Quality

Society of Hospital Medicine Creates Self-Assessment Tool for Hospitalist Groups


 

Are you looking to improve your hospital medicine group (HMG)? Would you like to measure your group against other groups?

The February 2013 issue of the Journal of Hospital Medicine included a seminal article for our specialty, “The Key Principles and Characteristics of an Effective Hospital Medicine Group: an assessment guide for hospitals and hospitalists.” This paper has received a vast amount of attention around the country from hospitalists, hospitalist leaders, HMGs, and hospital executives. The report (www.hospitalmedicine.org/keychar) is a first step for physicians and executives looking to benchmark their practices, and it has stimulated discussions among many HMGs, beginning a process of self-review and considering action.

Join the Discussion Via HMX, Free Webinars

What makes a hospital medicine group (HMG) effective? How can your hospitalists improve their performance? Share your feedback in the practice management community on HMX today (www.hmxchange.org). And join one of the free informational webinars below to learn more about the new guidelines from experts in the field helping hospital executives and HMGs evaluate their performance.

AHA Webinar

Date: Thursday, April 17

Time: 3:00-4:30 p.m.

www.ahaphysicianforum.org/webinar

SHM Webinar

Date: Tuesday, June 3

Time: 3:00-4:30 p.m. EST

www.hospitalmedicine.org/keychar

I am coming up on my 20th year as a hospitalist, and the debate over what makes a high-performing HMG has continued that entire time. In the beginning, there were questions about the mere existence of hospital medicine and HMGs. The discussion about what makes a high-performing HMG started among the physicians, medical groups, and hospitals that signed on early to the HM movement. At conferences, HMG leaders debated how to set up a program. A series of pioneer hospitalists, many with only a few years of experience, roamed the country as consultants giving advice on best practices. A professional society, the National Association of Inpatient Physicians, was born and, later, recast as the Society of Hospital Medicine (SHM)—and the discussion continued.

SHM furthered the debate with such important milestones as The Core Competencies in Hospital Medicine: A Framework for Curriculum Development, white papers on career satisfaction and hospitalist involvement in quality/safety and transitions of care. Different types of practice arrangements developed. Some were hospital-based, some physician practice-centered. Some were local, and others were regional and national. Each of these spawned innovations in HMG processes and contributed to the growing body of best practices.

Over the past five years, a consensus regarding those best practices has seemingly developed, and the discussions are centered on fine details rather than significant differences. To that end, approximately three years ago, a small group of SHM members met and discussed how to capture this information and disseminate it better among hospitalists, HMGs, and hospitals. We had all come to a similar conclusion—high-performing HMGs share common characteristics. Furthermore, every hospital and HMG seeks excellence, striving to be the best that they can be. We settled on a plan to write this up.

After a year of debate, we sought SHM’s help in the development phase and, in early 2012, SHM’s board of directors appointed a workgroup to identify the key principles and characteristics of an effective HMG. The initial group was widened to make sure we included different backgrounds and experiences in hospital medicine. The group had a wide array of involvement in HMG models, including HMG members, HMG leaders, hospital executives, and some involved in consulting. Many of the individuals had multiple experiences. The conversation among these individuals was lively!

The workgroup developed an initial draft of characteristics, which then went through a multi-step process of review and redrafting. More than 200 individuals, representing a broad group of stakeholders in hospital medicine and in the healthcare industry in general, provided comments and feedback. In addition, the workgroup went through a two-step Delphi process to consolidate and/or eliminate characteristics that were redundant or unnecessary.

In the final framework, 47 key characteristics were defined and organized under 10 principles (see Figure 1).

The authors and SHM’s board of directors view this document as an aspirational approach to improvement. We feel it helps to “raise the bar” for the specialty of hospital medicine by laying out a roadmap of potential improvement. These principles and characteristics provide a framework for HMGs seeking to conduct self-assessments, outlining a pathway for improvement, and better defining the central role of hospitalists in coordinating team-based, patient-centered care in the acute care setting.

In enhancing quality, the approach of a gap analysis is a very effective tool. These principles provide an excellent approach to begin that review.

So how do you get started? Hopefully, your HMG has a regular meeting. Take a principle and have a conversation. For example, what do we have? What don’t we have?

Other groups may want to tackle the entire document in a daylong strategy review. Some may want an outside facilitator. Bottom line: It doesn’t matter how you do it; just start with a conversation.


Dr. Cawley is CEO of Medical University of South Carolina Medical Center in Charleston. He is past president of SHM.

Reference

  1. Cawley P, Deitelzweig S, Flores L, et al. The key principles and characteristics of an effective hospital medicine group: An assessment guide for hospitals and hospitalists. J Hosp Med. 2014;9(2):123-128.

Figure 1. The 10 Key Principles and 47 Key Characteristics of an Effective Hospital Medicine Group1

Principle 1: The HMG has effective leadership

Characteristic 1.1: The HMG has one or more designated hospitalist practice leaders with appropriate dedicated administrative time.

1.2: The HMG has an active leadership development plan that is supported with appropriate budget, time, and other resources.

1.3: The HMG’s hospitalist practice leader has an important role within the hospital and medical staff leadership.

Principle 2: The HMG has engaged hospitalists

2.1: The HMG conducts regularly scheduled meetings to address key issues for the practice, and the hospitalists actively participate in such meetings.

2.2: The HMG’s hospitalists receive regular, meaningful feedback about their individual performances and contributions to the HMG and the hospital/health system.

2.3: The HMG’s vision, mission, and values are clearly articulated and understood by all members of the HMG team.

2.4: Hospitalists in the HMG know the performance status of both the group and the hospital.

Principle 3: The HMG has adequate resources

3.1: The HMG has defined its needs for non-clinician administrative management and clerical support and is adequately staffed to meet these needs.

3.2: All HMG team members (including physicians, nurse practitioners, physician assistants, and ancillary staff) have clearly defined, meaningful roles.

3.3: The HMG has followed an objective approach to determine its staffing needs.

Principle 4: The HMG has an effective planning and management infrastructure

4.1: The HMG prepares an annual budget with adequate financial and administrative oversight.

4.2: The HMG generates periodic reports that characterize its performance for review by HMG members and other stakeholders.

4.3: The HMG has a current set of written policies and procedures that are readily accessible by all members of the HMG team.

4.4: The HMG has a documentation and coding compliance plan.

4.5: The HMG is supported by appropriate practice management information technology, clinical information technology, and data analytics.

4.6: The HMG has a strategic or business plan that is reviewed and updated at least every three years.

Principal 5: The HMG is aligned with the hospital and/or health system

5.1: The HMG develops annual goals that align with the goals of the hospital(s) it serves and the goals of the hospitalists’ employer (if different).

5.2: The HMG’s compensation model aligns hospitalist incentives with the goals of the hospital and the goals of the hospitalists’ employer (if different).

5.3: The HMG collaborates with hospital patient relations and/or risk management staff to implement practices that reduce errors and improve the patient’s perception of the hospital.

5.4: The HMG periodically solicits satisfaction feedback from key stakeholder groups, which is shared with all hospitalists and used to develop and implement improvement plans.

Principle 6: The HMG supports care coordination across care settings

6.1: The HMG has systems in place to ensure effective and reliable communication with the patient’s primary care provider and/or other provider(s) involved in the patient’s care in the non-acute-care setting.

6.2: The HMG contributes in meaningful ways to the hospital’s efforts to improve care transitions.

Principle 7: The HMG plays a leadership role in addressing key clinical issues in the hospital and/or health system: teaching, quality, safety, efficiency, and the patient/family experience

7.1: The HMG’s hospitalists are committed to teaching other members of the clinical team.

7.2: The HMG actively seeks to maximize effectiveness of care by consistently implementing evidence-based practices and reducing unwarranted variation in care.

7.3: The HMG’s hospitalists champion and model behaviors intended to promote patient safety.

7.4: The HMG contributes in meaningful ways to hospital efficiency by optimizing length of stay and improving patient flow.

7.5: The HMG contributes in meaningful ways to improving the patient and family experience.

7.6: The HMG contributes in meaningful ways to optimizing clinical resource utilization and cost per stay.

7.7: The HMG’s hospitalists demonstrate a commitment to continuous quality improvement (CQI) and actively participate in initiatives directed at measurably improving quality and patient safety.

Principle 8: The HMG takes a thoughtful and rational approach to its scope of clinical activities

8.1: The HMG has a well-defined plan for evolving the scope of hospitalist clinical activities to meet the changing needs of the institution.

8.2: The respective roles of the hospitalists and physicians in other specialties in treating patients, including patients that are co-managed, are clearly defined with a mechanism to resolve issues with regard to scope and responsibilities.

8.3: The HMG uses appropriate references to define the clinical responsibilities of hospitalists.

Principle 9: The HMG has implemented a practice model that is patient- and family-centered, team-based, and emphasizes effective communication and care coordination

9.1: The HMG’s hospitalists provide care that respects and responds to patient and family preferences, needs, and values.

9.2: The HMG’s hospitalists have access to and regularly use patient/family education resources.

9.3: The HMG actively participates in interprofessional, team-based decision-making with members of the clinical care team.

9.4: The HMG has effective and efficient internal hand-off processes for both change of shift and change of responsible provider.

9.5: When serving as attending physicians, the HMG’s hospitalists (in coordination with other clinicians as appropriate) assure that a coordinated plan of care is implemented.

Principle 10: The HMG recruits and retains qualified clinicians

10.1: Hospitalist compensation is market competitive.

10.2: The HMG’s hospitalists all have valid and comprehensive employment or independent contractor agreements.

10.3: The HMG’s hospitalists are actively engaged in sourcing and recruiting new members.

10.4: The HMG has a comprehensive orientation process for new clinicians.

10.5: The HMG provides its hospitalists with resources for professional growth and enhancement, including access to continuing medical education (CME).

10.6: The HMG measures, monitors, and fosters its hospitalists’ job satisfaction, well being, and professional development.

10.7: The medical staff has a clear mechanism to credential and privilege hospitalists, and the hospitalists hold unrestricted staff privileges in the applicable medical staff department.

10.8: The HMG has a documented method for monitoring clinical competency and professionalism for all clinical staff and addressing deficiencies when identified.

10.9: A significant portion of full-time hospitalists in the HMG demonstrate a commitment to a career in hospital medicine.

10.10: The HMG’s full-time and regular part-time hospitalists are board certified or board eligible in an applicable medical specialty or subspecialty.

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