Being a good hospitalist means more than being an adroit clinician. But when it comes to teaching nonclinical aptitude, traditional residency programs often come up short, says Russell Holman, MD, MHM, former SHM president and chief clinical officer of Brentwood, Tenn.-based Cogent Healthcare. He and other HM experts recommend that boots-on-the-ground hospitalists acquire the following nonclinical skills in a purposeful manner as part of their ongoing learning and long-term career goals.
Hospitalists are the liaison between hospital administrators, managed-care companies, case managers, patients, patients’ families, and primary-care physicians (PCPs), says Isela Sotolongo, executive director of the Southeast region for North Hollywood, Calif.-based IPC: The Hospitalist Company. “A lot of times, more time is spent communicating with all the individuals that are involved in the patient’s admission than is actually spent with the patient,” she says.
—Isela Sotolongo, executive director, Southeast region, IPC: The Hospitalist Company, North Hollywood, Calif.
Hospitalists must quickly establish a relationship with patients and their families; manage specialists and ancillary personnel; brief a PCP on a patient’s needs after discharge; update case managers on a course of hospitalization; and demonstrate effective, efficient patient care to hospital administrators. Being able to express such information in a concise manner that is understood by others will reduce errors and save time and effort, Dr. Holman and Sotolongo say.
Quality Improvement (QI)
An awareness and working knowledge of QI methodologies should be part of a hospitalist’s everyday professional life, Dr. Holman says. QI helps reduce unwanted variation in patient care and enhances the process and outcomes of such care.
“Hospitalists are almost always looked to as being a linchpin in the hospital to improving quality,” he says. Therefore, while QI might not be a hospitalist’s special interest, it is still good to know the basics and how to apply them to actual HM practice, Dr. Holman says.
“Even if a hospitalist is not serving as medical director of their hospital medicine group, they are considered to be a leader in their own right,” Dr. Holman says.
A hospitalist takes charge of the admission process and is the person who manages all aspects of a patient’s care throughout the hospital stay to the point of discharge, Sotolongo says. (Click here to listen to Isela Sotolongo discuss hospitalist leadership and communication in detail.)
Also, a hospitalist might be leading and participating in QI activities at the hospital or leading the discussion for a multidisciplinary team, Dr. Holman notes. Having leadership skills helps a hospitalist appreciate the work their medical director must do, or the work that hospital administrators are trying to accomplish, he says.
Teamwork is an essential skill for hospitalists, yet traditional medical training often teaches doctors to be more of a rugged individualist, Dr. Holman says. Hospitalists should make it a point to adopt new behaviors that are teamwork-friendly:
- Value other members of the healthcare team;
- Direct people’s talents to their highest and best use; and
- Delegate tasks to those who are best suited to accomplish those particular needs.
“Teamwork tends to place much more emphasis on the patient being the center of care and others on the healthcare team going to support those patient-centered interests,” Dr. Holman say.
The Patient Perspective
How a patient moves through the healthcare system in theory is often different from reality. A hospitalist should physically follow some of their patients as they move from the hospital back to their caregivers at home or to a rehabilitation center, nursing home, or other facility in order to watch the transition, says Jasen Gundersen, MD, MBA, CPE, SFHM, chief medical officer of the hospital medicine division in Fort Lauderdale, Fla., for Knoxville, Tenn.-based TeamHealth. By doing this, a hospitalist can see where problems arise during handoffs and how to resolve them so that hospital readmissions are reduced.
Teaching skills can be applicable in any hospital environment, Dr. Holman adds. Hospitalists who work in nonteaching hospitals often serve as teachers to nursing staff, case management, pharmacists, discharge planners, and other ancillary staff in their daily interaction or over lunchtime educational programs. HM also can provide the bulk of a hospital’s grand rounds or other departmental educational sessions, he says.
“Let's not forget about patients and caregivers,” Dr. Holman adds. “The ability to teach patients and caregivers the necessary information and skills that they need for self-care, for follow-up care, and for compliance to a medical plan is important.”
A hospitalist has to know on which metrics and measurements their success will be based, Dr. Holman says. Will it be patient satisfaction, length of stay, readmission rates, mortality rates, or some other measure?
“We have to be aware of what the hospital’s needs are, what the hospital’s key points are that they look for,” Sotolongo says.
Once the metrics are clear, a hospitalist can set goals to accomplish individually, as a member of an HM group, and partner with the hospital, Dr. Holman says.
Lisa Ryan is a freelance writer based in New Jersey.