Thomas R. Collins

RIV winner Vineet Chopra, MD, MSc, assistant professor at the University of Michigan in Ann Arbor, talks about his research on the costs and complications associated with PICC line use.

RIV winner Vineet Chopra, MD, MSc, assistant professor at the University of Michigan in Ann Arbor, talks about his research on the costs and complications associated with PICC line use.

RIV winner Vineet Chopra, MD, MSc, assistant professor at the University of Michigan in Ann Arbor, talks about his research on the costs and complications associated with PICC line use.

Jordan Romano, DO, a hospitalist at Massachusetts General Hospital, talks about lessons gleaned at HM16 on the importance of taking small steps toward your goals of getting published and how burnout can be relative.

Jordan Romano, DO, a hospitalist at Massachusetts General Hospital, talks about lessons gleaned at HM16 on the importance of taking small steps toward your goals of getting published and how burnout can be relative.

Jordan Romano, DO, a hospitalist at Massachusetts General Hospital, talks about lessons gleaned at HM16 on the importance of taking small steps toward your goals of getting published and how burnout can be relative.

One of the things that Jennifer Feighner, MD, cheerfully came away with at HM16 was how to better complete a task that is distinctly uncheerful but also important to any high-performing hospital: how to collect the data of the dead.

The quality improvement session “Reducing Inpatient Mortality: A Standardized Approach to Identify Preventable Deaths” demonstrated still evolving but, so far, well-performing projects that have been rolled out at Brigham and Women’s Hospital and the Duke University Health System.

“I was struck by the methodology for getting input from multiple providers and the nursing staff,” said Dr. Feighner, director of hospital medicine at Marcus Daly Memorial Hospital in Hamilton, Mont.

As the role of the hospitalist as agent of change and improvement continues to grow, the topic of quality improvement (QI) maintained a high profile at the annual meeting, with talks on the latest literature, sustaining motivation to complete projects, and dealing with issues such as handoffs and frequent fliers.

In the mortality review session, presenters set out to give details that could be a model to be used elsewhere. At Brigham and Women’s, all of the frontline clinicians are asked by email to fill out a report when a death occurs in any case with which they’ve been involved, with the Web-based reports to be completed within 48 to 72 hours of the death.

The number of deaths, the report completion rate, death “preventability,” and issues that arose for the patient during hospitalization are some of the data that are tracked. So far, the system has identified such themes as “alarm fatigue,” high oxygen requirements on non-intensive-care floors, handoffs, and transfers from other hospitals, said Kiran Gupta, MD, MPH, who completed her residency at Brigham and is now assistant professor of clinical medicine at the University of California San Francisco.

At Duke, where the mortality review system improvements have been led by Jonathan Bae, MD, assistant professor of medicine, self-nicknamed “Dr. Death,” inpatient deaths undergo a similarly comprehensive review, with an enhanced end-of-life section to cover issues particular to those cases and flags for cases that need independent review.

Dr. Gupta and Dr. Bae emphasized the confidentiality of the reviews and that they are non-discoverable in the event of litigation, which they hope give clinicians the freedom to fully report their observations.

Dr. Feighner said that her 23-bed hospital is far smaller than either Brigham or Duke, of course, but that the overall ideas can translate.

“I am the medical director of our hospitalist program, and our chief of staff and I’ve created a peer-review medical staff quality improvement committee,” she said. “So this obviously has a lot of interest to me.”

With only 4.2 full-time equivalents (FTEs) in her department, she said changes would be even easier to put into place.

“I think that will be really helpful for our peer-review committee and our quality and safety committee. I could see how we could take this and kind of revise it a little bit,” she said. “When you’re in charge of that few people, it’s easy to get processes implemented. We are more limited in monetary resources, but we make up for that in manpower-to-problem ratio, I guess.”

In another session, Jordan Messler, MD, SFHM, a hospitalist and former medical director of the hospitalist group at Morton Plant Hospital in Clearwater, Fla., confronted the startling statistic that 80% of initiatives in hospitals never meet their objectives. Hurdles such as burnout and disengagement, he said, often stand in the way of successful QI projects.

He emphasized the importance of intrinsic motivation (a sense of ownership and passion for the work) over extrinsic motivation (a fear of reprisal if something isn’t done). A step as simple as assigning a title (e.g., “head of readmissions”) can be a motivator, he said. But he also emphasized that project ideas need to be timed correctly and the ideas should ideally come from the physicians leading them.

Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, said he was struck by the lessons gleaned in a workshop on the I-PASS system of handoffs—a standardized system with a handoff sheet, studied prospectively, in which medical errors decreased by 23% and preventable adverse events fell by 30%.1 The system was created in pediatric departments but was deliberately made to be translatable to other settings.

“Instead of focusing on the outcome of the quality of the handoff, they focus on the quality of the feedback sessions,” Clothier said. “So it’s not the person giving the handoff or receiving the handoff that actually assesses it. It’s just the person who’s sitting there watching.”

He said the workshop underscored the importance of standardization, a concept with which he was familiar but which now seemed particularly vital.

“If you do the process and everybody does it the same, then it’s not only the person that’s giving the information who can do it in a very standardized way but the person who’s listening already knows what they’re going to be listening for so they hear it more clearly because they don’t have to discern what’s coming next,” Clothier said. “They already know what’s coming next.” TH

Reference

1. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803-1812.

One of the things that Jennifer Feighner, MD, cheerfully came away with at HM16 was how to better complete a task that is distinctly uncheerful but also important to any high-performing hospital: how to collect the data of the dead.

The quality improvement session “Reducing Inpatient Mortality: A Standardized Approach to Identify Preventable Deaths” demonstrated still evolving but, so far, well-performing projects that have been rolled out at Brigham and Women’s Hospital and the Duke University Health System.

“I was struck by the methodology for getting input from multiple providers and the nursing staff,” said Dr. Feighner, director of hospital medicine at Marcus Daly Memorial Hospital in Hamilton, Mont.

As the role of the hospitalist as agent of change and improvement continues to grow, the topic of quality improvement (QI) maintained a high profile at the annual meeting, with talks on the latest literature, sustaining motivation to complete projects, and dealing with issues such as handoffs and frequent fliers.

In the mortality review session, presenters set out to give details that could be a model to be used elsewhere. At Brigham and Women’s, all of the frontline clinicians are asked by email to fill out a report when a death occurs in any case with which they’ve been involved, with the Web-based reports to be completed within 48 to 72 hours of the death.

The number of deaths, the report completion rate, death “preventability,” and issues that arose for the patient during hospitalization are some of the data that are tracked. So far, the system has identified such themes as “alarm fatigue,” high oxygen requirements on non-intensive-care floors, handoffs, and transfers from other hospitals, said Kiran Gupta, MD, MPH, who completed her residency at Brigham and is now assistant professor of clinical medicine at the University of California San Francisco.

At Duke, where the mortality review system improvements have been led by Jonathan Bae, MD, assistant professor of medicine, self-nicknamed “Dr. Death,” inpatient deaths undergo a similarly comprehensive review, with an enhanced end-of-life section to cover issues particular to those cases and flags for cases that need independent review.

Dr. Gupta and Dr. Bae emphasized the confidentiality of the reviews and that they are non-discoverable in the event of litigation, which they hope give clinicians the freedom to fully report their observations.

Dr. Feighner said that her 23-bed hospital is far smaller than either Brigham or Duke, of course, but that the overall ideas can translate.

“I am the medical director of our hospitalist program, and our chief of staff and I’ve created a peer-review medical staff quality improvement committee,” she said. “So this obviously has a lot of interest to me.”

With only 4.2 full-time equivalents (FTEs) in her department, she said changes would be even easier to put into place.

“I think that will be really helpful for our peer-review committee and our quality and safety committee. I could see how we could take this and kind of revise it a little bit,” she said. “When you’re in charge of that few people, it’s easy to get processes implemented. We are more limited in monetary resources, but we make up for that in manpower-to-problem ratio, I guess.”

In another session, Jordan Messler, MD, SFHM, a hospitalist and former medical director of the hospitalist group at Morton Plant Hospital in Clearwater, Fla., confronted the startling statistic that 80% of initiatives in hospitals never meet their objectives. Hurdles such as burnout and disengagement, he said, often stand in the way of successful QI projects.

He emphasized the importance of intrinsic motivation (a sense of ownership and passion for the work) over extrinsic motivation (a fear of reprisal if something isn’t done). A step as simple as assigning a title (e.g., “head of readmissions”) can be a motivator, he said. But he also emphasized that project ideas need to be timed correctly and the ideas should ideally come from the physicians leading them.

Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, said he was struck by the lessons gleaned in a workshop on the I-PASS system of handoffs—a standardized system with a handoff sheet, studied prospectively, in which medical errors decreased by 23% and preventable adverse events fell by 30%.1 The system was created in pediatric departments but was deliberately made to be translatable to other settings.

“Instead of focusing on the outcome of the quality of the handoff, they focus on the quality of the feedback sessions,” Clothier said. “So it’s not the person giving the handoff or receiving the handoff that actually assesses it. It’s just the person who’s sitting there watching.”

He said the workshop underscored the importance of standardization, a concept with which he was familiar but which now seemed particularly vital.

“If you do the process and everybody does it the same, then it’s not only the person that’s giving the information who can do it in a very standardized way but the person who’s listening already knows what they’re going to be listening for so they hear it more clearly because they don’t have to discern what’s coming next,” Clothier said. “They already know what’s coming next.” TH

Reference

1. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803-1812.

One of the things that Jennifer Feighner, MD, cheerfully came away with at HM16 was how to better complete a task that is distinctly uncheerful but also important to any high-performing hospital: how to collect the data of the dead.

The quality improvement session “Reducing Inpatient Mortality: A Standardized Approach to Identify Preventable Deaths” demonstrated still evolving but, so far, well-performing projects that have been rolled out at Brigham and Women’s Hospital and the Duke University Health System.

“I was struck by the methodology for getting input from multiple providers and the nursing staff,” said Dr. Feighner, director of hospital medicine at Marcus Daly Memorial Hospital in Hamilton, Mont.

As the role of the hospitalist as agent of change and improvement continues to grow, the topic of quality improvement (QI) maintained a high profile at the annual meeting, with talks on the latest literature, sustaining motivation to complete projects, and dealing with issues such as handoffs and frequent fliers.

In the mortality review session, presenters set out to give details that could be a model to be used elsewhere. At Brigham and Women’s, all of the frontline clinicians are asked by email to fill out a report when a death occurs in any case with which they’ve been involved, with the Web-based reports to be completed within 48 to 72 hours of the death.

The number of deaths, the report completion rate, death “preventability,” and issues that arose for the patient during hospitalization are some of the data that are tracked. So far, the system has identified such themes as “alarm fatigue,” high oxygen requirements on non-intensive-care floors, handoffs, and transfers from other hospitals, said Kiran Gupta, MD, MPH, who completed her residency at Brigham and is now assistant professor of clinical medicine at the University of California San Francisco.

At Duke, where the mortality review system improvements have been led by Jonathan Bae, MD, assistant professor of medicine, self-nicknamed “Dr. Death,” inpatient deaths undergo a similarly comprehensive review, with an enhanced end-of-life section to cover issues particular to those cases and flags for cases that need independent review.

Dr. Gupta and Dr. Bae emphasized the confidentiality of the reviews and that they are non-discoverable in the event of litigation, which they hope give clinicians the freedom to fully report their observations.

Dr. Feighner said that her 23-bed hospital is far smaller than either Brigham or Duke, of course, but that the overall ideas can translate.

“I am the medical director of our hospitalist program, and our chief of staff and I’ve created a peer-review medical staff quality improvement committee,” she said. “So this obviously has a lot of interest to me.”

With only 4.2 full-time equivalents (FTEs) in her department, she said changes would be even easier to put into place.

“I think that will be really helpful for our peer-review committee and our quality and safety committee. I could see how we could take this and kind of revise it a little bit,” she said. “When you’re in charge of that few people, it’s easy to get processes implemented. We are more limited in monetary resources, but we make up for that in manpower-to-problem ratio, I guess.”

In another session, Jordan Messler, MD, SFHM, a hospitalist and former medical director of the hospitalist group at Morton Plant Hospital in Clearwater, Fla., confronted the startling statistic that 80% of initiatives in hospitals never meet their objectives. Hurdles such as burnout and disengagement, he said, often stand in the way of successful QI projects.

He emphasized the importance of intrinsic motivation (a sense of ownership and passion for the work) over extrinsic motivation (a fear of reprisal if something isn’t done). A step as simple as assigning a title (e.g., “head of readmissions”) can be a motivator, he said. But he also emphasized that project ideas need to be timed correctly and the ideas should ideally come from the physicians leading them.

Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, said he was struck by the lessons gleaned in a workshop on the I-PASS system of handoffs—a standardized system with a handoff sheet, studied prospectively, in which medical errors decreased by 23% and preventable adverse events fell by 30%.1 The system was created in pediatric departments but was deliberately made to be translatable to other settings.

“Instead of focusing on the outcome of the quality of the handoff, they focus on the quality of the feedback sessions,” Clothier said. “So it’s not the person giving the handoff or receiving the handoff that actually assesses it. It’s just the person who’s sitting there watching.”

He said the workshop underscored the importance of standardization, a concept with which he was familiar but which now seemed particularly vital.

“If you do the process and everybody does it the same, then it’s not only the person that’s giving the information who can do it in a very standardized way but the person who’s listening already knows what they’re going to be listening for so they hear it more clearly because they don’t have to discern what’s coming next,” Clothier said. “They already know what’s coming next.” TH

Reference

1. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803-1812.

SAN DIEGO — Think beyond your four walls, speakers told hospitalists at HM16. When it comes to public health and public policy, with your experience and knowledge, your input is simply too valuable not to share, they said.

During several sessions at the SHM annual meeting, hospitalists were urged to understand that they could influence the world of healthcare beyond their own patients and their own centers.

“You have more power than you realize,” U.S. Surgeon General Vivek Murthy, MD, MBA, told hospitalists in his opening address. As a hospitalist at Brigham and Women’s Hospital in Boston, Dr. Murthy created the nonprofit organization Doctors for America, which promotes affordable, high-quality healthcare for all Americans.

A member of Congress, he said, once told him that a call from a doctor is listed as “a notable event” and 10 calls from doctors in a day is “a full-blown crisis.” “I’m often struck by how infrequently elected leaders hear from doctors,” Dr. Murthy added. “I’m also struck by how many good ideas I hear from doctors.”

Dr. Murthy suggested that as the HM movement grows, hospitalists should ask themselves questions around issues of leadership, change, and public health.

“Can hospitalists leverage their leadership in the hospital to not only improve systems but also create a culture that supports healing in health?” Dr. Murthy asked. “Can hospitalists be as powerful a force for change outside the hospital as they are inside the hospital, recognizing that critical drivers of illness like nutrition, safety, and physical activity are most often grounded in the community rather than the clinic? As people who often mentor trainees and younger physicians, can we inspire the next generation of physicians with a broader vision of medicine, one where physicians’ sacred duty is to safeguard the health of their community by treating illness but also by preventing it?”

Achieving such goals might be a tall order. When asked about how influential they feel in the world of public health, some hospitalists said they feel they can have some impact in their daily work but, beyond the hospital, not so much.

“I don’t feel very empowered,” said Janna Gelderman-Moffett, DO, a locum tenens physician in Boulder City, Colo. She added, though, that she is “frustrated with how medicine is portrayed.”

Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California, San Francisco Medical Center, who coined the term “hospitalist” 20 years ago, told hospitalists at HM16 that it’s “crucial” for them to take on new roles. But he also waved a caution flag: too much and you may go too far afield.

“We have to be careful about scope creep,” Dr. Wachter said. “And as much as I enjoyed the Surgeon General’s comments, I think we’ve got to be thoughtful about taking on [too much responsibility]. I have people in my group who do a lot of work, for example, in population health. That’s part of their job, but I’m not sure that’s our job, to fix the world of prevention outside of the hospital and SNF. If we begin becoming something for everybody, I think we’ll lose the special focus that made us successful.”

Ron Greeno, MD, FCCP, MHM, chief strategy officer for IPC Healthcare in North Hollywood, Calif., chair of SHM’s Public Policy Committee, and an SHM board member, said the society and hospitalists are “specially suited” to give input to help shape the details of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the repealed Sustainable Growth Rate (SGR) formula.

With MACRA, SGR’s threat of broader Medicare payment cuts is eliminated, but it increases the scope of quality measurement, including resource use and clinical-improvement practices. It also uses incentives to push providers toward risk-based models.

With many of MACRA’s specifics now left to the rule-making process, it’s still largely “a creature devoid of form,” Dr. Greeno said. Hospitalists and SHM can make a difference largely because of their roles within systems, he said. “We are trying to actually make things better,” he added. “We’re always looking for a better way to do things.”

Joining SHM’s Grassroots Network, which can involve something as simple as sending a pre-written letter to Washington, D.C.–based legislators, can be a big help. “You know what?” Dr. Greeno said. “This stuff actually has an impact.”

Tresa McNeal, MD, a hospitalist at Baylor Scott & White Health, a not-for-profit healthcare system serving Texas communities, said she was motivated by the speakers’ remarks.

“It’s really good to know that we have people representing us from SHM to [not only] help us learn about these issues but also represent us,” Dr. McNeal said. “I think it makes me want to be part of the grassroots initiative, just realizing that there’s power in numbers.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — Think beyond your four walls, speakers told hospitalists at HM16. When it comes to public health and public policy, with your experience and knowledge, your input is simply too valuable not to share, they said.

During several sessions at the SHM annual meeting, hospitalists were urged to understand that they could influence the world of healthcare beyond their own patients and their own centers.

“You have more power than you realize,” U.S. Surgeon General Vivek Murthy, MD, MBA, told hospitalists in his opening address. As a hospitalist at Brigham and Women’s Hospital in Boston, Dr. Murthy created the nonprofit organization Doctors for America, which promotes affordable, high-quality healthcare for all Americans.

A member of Congress, he said, once told him that a call from a doctor is listed as “a notable event” and 10 calls from doctors in a day is “a full-blown crisis.” “I’m often struck by how infrequently elected leaders hear from doctors,” Dr. Murthy added. “I’m also struck by how many good ideas I hear from doctors.”

Dr. Murthy suggested that as the HM movement grows, hospitalists should ask themselves questions around issues of leadership, change, and public health.

“Can hospitalists leverage their leadership in the hospital to not only improve systems but also create a culture that supports healing in health?” Dr. Murthy asked. “Can hospitalists be as powerful a force for change outside the hospital as they are inside the hospital, recognizing that critical drivers of illness like nutrition, safety, and physical activity are most often grounded in the community rather than the clinic? As people who often mentor trainees and younger physicians, can we inspire the next generation of physicians with a broader vision of medicine, one where physicians’ sacred duty is to safeguard the health of their community by treating illness but also by preventing it?”

Achieving such goals might be a tall order. When asked about how influential they feel in the world of public health, some hospitalists said they feel they can have some impact in their daily work but, beyond the hospital, not so much.

“I don’t feel very empowered,” said Janna Gelderman-Moffett, DO, a locum tenens physician in Boulder City, Colo. She added, though, that she is “frustrated with how medicine is portrayed.”

Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California, San Francisco Medical Center, who coined the term “hospitalist” 20 years ago, told hospitalists at HM16 that it’s “crucial” for them to take on new roles. But he also waved a caution flag: too much and you may go too far afield.

“We have to be careful about scope creep,” Dr. Wachter said. “And as much as I enjoyed the Surgeon General’s comments, I think we’ve got to be thoughtful about taking on [too much responsibility]. I have people in my group who do a lot of work, for example, in population health. That’s part of their job, but I’m not sure that’s our job, to fix the world of prevention outside of the hospital and SNF. If we begin becoming something for everybody, I think we’ll lose the special focus that made us successful.”

Ron Greeno, MD, FCCP, MHM, chief strategy officer for IPC Healthcare in North Hollywood, Calif., chair of SHM’s Public Policy Committee, and an SHM board member, said the society and hospitalists are “specially suited” to give input to help shape the details of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the repealed Sustainable Growth Rate (SGR) formula.

With MACRA, SGR’s threat of broader Medicare payment cuts is eliminated, but it increases the scope of quality measurement, including resource use and clinical-improvement practices. It also uses incentives to push providers toward risk-based models.

With many of MACRA’s specifics now left to the rule-making process, it’s still largely “a creature devoid of form,” Dr. Greeno said. Hospitalists and SHM can make a difference largely because of their roles within systems, he said. “We are trying to actually make things better,” he added. “We’re always looking for a better way to do things.”

Joining SHM’s Grassroots Network, which can involve something as simple as sending a pre-written letter to Washington, D.C.–based legislators, can be a big help. “You know what?” Dr. Greeno said. “This stuff actually has an impact.”

Tresa McNeal, MD, a hospitalist at Baylor Scott & White Health, a not-for-profit healthcare system serving Texas communities, said she was motivated by the speakers’ remarks.

“It’s really good to know that we have people representing us from SHM to [not only] help us learn about these issues but also represent us,” Dr. McNeal said. “I think it makes me want to be part of the grassroots initiative, just realizing that there’s power in numbers.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — Think beyond your four walls, speakers told hospitalists at HM16. When it comes to public health and public policy, with your experience and knowledge, your input is simply too valuable not to share, they said.

During several sessions at the SHM annual meeting, hospitalists were urged to understand that they could influence the world of healthcare beyond their own patients and their own centers.

“You have more power than you realize,” U.S. Surgeon General Vivek Murthy, MD, MBA, told hospitalists in his opening address. As a hospitalist at Brigham and Women’s Hospital in Boston, Dr. Murthy created the nonprofit organization Doctors for America, which promotes affordable, high-quality healthcare for all Americans.

A member of Congress, he said, once told him that a call from a doctor is listed as “a notable event” and 10 calls from doctors in a day is “a full-blown crisis.” “I’m often struck by how infrequently elected leaders hear from doctors,” Dr. Murthy added. “I’m also struck by how many good ideas I hear from doctors.”

Dr. Murthy suggested that as the HM movement grows, hospitalists should ask themselves questions around issues of leadership, change, and public health.

“Can hospitalists leverage their leadership in the hospital to not only improve systems but also create a culture that supports healing in health?” Dr. Murthy asked. “Can hospitalists be as powerful a force for change outside the hospital as they are inside the hospital, recognizing that critical drivers of illness like nutrition, safety, and physical activity are most often grounded in the community rather than the clinic? As people who often mentor trainees and younger physicians, can we inspire the next generation of physicians with a broader vision of medicine, one where physicians’ sacred duty is to safeguard the health of their community by treating illness but also by preventing it?”

Achieving such goals might be a tall order. When asked about how influential they feel in the world of public health, some hospitalists said they feel they can have some impact in their daily work but, beyond the hospital, not so much.

“I don’t feel very empowered,” said Janna Gelderman-Moffett, DO, a locum tenens physician in Boulder City, Colo. She added, though, that she is “frustrated with how medicine is portrayed.”

Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California, San Francisco Medical Center, who coined the term “hospitalist” 20 years ago, told hospitalists at HM16 that it’s “crucial” for them to take on new roles. But he also waved a caution flag: too much and you may go too far afield.

“We have to be careful about scope creep,” Dr. Wachter said. “And as much as I enjoyed the Surgeon General’s comments, I think we’ve got to be thoughtful about taking on [too much responsibility]. I have people in my group who do a lot of work, for example, in population health. That’s part of their job, but I’m not sure that’s our job, to fix the world of prevention outside of the hospital and SNF. If we begin becoming something for everybody, I think we’ll lose the special focus that made us successful.”

Ron Greeno, MD, FCCP, MHM, chief strategy officer for IPC Healthcare in North Hollywood, Calif., chair of SHM’s Public Policy Committee, and an SHM board member, said the society and hospitalists are “specially suited” to give input to help shape the details of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the repealed Sustainable Growth Rate (SGR) formula.

With MACRA, SGR’s threat of broader Medicare payment cuts is eliminated, but it increases the scope of quality measurement, including resource use and clinical-improvement practices. It also uses incentives to push providers toward risk-based models.

With many of MACRA’s specifics now left to the rule-making process, it’s still largely “a creature devoid of form,” Dr. Greeno said. Hospitalists and SHM can make a difference largely because of their roles within systems, he said. “We are trying to actually make things better,” he added. “We’re always looking for a better way to do things.”

Joining SHM’s Grassroots Network, which can involve something as simple as sending a pre-written letter to Washington, D.C.–based legislators, can be a big help. “You know what?” Dr. Greeno said. “This stuff actually has an impact.”

Tresa McNeal, MD, a hospitalist at Baylor Scott & White Health, a not-for-profit healthcare system serving Texas communities, said she was motivated by the speakers’ remarks.

“It’s really good to know that we have people representing us from SHM to [not only] help us learn about these issues but also represent us,” Dr. McNeal said. “I think it makes me want to be part of the grassroots initiative, just realizing that there’s power in numbers.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — To talk to Nancy Allen, MD, a locum tenens physician who works in Portland, Me., is to get a sense of that head-spinning sensation you can have in the digital age. For hospitalists, it’s an endless stream of patients, diagnoses, documentation, and performance metrics. Following an HM16 session here, it’s also an endless litany of ways to try to make all of it more manageable.

Looking for on-the-job shortcuts, Dr. Allen attended the session “There Is an App for That, 2016: Update in Hospital Medicine Mobile Applications.”

“You always feel like there’s too much information,” she said. “I do 14-hour days. To add anything that takes time is crippling.”

The session was helpful, she said, with eye-opening presentations on apps Dr. Allen never knew existed. Most important, the recommendations came with the seal of approval of practicing hospitalists. But even the information presented in the session felt perhaps too much, she said.

“They seemed really doable,” Dr. Allen said. “But I felt like by the end, I’m overwhelmed.”

Health information technology (IT) had its own educational track for the first time at the annual meeting, with offerings on using technology for better documentation, social media, and clinical informatics.

In the apps session, presenters Bradley Benson, MD, professor of internal medicine and pediatrics at the University of Minnesota, and J. Richard Pittman Jr., MD, assistant professor of medicine at Emory University, cautioned that FDA regulation of mobile apps will be getting more stringent. They encouraged physicians to stay ahead of the game, using apps that are based on sound research so that they don’t begin to rely on apps that will eventually no longer be options.

Their recommendations were based on personal experience, some admittedly biased published reviews, objective criterion-referenced reviews, and peer-reviewed study data.

Dr. Allen said she was especially interested in MedCalX, an app designed for physicians and featuring medical formulas, scores, and classifications. She also liked that the presenters gave a lesson, short but complete, on how to get a Web-based app that you find on a browser to appear as an icon on your phone, just like any other app.

Presenter recommendations ranged from the nifty (GoodRx allows you to type in a medication and map both local pharmacies and what they charge for the drug) to those that help with basic life and job logistics (Evernote makes it easy to file away emails, attachments, and images). Evernote is the app Dr. Pittman said he’d keep if he could only use one.

As dizzying as it was, the session seemed to lift Dr. Allen’s hopes that she’d be able to incorporate apps more into her work.

“You have to make a decision on the fly a lot of the time,” she said. “You have to do it in real time. … In theory, apps should be able to do that.”

Teri Dyess, MD, director of hospital medicine at St. Dominic Hospital in Jackson, Miss., said that the “Optimizing IT for Documentation and Handoffs” session underscored a problem she has noticed in her department: doctors cutting and pasting too much information in their progress notes. That includes CT reports, labs, pretty much everything, she said.

“It’s just one long note,” she said, adding some notes “get out of hand.” Now, she has information—and reinforcement of her own concerns—that she can take back to her center.

Presenters said that physicians should remember that notes primarily serve the needs of patients and providers and should focus on quality and clarity rather than excessive detail. They recommended the “APSO” format, with the assessment and plan at the beginning, then the subjective history next, then the objective info such as vital signs and physical exam details. Studies have found this tends to work better than the “SOAP” method, with subjective history first.

Katherine Chretien, MD, chief of the hospitalist section at the Washington, D.C., VA Medical Center, described the growing use of crowd-sourcing and social media in medicine, by both physicians and patients. More than half of patients, a survey found, said that they are comfortable or very comfortable with their doctor seeking advice online. And about half of hospitals have a presence on Facebook, Twitter, Yelp, and Foursquare.

With the growing use of social media, though, comes the importance of knowing etiquette and being aware of the legal pitfalls, Dr. Chretien said. Posting specifics, even without names, about a case might violate patient privacy laws simply because the date of the post might give away too much information, she warned. Mixing the personal and the professional is not advised.

Peter Balingit, MD, a hospitalist at Olive View-UCLA Medical Center who said he doesn’t use social media for his work, said the session raised his confidence, and he might start a Facebook page or begin interacting through a patient portal.

“After hearing this, I think I’m more comfortable trying to develop more of an online presence,” he said. “My biggest fear is trying to keep my personal life and my professional life separate.” TH

SAN DIEGO — To talk to Nancy Allen, MD, a locum tenens physician who works in Portland, Me., is to get a sense of that head-spinning sensation you can have in the digital age. For hospitalists, it’s an endless stream of patients, diagnoses, documentation, and performance metrics. Following an HM16 session here, it’s also an endless litany of ways to try to make all of it more manageable.

Looking for on-the-job shortcuts, Dr. Allen attended the session “There Is an App for That, 2016: Update in Hospital Medicine Mobile Applications.”

“You always feel like there’s too much information,” she said. “I do 14-hour days. To add anything that takes time is crippling.”

The session was helpful, she said, with eye-opening presentations on apps Dr. Allen never knew existed. Most important, the recommendations came with the seal of approval of practicing hospitalists. But even the information presented in the session felt perhaps too much, she said.

“They seemed really doable,” Dr. Allen said. “But I felt like by the end, I’m overwhelmed.”

Health information technology (IT) had its own educational track for the first time at the annual meeting, with offerings on using technology for better documentation, social media, and clinical informatics.

In the apps session, presenters Bradley Benson, MD, professor of internal medicine and pediatrics at the University of Minnesota, and J. Richard Pittman Jr., MD, assistant professor of medicine at Emory University, cautioned that FDA regulation of mobile apps will be getting more stringent. They encouraged physicians to stay ahead of the game, using apps that are based on sound research so that they don’t begin to rely on apps that will eventually no longer be options.

Their recommendations were based on personal experience, some admittedly biased published reviews, objective criterion-referenced reviews, and peer-reviewed study data.

Dr. Allen said she was especially interested in MedCalX, an app designed for physicians and featuring medical formulas, scores, and classifications. She also liked that the presenters gave a lesson, short but complete, on how to get a Web-based app that you find on a browser to appear as an icon on your phone, just like any other app.

Presenter recommendations ranged from the nifty (GoodRx allows you to type in a medication and map both local pharmacies and what they charge for the drug) to those that help with basic life and job logistics (Evernote makes it easy to file away emails, attachments, and images). Evernote is the app Dr. Pittman said he’d keep if he could only use one.

As dizzying as it was, the session seemed to lift Dr. Allen’s hopes that she’d be able to incorporate apps more into her work.

“You have to make a decision on the fly a lot of the time,” she said. “You have to do it in real time. … In theory, apps should be able to do that.”

Teri Dyess, MD, director of hospital medicine at St. Dominic Hospital in Jackson, Miss., said that the “Optimizing IT for Documentation and Handoffs” session underscored a problem she has noticed in her department: doctors cutting and pasting too much information in their progress notes. That includes CT reports, labs, pretty much everything, she said.

“It’s just one long note,” she said, adding some notes “get out of hand.” Now, she has information—and reinforcement of her own concerns—that she can take back to her center.

Presenters said that physicians should remember that notes primarily serve the needs of patients and providers and should focus on quality and clarity rather than excessive detail. They recommended the “APSO” format, with the assessment and plan at the beginning, then the subjective history next, then the objective info such as vital signs and physical exam details. Studies have found this tends to work better than the “SOAP” method, with subjective history first.

Katherine Chretien, MD, chief of the hospitalist section at the Washington, D.C., VA Medical Center, described the growing use of crowd-sourcing and social media in medicine, by both physicians and patients. More than half of patients, a survey found, said that they are comfortable or very comfortable with their doctor seeking advice online. And about half of hospitals have a presence on Facebook, Twitter, Yelp, and Foursquare.

With the growing use of social media, though, comes the importance of knowing etiquette and being aware of the legal pitfalls, Dr. Chretien said. Posting specifics, even without names, about a case might violate patient privacy laws simply because the date of the post might give away too much information, she warned. Mixing the personal and the professional is not advised.

Peter Balingit, MD, a hospitalist at Olive View-UCLA Medical Center who said he doesn’t use social media for his work, said the session raised his confidence, and he might start a Facebook page or begin interacting through a patient portal.

“After hearing this, I think I’m more comfortable trying to develop more of an online presence,” he said. “My biggest fear is trying to keep my personal life and my professional life separate.” TH

SAN DIEGO — To talk to Nancy Allen, MD, a locum tenens physician who works in Portland, Me., is to get a sense of that head-spinning sensation you can have in the digital age. For hospitalists, it’s an endless stream of patients, diagnoses, documentation, and performance metrics. Following an HM16 session here, it’s also an endless litany of ways to try to make all of it more manageable.

Looking for on-the-job shortcuts, Dr. Allen attended the session “There Is an App for That, 2016: Update in Hospital Medicine Mobile Applications.”

“You always feel like there’s too much information,” she said. “I do 14-hour days. To add anything that takes time is crippling.”

The session was helpful, she said, with eye-opening presentations on apps Dr. Allen never knew existed. Most important, the recommendations came with the seal of approval of practicing hospitalists. But even the information presented in the session felt perhaps too much, she said.

“They seemed really doable,” Dr. Allen said. “But I felt like by the end, I’m overwhelmed.”

Health information technology (IT) had its own educational track for the first time at the annual meeting, with offerings on using technology for better documentation, social media, and clinical informatics.

In the apps session, presenters Bradley Benson, MD, professor of internal medicine and pediatrics at the University of Minnesota, and J. Richard Pittman Jr., MD, assistant professor of medicine at Emory University, cautioned that FDA regulation of mobile apps will be getting more stringent. They encouraged physicians to stay ahead of the game, using apps that are based on sound research so that they don’t begin to rely on apps that will eventually no longer be options.

Their recommendations were based on personal experience, some admittedly biased published reviews, objective criterion-referenced reviews, and peer-reviewed study data.

Dr. Allen said she was especially interested in MedCalX, an app designed for physicians and featuring medical formulas, scores, and classifications. She also liked that the presenters gave a lesson, short but complete, on how to get a Web-based app that you find on a browser to appear as an icon on your phone, just like any other app.

Presenter recommendations ranged from the nifty (GoodRx allows you to type in a medication and map both local pharmacies and what they charge for the drug) to those that help with basic life and job logistics (Evernote makes it easy to file away emails, attachments, and images). Evernote is the app Dr. Pittman said he’d keep if he could only use one.

As dizzying as it was, the session seemed to lift Dr. Allen’s hopes that she’d be able to incorporate apps more into her work.

“You have to make a decision on the fly a lot of the time,” she said. “You have to do it in real time. … In theory, apps should be able to do that.”

Teri Dyess, MD, director of hospital medicine at St. Dominic Hospital in Jackson, Miss., said that the “Optimizing IT for Documentation and Handoffs” session underscored a problem she has noticed in her department: doctors cutting and pasting too much information in their progress notes. That includes CT reports, labs, pretty much everything, she said.

“It’s just one long note,” she said, adding some notes “get out of hand.” Now, she has information—and reinforcement of her own concerns—that she can take back to her center.

Presenters said that physicians should remember that notes primarily serve the needs of patients and providers and should focus on quality and clarity rather than excessive detail. They recommended the “APSO” format, with the assessment and plan at the beginning, then the subjective history next, then the objective info such as vital signs and physical exam details. Studies have found this tends to work better than the “SOAP” method, with subjective history first.

Katherine Chretien, MD, chief of the hospitalist section at the Washington, D.C., VA Medical Center, described the growing use of crowd-sourcing and social media in medicine, by both physicians and patients. More than half of patients, a survey found, said that they are comfortable or very comfortable with their doctor seeking advice online. And about half of hospitals have a presence on Facebook, Twitter, Yelp, and Foursquare.

With the growing use of social media, though, comes the importance of knowing etiquette and being aware of the legal pitfalls, Dr. Chretien said. Posting specifics, even without names, about a case might violate patient privacy laws simply because the date of the post might give away too much information, she warned. Mixing the personal and the professional is not advised.

Peter Balingit, MD, a hospitalist at Olive View-UCLA Medical Center who said he doesn’t use social media for his work, said the session raised his confidence, and he might start a Facebook page or begin interacting through a patient portal.

“After hearing this, I think I’m more comfortable trying to develop more of an online presence,” he said. “My biggest fear is trying to keep my personal life and my professional life separate.” TH

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

SAN DIEGO — Hospital medicine’s annual extravaganza nestled into the southwestern corner of the country in March, with a record 4,000 hospitalists and others expanding their knowledge of clinical care, management, leadership, technology, and quality improvement.

They listened, they laughed, they learned.

Read more about the knowledge, experiences hospitalists shared at HM16.

Between the nitty-gritty of the workshops, expert panels, and forums, three high-profile speakers offered broad and insightful perspectives:

• U.S. Surgeon General Vivek Murthy, MD, MBA, a hospitalist by training, on his experiences as a hospitalist and his thoughts on the importance of public health in America;
• New SHM President Brian Harte, MD, SFHM, on the role of hospital medicine in cultivating leadership; and
• Hospitalist pioneer Robert Wachter, MD, MHM, on the future of hospital medicine as it reaches its 20th year since he introduced the term “hospitalist” in a New England Journal of Medicine article.

Dr. Murthy, formerly a hospitalist at Brigham and Women’s Hospital in Boston who in 2009 founded Doctors for America, an organization for healthcare improvement in the U.S., said his career as a hospitalist came as a surprise to him.

“When I was in medical school, I didn’t even know what a hospitalist was,” he said. “When I became a hospitalist, I thought it would be a temporary gig, something I did for a couple of years while I figured out what I really wanted to do. But as it turned out, I really loved what I did as a hospitalist. I love teaching. I love caring for patients. I love being part of a tight-knit team.”

He called good health “the key to opportunity,” explaining health is “intrinsically connected to the American dream.”

Hospitalists can play a role in building a “foundation for health,” he said. Four ingredients to this, he said, are creating a culture in which “healthy is equated with happiness” rather than associated with an attitude of “suck it up and eat your spinach”; changing our environment, such as adding sidewalks to encourage walking, to promote healthy behavior change; focusing on the spirit and mind as well as the body; and cultivating our ability to give and receive kindness, which he called “a source of healing.”

Dr. Harte described hospital medicine as “fertile ground” for leadership development.

“Our day-to-day experiences provide a leadership incubator that really no other specialty can claim,” he said.

He said he hopes that over the next several years, hospitalists and SHM make strides in these areas:

• Continuing and expanding membership;
• Continuing to push members and projects to focus on the Triple Aim, particularly patient- and family-centered care; and
• Better understanding hospitalists’ role in the era of risk.

“We need to clarify our position regarding specialty training and our training programs,” he added.

Dr. Harte recognized that such a discussion can get “difficult and contentious and political,” but that “when we look at what we have to do to be clinically effective, and what our current training programs and family medicine, internal medicine, and pediatrics provide for us, that gap to me only appears to be increasing.”

He said SHM has and will “continue to step up with curricula to fill those gaps.” However, he also said hospitalists “have to question what is the best way to train physicians for the roles of providers in the acute-care setting.”

Dr. Wachter, keeping his tradition of giving the final talk of the four-day conference, retraced the roots and successes of the field over the last 20 years. It was part history lesson, part report card, and part prognostication.

What the field has gotten wrong, so far, amounts to “an amazingly short list,” he said, but it’s not a nonexistent list.

“I think one thing we got wrong was a 7-days-on/7-days-off schedule,” he said, drawing applause. While it might be appealing to a 35-year-old doctor, he added, “I don’t believe this is a viable schedule for a 60-year-old.”

HM modeled itself after its closest cousin, emergency medicine, in which doctors frequently work 10- to 12-hour shifts every other day. Since that every-other-day schedule is not good for continuity, HM essentially strung together shifts for as many consecutive days as possible, leading to the 7-on/7-off. Now, many clinicians won’t consider positions without such a schedule even though it’s not a schedule suitable for everyone.

“I think we’ve shot ourselves in the foot,” he said. “Because what it means is you take all the work that needs to be done and you shove it into a very small amount of space. Therefore, the amount of intensity in that work that you have is, I think, undoable over time. I hope we rethink that.”

He cautioned that SHM is near the age when, all too often, societies begin to be complacent and needs to guard against the instinct to keep doing things as they have always been done.

“We need to instinctively say, ‘Wait a second, am I turning into all of those other societies that have become irrelevant—or less relevant—because of that reflex?’” he questioned.

He predicted that, even though value in care is now becoming an obsession, the digitization of healthcare ultimately will have a deeper impact on medicine.

“You ask me 10 years from now, I’m guessing that the fact that we’ve just gone from analog to digital will have turned out to be a bigger transformation,” he explained. “And the reason I say that is if you look at the history of every other industry that went from analog to digital, eventually the industries got turned upside down.”

Burnout, a prominent topic at the meeting, still doesn’t seem to be worse in hospital medicine than in many other specialties, he said, but it is a concern.

“We need to rethink this. We need to come up with some new practice models using information technology in new ways, collaborating with members of the team in different ways,” he said. “We have to take this issue and figure out a way of solving it.”

Dr. Wachter said hospital medicine needs to keep innovating and finding ways to add value; otherwise, the financial support hospitals give to hospital medicine could begin to shrink.

The field is facing challenges, he said, but he is clearly proud of its accomplishments. He said that before he went out on the stage at an early conference he organized in 1998, during the early days of hospital medicine, his wife asked him, “Are you sure this is a good idea?”

“What I said to her was, ‘It is a good idea, and it will be a good idea if we are successful in recruiting and retaining young people, innovative people who want to change the world,’” he said. “I think we have done that, and I thank all of you for turning this into a good idea.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — Hospital medicine’s annual extravaganza nestled into the southwestern corner of the country in March, with a record 4,000 hospitalists and others expanding their knowledge of clinical care, management, leadership, technology, and quality improvement.

They listened, they laughed, they learned.

Read more about the knowledge, experiences hospitalists shared at HM16.

Between the nitty-gritty of the workshops, expert panels, and forums, three high-profile speakers offered broad and insightful perspectives:

• U.S. Surgeon General Vivek Murthy, MD, MBA, a hospitalist by training, on his experiences as a hospitalist and his thoughts on the importance of public health in America;
• New SHM President Brian Harte, MD, SFHM, on the role of hospital medicine in cultivating leadership; and
• Hospitalist pioneer Robert Wachter, MD, MHM, on the future of hospital medicine as it reaches its 20th year since he introduced the term “hospitalist” in a New England Journal of Medicine article.

Dr. Murthy, formerly a hospitalist at Brigham and Women’s Hospital in Boston who in 2009 founded Doctors for America, an organization for healthcare improvement in the U.S., said his career as a hospitalist came as a surprise to him.

“When I was in medical school, I didn’t even know what a hospitalist was,” he said. “When I became a hospitalist, I thought it would be a temporary gig, something I did for a couple of years while I figured out what I really wanted to do. But as it turned out, I really loved what I did as a hospitalist. I love teaching. I love caring for patients. I love being part of a tight-knit team.”

He called good health “the key to opportunity,” explaining health is “intrinsically connected to the American dream.”

Hospitalists can play a role in building a “foundation for health,” he said. Four ingredients to this, he said, are creating a culture in which “healthy is equated with happiness” rather than associated with an attitude of “suck it up and eat your spinach”; changing our environment, such as adding sidewalks to encourage walking, to promote healthy behavior change; focusing on the spirit and mind as well as the body; and cultivating our ability to give and receive kindness, which he called “a source of healing.”

Dr. Harte described hospital medicine as “fertile ground” for leadership development.

“Our day-to-day experiences provide a leadership incubator that really no other specialty can claim,” he said.

He said he hopes that over the next several years, hospitalists and SHM make strides in these areas:

• Continuing and expanding membership;
• Continuing to push members and projects to focus on the Triple Aim, particularly patient- and family-centered care; and
• Better understanding hospitalists’ role in the era of risk.

“We need to clarify our position regarding specialty training and our training programs,” he added.

Dr. Harte recognized that such a discussion can get “difficult and contentious and political,” but that “when we look at what we have to do to be clinically effective, and what our current training programs and family medicine, internal medicine, and pediatrics provide for us, that gap to me only appears to be increasing.”

He said SHM has and will “continue to step up with curricula to fill those gaps.” However, he also said hospitalists “have to question what is the best way to train physicians for the roles of providers in the acute-care setting.”

Dr. Wachter, keeping his tradition of giving the final talk of the four-day conference, retraced the roots and successes of the field over the last 20 years. It was part history lesson, part report card, and part prognostication.

What the field has gotten wrong, so far, amounts to “an amazingly short list,” he said, but it’s not a nonexistent list.

“I think one thing we got wrong was a 7-days-on/7-days-off schedule,” he said, drawing applause. While it might be appealing to a 35-year-old doctor, he added, “I don’t believe this is a viable schedule for a 60-year-old.”

HM modeled itself after its closest cousin, emergency medicine, in which doctors frequently work 10- to 12-hour shifts every other day. Since that every-other-day schedule is not good for continuity, HM essentially strung together shifts for as many consecutive days as possible, leading to the 7-on/7-off. Now, many clinicians won’t consider positions without such a schedule even though it’s not a schedule suitable for everyone.

“I think we’ve shot ourselves in the foot,” he said. “Because what it means is you take all the work that needs to be done and you shove it into a very small amount of space. Therefore, the amount of intensity in that work that you have is, I think, undoable over time. I hope we rethink that.”

He cautioned that SHM is near the age when, all too often, societies begin to be complacent and needs to guard against the instinct to keep doing things as they have always been done.

“We need to instinctively say, ‘Wait a second, am I turning into all of those other societies that have become irrelevant—or less relevant—because of that reflex?’” he questioned.

He predicted that, even though value in care is now becoming an obsession, the digitization of healthcare ultimately will have a deeper impact on medicine.

“You ask me 10 years from now, I’m guessing that the fact that we’ve just gone from analog to digital will have turned out to be a bigger transformation,” he explained. “And the reason I say that is if you look at the history of every other industry that went from analog to digital, eventually the industries got turned upside down.”

Burnout, a prominent topic at the meeting, still doesn’t seem to be worse in hospital medicine than in many other specialties, he said, but it is a concern.

“We need to rethink this. We need to come up with some new practice models using information technology in new ways, collaborating with members of the team in different ways,” he said. “We have to take this issue and figure out a way of solving it.”

Dr. Wachter said hospital medicine needs to keep innovating and finding ways to add value; otherwise, the financial support hospitals give to hospital medicine could begin to shrink.

The field is facing challenges, he said, but he is clearly proud of its accomplishments. He said that before he went out on the stage at an early conference he organized in 1998, during the early days of hospital medicine, his wife asked him, “Are you sure this is a good idea?”

“What I said to her was, ‘It is a good idea, and it will be a good idea if we are successful in recruiting and retaining young people, innovative people who want to change the world,’” he said. “I think we have done that, and I thank all of you for turning this into a good idea.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — Hospital medicine’s annual extravaganza nestled into the southwestern corner of the country in March, with a record 4,000 hospitalists and others expanding their knowledge of clinical care, management, leadership, technology, and quality improvement.

They listened, they laughed, they learned.

Read more about the knowledge, experiences hospitalists shared at HM16.

Between the nitty-gritty of the workshops, expert panels, and forums, three high-profile speakers offered broad and insightful perspectives:

• U.S. Surgeon General Vivek Murthy, MD, MBA, a hospitalist by training, on his experiences as a hospitalist and his thoughts on the importance of public health in America;
• New SHM President Brian Harte, MD, SFHM, on the role of hospital medicine in cultivating leadership; and
• Hospitalist pioneer Robert Wachter, MD, MHM, on the future of hospital medicine as it reaches its 20th year since he introduced the term “hospitalist” in a New England Journal of Medicine article.

Dr. Murthy, formerly a hospitalist at Brigham and Women’s Hospital in Boston who in 2009 founded Doctors for America, an organization for healthcare improvement in the U.S., said his career as a hospitalist came as a surprise to him.

“When I was in medical school, I didn’t even know what a hospitalist was,” he said. “When I became a hospitalist, I thought it would be a temporary gig, something I did for a couple of years while I figured out what I really wanted to do. But as it turned out, I really loved what I did as a hospitalist. I love teaching. I love caring for patients. I love being part of a tight-knit team.”

He called good health “the key to opportunity,” explaining health is “intrinsically connected to the American dream.”

Hospitalists can play a role in building a “foundation for health,” he said. Four ingredients to this, he said, are creating a culture in which “healthy is equated with happiness” rather than associated with an attitude of “suck it up and eat your spinach”; changing our environment, such as adding sidewalks to encourage walking, to promote healthy behavior change; focusing on the spirit and mind as well as the body; and cultivating our ability to give and receive kindness, which he called “a source of healing.”

Dr. Harte described hospital medicine as “fertile ground” for leadership development.

“Our day-to-day experiences provide a leadership incubator that really no other specialty can claim,” he said.

He said he hopes that over the next several years, hospitalists and SHM make strides in these areas:

• Continuing and expanding membership;
• Continuing to push members and projects to focus on the Triple Aim, particularly patient- and family-centered care; and
• Better understanding hospitalists’ role in the era of risk.

“We need to clarify our position regarding specialty training and our training programs,” he added.

Dr. Harte recognized that such a discussion can get “difficult and contentious and political,” but that “when we look at what we have to do to be clinically effective, and what our current training programs and family medicine, internal medicine, and pediatrics provide for us, that gap to me only appears to be increasing.”

He said SHM has and will “continue to step up with curricula to fill those gaps.” However, he also said hospitalists “have to question what is the best way to train physicians for the roles of providers in the acute-care setting.”

Dr. Wachter, keeping his tradition of giving the final talk of the four-day conference, retraced the roots and successes of the field over the last 20 years. It was part history lesson, part report card, and part prognostication.

What the field has gotten wrong, so far, amounts to “an amazingly short list,” he said, but it’s not a nonexistent list.

“I think one thing we got wrong was a 7-days-on/7-days-off schedule,” he said, drawing applause. While it might be appealing to a 35-year-old doctor, he added, “I don’t believe this is a viable schedule for a 60-year-old.”

HM modeled itself after its closest cousin, emergency medicine, in which doctors frequently work 10- to 12-hour shifts every other day. Since that every-other-day schedule is not good for continuity, HM essentially strung together shifts for as many consecutive days as possible, leading to the 7-on/7-off. Now, many clinicians won’t consider positions without such a schedule even though it’s not a schedule suitable for everyone.

“I think we’ve shot ourselves in the foot,” he said. “Because what it means is you take all the work that needs to be done and you shove it into a very small amount of space. Therefore, the amount of intensity in that work that you have is, I think, undoable over time. I hope we rethink that.”

He cautioned that SHM is near the age when, all too often, societies begin to be complacent and needs to guard against the instinct to keep doing things as they have always been done.

“We need to instinctively say, ‘Wait a second, am I turning into all of those other societies that have become irrelevant—or less relevant—because of that reflex?’” he questioned.

He predicted that, even though value in care is now becoming an obsession, the digitization of healthcare ultimately will have a deeper impact on medicine.

“You ask me 10 years from now, I’m guessing that the fact that we’ve just gone from analog to digital will have turned out to be a bigger transformation,” he explained. “And the reason I say that is if you look at the history of every other industry that went from analog to digital, eventually the industries got turned upside down.”

Burnout, a prominent topic at the meeting, still doesn’t seem to be worse in hospital medicine than in many other specialties, he said, but it is a concern.

“We need to rethink this. We need to come up with some new practice models using information technology in new ways, collaborating with members of the team in different ways,” he said. “We have to take this issue and figure out a way of solving it.”

Dr. Wachter said hospital medicine needs to keep innovating and finding ways to add value; otherwise, the financial support hospitals give to hospital medicine could begin to shrink.

The field is facing challenges, he said, but he is clearly proud of its accomplishments. He said that before he went out on the stage at an early conference he organized in 1998, during the early days of hospital medicine, his wife asked him, “Are you sure this is a good idea?”

“What I said to her was, ‘It is a good idea, and it will be a good idea if we are successful in recruiting and retaining young people, innovative people who want to change the world,’” he said. “I think we have done that, and I thank all of you for turning this into a good idea.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — If you arrived late, or even right on time, to the session on becoming a better attending, you’d better have been ready to find a clear spot on the floor or have had the energy to stand for an hour.

Read more about the speakers at HM16.

But the dynamic talk, you could even say performance, by Jeffrey Wiese, MD, MHM, crackled with energy, so there was plenty of it to go around. The session, in its 10th year and now practically an institution of its own at the annual meeting, was a highlight among the offerings on career development at HM16.

Dr. Wiese liberally seasoned the session with role-playing and humor—the “patient” on the session-room floor but without a pillow meant “Press Ganey’s going to take a hit on this one,” he joked. He emphasized the importance of attending physicians to give reasons to support the expectations they have for their trainees.

“The key piece is giving that rationale. Once they have a reason for why they’re going to do it, now the expectation’s grounded, now it actually makes sense,” said Dr. Wiese, professor of medicine at Tulane University Health Sciences Center in New Orleans and a past SHM president. “You don’t do that, they’re going to fill in the gaps with their own expectations.”

Other points of emphasis:

• The importance of autonomy and choice so that trainees have a sense of purpose;
• The transition from self-interested medical students to residents who are concerned with the well-being of team members;
• The assurance of an endpoint so that hectic periods don’t spiral out of control; and
• Acts of ritual, such as using Purell before entering a patient’s room, as moments of “genuflect” to regain perspective.

Charles Kast, MD, an attending physician at Long Island Jewish Medical Center in New Hyde Park, N.Y., said the relationship theme resonated with him the most.

“It’s more the relationships the attendings have with their residents and with their students, and it’s more of an emotional connection,” he said. “Whether it’s education or mentoring or what have you, it’s all about developing that trust between the resident and the attending.”

But it’s a gradual process.

“It’s baby steps,” Dr. Kast added. “There were 17 different lists in there, right? So you’ve got to pick one and kind of go with it. I think it’s kind of an organic process, where one thing kind of leads to the next.”

Tactics to avoid burnout—by cultivating a sense of purpose while understanding and relating to trainees’ concerns—were a key part of Dr. Wiese’s message. Burnout was a topic that HM16 attendees returned to again and again when discussing their take-homes from the meeting. The subject popped up in almost every session to one degree or another.

David Nevin, MD, a hospitalist at ThedaCare in Wisconsin, said that he was reminded in one session—“Staying in the Game: Self-Care for Hospitalists”—that taking even brief moments for yourself can make a difference.

“Focusing on the positive for a moment and what’s good about your life, and doing that kind of exercise, helps sort of deal with burnout and bring things into perspective,” he said. “You get sort of worn down, you’re not as sharp, you miss things when you’re not at your peak in terms of looking at things.”

Ariana Peters, DO, who works at Mayo Clinic in Scottsdale, Ariz., said a similar message resonated with her, as well. There are ample situations when, if she doesn’t consciously take time for herself, things will seem to mushroom.

In just one recent example, she reflected on an especially difficult day.

“I had 18 patients, and it was horrible,” she said. “I left my office in the morning and didn’t come back until 8 p.m. that night. I was literally eating peanut butter and graham crackers on the floor.

“It doesn’t take long to just stop and take a breath. Twenty seconds is not a long time.”

Waiting for a session on personal productivity to start, Adam Garber, MD, assistant professor at Virginia Commonwealth University in Richmond, said that he found the introduction to the SMART approach (Specific, Measurable, Achievable, Relevant, and Time-Bound), meaning being able to be done within a certain period, was a good guideline to approaching projects of all kinds.

“I think you can apply it to any problem and career-development project you want to work on,” he said. “It just kind of gives you that framework of how to organize it, present it logically, and carry it out.” TH

SAN DIEGO — If you arrived late, or even right on time, to the session on becoming a better attending, you’d better have been ready to find a clear spot on the floor or have had the energy to stand for an hour.

Read more about the speakers at HM16.

But the dynamic talk, you could even say performance, by Jeffrey Wiese, MD, MHM, crackled with energy, so there was plenty of it to go around. The session, in its 10th year and now practically an institution of its own at the annual meeting, was a highlight among the offerings on career development at HM16.

Dr. Wiese liberally seasoned the session with role-playing and humor—the “patient” on the session-room floor but without a pillow meant “Press Ganey’s going to take a hit on this one,” he joked. He emphasized the importance of attending physicians to give reasons to support the expectations they have for their trainees.

“The key piece is giving that rationale. Once they have a reason for why they’re going to do it, now the expectation’s grounded, now it actually makes sense,” said Dr. Wiese, professor of medicine at Tulane University Health Sciences Center in New Orleans and a past SHM president. “You don’t do that, they’re going to fill in the gaps with their own expectations.”

Other points of emphasis:

• The importance of autonomy and choice so that trainees have a sense of purpose;
• The transition from self-interested medical students to residents who are concerned with the well-being of team members;
• The assurance of an endpoint so that hectic periods don’t spiral out of control; and
• Acts of ritual, such as using Purell before entering a patient’s room, as moments of “genuflect” to regain perspective.

Charles Kast, MD, an attending physician at Long Island Jewish Medical Center in New Hyde Park, N.Y., said the relationship theme resonated with him the most.

“It’s more the relationships the attendings have with their residents and with their students, and it’s more of an emotional connection,” he said. “Whether it’s education or mentoring or what have you, it’s all about developing that trust between the resident and the attending.”

But it’s a gradual process.

“It’s baby steps,” Dr. Kast added. “There were 17 different lists in there, right? So you’ve got to pick one and kind of go with it. I think it’s kind of an organic process, where one thing kind of leads to the next.”

Tactics to avoid burnout—by cultivating a sense of purpose while understanding and relating to trainees’ concerns—were a key part of Dr. Wiese’s message. Burnout was a topic that HM16 attendees returned to again and again when discussing their take-homes from the meeting. The subject popped up in almost every session to one degree or another.

David Nevin, MD, a hospitalist at ThedaCare in Wisconsin, said that he was reminded in one session—“Staying in the Game: Self-Care for Hospitalists”—that taking even brief moments for yourself can make a difference.

“Focusing on the positive for a moment and what’s good about your life, and doing that kind of exercise, helps sort of deal with burnout and bring things into perspective,” he said. “You get sort of worn down, you’re not as sharp, you miss things when you’re not at your peak in terms of looking at things.”

Ariana Peters, DO, who works at Mayo Clinic in Scottsdale, Ariz., said a similar message resonated with her, as well. There are ample situations when, if she doesn’t consciously take time for herself, things will seem to mushroom.

In just one recent example, she reflected on an especially difficult day.

“I had 18 patients, and it was horrible,” she said. “I left my office in the morning and didn’t come back until 8 p.m. that night. I was literally eating peanut butter and graham crackers on the floor.

“It doesn’t take long to just stop and take a breath. Twenty seconds is not a long time.”

Waiting for a session on personal productivity to start, Adam Garber, MD, assistant professor at Virginia Commonwealth University in Richmond, said that he found the introduction to the SMART approach (Specific, Measurable, Achievable, Relevant, and Time-Bound), meaning being able to be done within a certain period, was a good guideline to approaching projects of all kinds.

“I think you can apply it to any problem and career-development project you want to work on,” he said. “It just kind of gives you that framework of how to organize it, present it logically, and carry it out.” TH

SAN DIEGO — If you arrived late, or even right on time, to the session on becoming a better attending, you’d better have been ready to find a clear spot on the floor or have had the energy to stand for an hour.

Read more about the speakers at HM16.

But the dynamic talk, you could even say performance, by Jeffrey Wiese, MD, MHM, crackled with energy, so there was plenty of it to go around. The session, in its 10th year and now practically an institution of its own at the annual meeting, was a highlight among the offerings on career development at HM16.

Dr. Wiese liberally seasoned the session with role-playing and humor—the “patient” on the session-room floor but without a pillow meant “Press Ganey’s going to take a hit on this one,” he joked. He emphasized the importance of attending physicians to give reasons to support the expectations they have for their trainees.

“The key piece is giving that rationale. Once they have a reason for why they’re going to do it, now the expectation’s grounded, now it actually makes sense,” said Dr. Wiese, professor of medicine at Tulane University Health Sciences Center in New Orleans and a past SHM president. “You don’t do that, they’re going to fill in the gaps with their own expectations.”

Other points of emphasis:

• The importance of autonomy and choice so that trainees have a sense of purpose;
• The transition from self-interested medical students to residents who are concerned with the well-being of team members;
• The assurance of an endpoint so that hectic periods don’t spiral out of control; and
• Acts of ritual, such as using Purell before entering a patient’s room, as moments of “genuflect” to regain perspective.

Charles Kast, MD, an attending physician at Long Island Jewish Medical Center in New Hyde Park, N.Y., said the relationship theme resonated with him the most.

“It’s more the relationships the attendings have with their residents and with their students, and it’s more of an emotional connection,” he said. “Whether it’s education or mentoring or what have you, it’s all about developing that trust between the resident and the attending.”

But it’s a gradual process.

“It’s baby steps,” Dr. Kast added. “There were 17 different lists in there, right? So you’ve got to pick one and kind of go with it. I think it’s kind of an organic process, where one thing kind of leads to the next.”

Tactics to avoid burnout—by cultivating a sense of purpose while understanding and relating to trainees’ concerns—were a key part of Dr. Wiese’s message. Burnout was a topic that HM16 attendees returned to again and again when discussing their take-homes from the meeting. The subject popped up in almost every session to one degree or another.

David Nevin, MD, a hospitalist at ThedaCare in Wisconsin, said that he was reminded in one session—“Staying in the Game: Self-Care for Hospitalists”—that taking even brief moments for yourself can make a difference.

“Focusing on the positive for a moment and what’s good about your life, and doing that kind of exercise, helps sort of deal with burnout and bring things into perspective,” he said. “You get sort of worn down, you’re not as sharp, you miss things when you’re not at your peak in terms of looking at things.”

Ariana Peters, DO, who works at Mayo Clinic in Scottsdale, Ariz., said a similar message resonated with her, as well. There are ample situations when, if she doesn’t consciously take time for herself, things will seem to mushroom.

In just one recent example, she reflected on an especially difficult day.

“I had 18 patients, and it was horrible,” she said. “I left my office in the morning and didn’t come back until 8 p.m. that night. I was literally eating peanut butter and graham crackers on the floor.

“It doesn’t take long to just stop and take a breath. Twenty seconds is not a long time.”

Waiting for a session on personal productivity to start, Adam Garber, MD, assistant professor at Virginia Commonwealth University in Richmond, said that he found the introduction to the SMART approach (Specific, Measurable, Achievable, Relevant, and Time-Bound), meaning being able to be done within a certain period, was a good guideline to approaching projects of all kinds.

“I think you can apply it to any problem and career-development project you want to work on,” he said. “It just kind of gives you that framework of how to organize it, present it logically, and carry it out.” TH

Yes, it rained some in dry San Diego—for the first time in a month, according to locals. But that was the extent of the disappointment at HM16—SHM’s annual meeting highlighted by inspiring words from the U.S. surgeon general, a fellow hospitalist.

Read more about the speakers at HM16.

HM16 featured fascinating perspectives from giants in the field, vigorous panel discussions, lively workshops, streamlined how-to’s, encouraging work-life talks, and practical presentations on management.

And a record-breaking crowd continued the field’s trajectory of expansion.

“You were 4,000 strong this year,” said assistant course director Leonard Feldman, MD, SFHM. “Next year, let’s try for five.”

Yes, it rained some in dry San Diego—for the first time in a month, according to locals. But that was the extent of the disappointment at HM16—SHM’s annual meeting highlighted by inspiring words from the U.S. surgeon general, a fellow hospitalist.

Read more about the speakers at HM16.

HM16 featured fascinating perspectives from giants in the field, vigorous panel discussions, lively workshops, streamlined how-to’s, encouraging work-life talks, and practical presentations on management.

And a record-breaking crowd continued the field’s trajectory of expansion.

“You were 4,000 strong this year,” said assistant course director Leonard Feldman, MD, SFHM. “Next year, let’s try for five.”

Yes, it rained some in dry San Diego—for the first time in a month, according to locals. But that was the extent of the disappointment at HM16—SHM’s annual meeting highlighted by inspiring words from the U.S. surgeon general, a fellow hospitalist.

Read more about the speakers at HM16.

HM16 featured fascinating perspectives from giants in the field, vigorous panel discussions, lively workshops, streamlined how-to’s, encouraging work-life talks, and practical presentations on management.

And a record-breaking crowd continued the field’s trajectory of expansion.

“You were 4,000 strong this year,” said assistant course director Leonard Feldman, MD, SFHM. “Next year, let’s try for five.”

Kendall Rogers, MD, SFHM, chair of SHM’s Health IT Committee, discusses HM16 having a separate track for health IT, to whom the track is geared, and translating tech-savviness into actually being effective in helping to develop practical health IT.

Kendall Rogers, MD, SFHM, chair of SHM’s Health IT Committee, discusses HM16 having a separate track for health IT, to whom the track is geared, and translating tech-savviness into actually being effective in helping to develop practical health IT.

Kendall Rogers, MD, SFHM, chair of SHM’s Health IT Committee, discusses HM16 having a separate track for health IT, to whom the track is geared, and translating tech-savviness into actually being effective in helping to develop practical health IT.