Managing budgets, billing and revenue cycles, resources, and performance metrics; and
  • Overseeing such operational issues as scheduling, workload, census, staffing, and recruitment.

Self-Training Resources

Here are a few books that veteran hospitalists have found useful early in their leadership careers:

  • Good to Great: Why Some Companies Make the Leap … and Others Don’t, by Jim Collins (HarperBusiness, 2001).
  • Switch: How to Change Things When Change Is Hard, by Chip Heath and Dan Heath (Broadway Business, 2010).
  • Getting to Yes: Negotiating Agreement Without Giving In (2nd Edition), by Roger Fisher and William Ury (Penguin, 1991).
  • The 21 Irrefutable Laws of Leadership: Follow Them and People Will Follow You (10th Anniversary Edition), by John C. Maxwell (Thomas Nelson, 2007).
  • Bargaining for Advantage: Negotiation Strategies for Reasonable People (2nd Edition), by G. Richard Shell (Penguin, 2006).
  • The Five Dysfunctions of a Team: A Leadership Fable, by Patrick Lencioni (Jossey-Bass, 2002).
  • Crucial Conversations: Tools for Talking When Stakes are High, by Kerry Patterson (McGraw-Hill, 2002).

These duties will likely be time-consuming, but a hospitalist leader should nevertheless maintain a portion of his or her clinical practice to continue to be connected to the core work. “The foundation of your credibility as a leader is that you have excellent clinical skills,” says Winthrop F. Whitcomb, MD, MHM, medical director of healthcare quality at Baystate Medical Center in Springfield, Mass., and SHM cofounder and past president.

Clinical excellence is the foundation of successful leadership because the best quality and safety practices will drive successful hospitalist business practices, according to Lakshmi K. Halasyamani, MD, SFHM, SHM board member and vice president for Quality and Systems Improvement at Saint Joseph Mercy Hospital in Ann Arbor, Mich. “As healthcare reform begins to financially incentivize things like safe patient handoffs and more evidence-based medicine,” she says, “the business part of running a practice is going to quickly align with quality and safety outcomes. That’s what hospital medicine leaders should be focusing on.”

Empathy and communication skills are essential for a leader, who must continually translate messages from hospital administration to rank-and-file physicians, and vice versa, Dr. Whitcomb says. For example, he says, the message that hospitalists want better work conditions and more staff should be presented so that administration hears something like this: “We don’t want care to be unsafe; that would hurt the hospital’s reputation. Some of the hospitalists are burning out, creating the risk of increasing turnover. In fact, length of stay would be lower if the group has better staffing, because they could get the patients earlier in the day and send them home sooner.”

Such “situational awareness” is necessary to win the trust and cooperation of others and avoid becoming marginalized by important allies, says Eric Howell, MD, SFHM, director of the Hospital Medicine Division at Johns Hopkins Bayview Medical Center in Baltimore. “I’ve seen very successful advocates of hospital medicine groups who were not very good leaders,” the SHM board member says, “because they could not see what the leadership above them needed.”

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