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Coordinating data collection in a QI project
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I am currently working with my mentor, Dr. Ian Jenkins, an attending in the Division of Hospital Medicine at the University of California, San Diego, to start piloting data collection on our project to cut catheter-associated urinary tract infections (CAUTI). We have contacted a number of potential units to recruit for CAUTI prevention efforts, but we are hoping to do a preliminary trial of data collection to better estimate the amount of time it takes to gather data for an individual unit.
I am quickly learning that conducting a successful quality improvement project requires one to be forward-looking in an attempt to identify challenges before they arise. With respect to coordinating data collection, it may have been helpful for us to initially meet with hospital staff to identify the best staff for coordinating data collection efforts (i.e. physician, nurse, trainee) within each individual unit. This could potentially have helped us to also better communicate and recruit individuals to partner with us for our project.
I am continuing to enjoy the challenges of performing a quality improvement project. One skill that I have developed is learning how to be forward-thinking in my approach to research in an attempt to handle challenges prospectively, as opposed to retrospectively. This has helped me improve everything from how I think about data collection to how I think about displaying results. I am truly grateful to my mentor Dr. Jenkins for his help in this regard.
Victor Ekuta is a third-year medical student at UC San Diego.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I am currently working with my mentor, Dr. Ian Jenkins, an attending in the Division of Hospital Medicine at the University of California, San Diego, to start piloting data collection on our project to cut catheter-associated urinary tract infections (CAUTI). We have contacted a number of potential units to recruit for CAUTI prevention efforts, but we are hoping to do a preliminary trial of data collection to better estimate the amount of time it takes to gather data for an individual unit.
I am quickly learning that conducting a successful quality improvement project requires one to be forward-looking in an attempt to identify challenges before they arise. With respect to coordinating data collection, it may have been helpful for us to initially meet with hospital staff to identify the best staff for coordinating data collection efforts (i.e. physician, nurse, trainee) within each individual unit. This could potentially have helped us to also better communicate and recruit individuals to partner with us for our project.
I am continuing to enjoy the challenges of performing a quality improvement project. One skill that I have developed is learning how to be forward-thinking in my approach to research in an attempt to handle challenges prospectively, as opposed to retrospectively. This has helped me improve everything from how I think about data collection to how I think about displaying results. I am truly grateful to my mentor Dr. Jenkins for his help in this regard.
Victor Ekuta is a third-year medical student at UC San Diego.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I am currently working with my mentor, Dr. Ian Jenkins, an attending in the Division of Hospital Medicine at the University of California, San Diego, to start piloting data collection on our project to cut catheter-associated urinary tract infections (CAUTI). We have contacted a number of potential units to recruit for CAUTI prevention efforts, but we are hoping to do a preliminary trial of data collection to better estimate the amount of time it takes to gather data for an individual unit.
I am quickly learning that conducting a successful quality improvement project requires one to be forward-looking in an attempt to identify challenges before they arise. With respect to coordinating data collection, it may have been helpful for us to initially meet with hospital staff to identify the best staff for coordinating data collection efforts (i.e. physician, nurse, trainee) within each individual unit. This could potentially have helped us to also better communicate and recruit individuals to partner with us for our project.
I am continuing to enjoy the challenges of performing a quality improvement project. One skill that I have developed is learning how to be forward-thinking in my approach to research in an attempt to handle challenges prospectively, as opposed to retrospectively. This has helped me improve everything from how I think about data collection to how I think about displaying results. I am truly grateful to my mentor Dr. Jenkins for his help in this regard.
Victor Ekuta is a third-year medical student at UC San Diego.
Understanding people is complex, yet essential for effective leadership
Editor’s note: Each month, Society of Hospital Medicine puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Log on to www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise to help SHM improve the care of hospitalized patients.
What are the requirements to become a Master in Hospital Medicine, and how has this designation been beneficial to your career?
I have been an SHM member since the early years (early 2000s, I think), and I became a Master in Hospital Medicine (MHM) in 2013. I see the MHM designation as recognizing accomplishments that have been critical in advancing the field of hospital medicine and SHM as a society.
I would guess that my contributions to the SHM Board, being SHM president, cofounding (with others) the Academic Hospitalist Academy, founding (with others) the Quality Safety Educators Academy, and being the founding chair of the American Board of Internal Medicine’s Focused Practice in Hospital Medicine pathway were probably what led to my induction.
The salient question probably isn’t “How has this designation been beneficial to my career?” but, rather, “How, after receiving the MHM designation, has my career benefited hospital medicine and SHM?” To my mind, there are some awards in life that recognize excellence in the completion of a task. They herald the end of a finite game: a “best research project” award, for example. But then there are a special few recognitions that, while they recognize past contributions, focus more upon the future than the past. They are infinite recognitions, because implicitly, they are recognitions of “promise” as much as achievement. They convey the organization’s trust in, and high expectations for, the recipient. In sum, they are simultaneously an honor and an obligation … an obligation and an expectation that the recipient will continue to do even more. In academic parlance, being “tenured” is a good example; for the Society of Hospital Medicine, the equivalent is the MHM recognition. I have done a lot for SHM, but the MHM designation obligates me to do even more. Honoring that obligation is what I plan to do with my career.
How did you become involved with SHM’s Leadership Academy, and how has the program developed over the years?
I started doing a 1-hour talk when the Mastering Teamwork course started. I did that for a couple of years but, as my career was evolving into higher-level institutional and hospital leadership, there was much more to talk about than I could fit into 1 hour.
The core of my leadership message is based in the “character ethic” (being better than who you are) and not the popular “personality ethic” (looking better than you are). So it’s that … plus all of the leadership mistakes I have made along the way. And that’s a lot of mistakes … enough to fill 9 hours of Mastering Teamwork.
In your opinion, what are some of the main takeaways for those who participate in SHM’s Leadership Academy?
Two of the three core components of great leadership are having a mission and purpose and being sincere. Leadership Academy can’t deliver the first two, so participants do have to come prepared to be trained.
Understanding people is the third core component, and mastering that skill is really complex. It is not something you can do with a clever slogan and a new lapel pin. It comes in many forms: teamwork, communication, networking, dealing with crisis, orchestrating change, etc. But at its core, Leadership Academy is all about training future leaders in how to understand people … and to develop the skills to inspire, motivate, and move their team to greater heights. Because at its core, leadership is about getting people to go places they otherwise didn’t want to go and to do things that they didn’t already want to do. And, to do that, you have to understand people.
As an active SHM member of many years, what advice do you have for members who wish to get more involved?
You have to start somewhere, and you have to see the entry level years as investing in yourself. There will be sacrifice involved, so don’t expect immediate returns on the investment, and the first few years might not be that fun.
Every year, there is a call for committee membership, and you need to get involved in one or more of those committees. Find the most senior hospitalist, who is the most involved in SHM, and tell her that you want to be on an SHM committee, and could she nominate you? If you do not have that luxury, then pay attention at the SHM annual conference. The SHM president-elect is responsible for building out the SHM committee nominees; as president, you are always looking to find enthusiastic people to be on the committees. Receiving emails from enthusiastic members is more welcome than you might think. As soon as that person is announced, find her email and start making the request to be on a committee. Be open to the assignment: Even if it is not your favorite committee, being there is more important than not.
But remember, networking and reputation are “two tailed.” You can improve your reputation by meaningful and consistent participation on a committee (leading to higher and better leadership opportunities), but you can also tarnish it by being assigned to a committee and not doing anything. You do that once, and there is a high probability that you will not be asked back again.
Great strategy, at the end of the day, is always putting yourself in a position with the maximum number of options. The key to personal development strategy is networking. The more people you know, the higher the probability that your email box will light up with the “Hey, do you want to collaborate on this project together?” sort of emails. Attend the annual conferences, attend the SHM Academies (Leadership, Quality and Safety Educators Academy, Academic Hospitalist Academy, etc.). Build genuine relationships with the people you meet there, and the rest will work out just fine.
Ms. Steele is the marketing communications specialist at the Society of Hospital Medicine.
Editor’s note: Each month, Society of Hospital Medicine puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Log on to www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise to help SHM improve the care of hospitalized patients.
What are the requirements to become a Master in Hospital Medicine, and how has this designation been beneficial to your career?
I have been an SHM member since the early years (early 2000s, I think), and I became a Master in Hospital Medicine (MHM) in 2013. I see the MHM designation as recognizing accomplishments that have been critical in advancing the field of hospital medicine and SHM as a society.
I would guess that my contributions to the SHM Board, being SHM president, cofounding (with others) the Academic Hospitalist Academy, founding (with others) the Quality Safety Educators Academy, and being the founding chair of the American Board of Internal Medicine’s Focused Practice in Hospital Medicine pathway were probably what led to my induction.
The salient question probably isn’t “How has this designation been beneficial to my career?” but, rather, “How, after receiving the MHM designation, has my career benefited hospital medicine and SHM?” To my mind, there are some awards in life that recognize excellence in the completion of a task. They herald the end of a finite game: a “best research project” award, for example. But then there are a special few recognitions that, while they recognize past contributions, focus more upon the future than the past. They are infinite recognitions, because implicitly, they are recognitions of “promise” as much as achievement. They convey the organization’s trust in, and high expectations for, the recipient. In sum, they are simultaneously an honor and an obligation … an obligation and an expectation that the recipient will continue to do even more. In academic parlance, being “tenured” is a good example; for the Society of Hospital Medicine, the equivalent is the MHM recognition. I have done a lot for SHM, but the MHM designation obligates me to do even more. Honoring that obligation is what I plan to do with my career.
How did you become involved with SHM’s Leadership Academy, and how has the program developed over the years?
I started doing a 1-hour talk when the Mastering Teamwork course started. I did that for a couple of years but, as my career was evolving into higher-level institutional and hospital leadership, there was much more to talk about than I could fit into 1 hour.
The core of my leadership message is based in the “character ethic” (being better than who you are) and not the popular “personality ethic” (looking better than you are). So it’s that … plus all of the leadership mistakes I have made along the way. And that’s a lot of mistakes … enough to fill 9 hours of Mastering Teamwork.
In your opinion, what are some of the main takeaways for those who participate in SHM’s Leadership Academy?
Two of the three core components of great leadership are having a mission and purpose and being sincere. Leadership Academy can’t deliver the first two, so participants do have to come prepared to be trained.
Understanding people is the third core component, and mastering that skill is really complex. It is not something you can do with a clever slogan and a new lapel pin. It comes in many forms: teamwork, communication, networking, dealing with crisis, orchestrating change, etc. But at its core, Leadership Academy is all about training future leaders in how to understand people … and to develop the skills to inspire, motivate, and move their team to greater heights. Because at its core, leadership is about getting people to go places they otherwise didn’t want to go and to do things that they didn’t already want to do. And, to do that, you have to understand people.
As an active SHM member of many years, what advice do you have for members who wish to get more involved?
You have to start somewhere, and you have to see the entry level years as investing in yourself. There will be sacrifice involved, so don’t expect immediate returns on the investment, and the first few years might not be that fun.
Every year, there is a call for committee membership, and you need to get involved in one or more of those committees. Find the most senior hospitalist, who is the most involved in SHM, and tell her that you want to be on an SHM committee, and could she nominate you? If you do not have that luxury, then pay attention at the SHM annual conference. The SHM president-elect is responsible for building out the SHM committee nominees; as president, you are always looking to find enthusiastic people to be on the committees. Receiving emails from enthusiastic members is more welcome than you might think. As soon as that person is announced, find her email and start making the request to be on a committee. Be open to the assignment: Even if it is not your favorite committee, being there is more important than not.
But remember, networking and reputation are “two tailed.” You can improve your reputation by meaningful and consistent participation on a committee (leading to higher and better leadership opportunities), but you can also tarnish it by being assigned to a committee and not doing anything. You do that once, and there is a high probability that you will not be asked back again.
Great strategy, at the end of the day, is always putting yourself in a position with the maximum number of options. The key to personal development strategy is networking. The more people you know, the higher the probability that your email box will light up with the “Hey, do you want to collaborate on this project together?” sort of emails. Attend the annual conferences, attend the SHM Academies (Leadership, Quality and Safety Educators Academy, Academic Hospitalist Academy, etc.). Build genuine relationships with the people you meet there, and the rest will work out just fine.
Ms. Steele is the marketing communications specialist at the Society of Hospital Medicine.
Editor’s note: Each month, Society of Hospital Medicine puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Log on to www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise to help SHM improve the care of hospitalized patients.
What are the requirements to become a Master in Hospital Medicine, and how has this designation been beneficial to your career?
I have been an SHM member since the early years (early 2000s, I think), and I became a Master in Hospital Medicine (MHM) in 2013. I see the MHM designation as recognizing accomplishments that have been critical in advancing the field of hospital medicine and SHM as a society.
I would guess that my contributions to the SHM Board, being SHM president, cofounding (with others) the Academic Hospitalist Academy, founding (with others) the Quality Safety Educators Academy, and being the founding chair of the American Board of Internal Medicine’s Focused Practice in Hospital Medicine pathway were probably what led to my induction.
The salient question probably isn’t “How has this designation been beneficial to my career?” but, rather, “How, after receiving the MHM designation, has my career benefited hospital medicine and SHM?” To my mind, there are some awards in life that recognize excellence in the completion of a task. They herald the end of a finite game: a “best research project” award, for example. But then there are a special few recognitions that, while they recognize past contributions, focus more upon the future than the past. They are infinite recognitions, because implicitly, they are recognitions of “promise” as much as achievement. They convey the organization’s trust in, and high expectations for, the recipient. In sum, they are simultaneously an honor and an obligation … an obligation and an expectation that the recipient will continue to do even more. In academic parlance, being “tenured” is a good example; for the Society of Hospital Medicine, the equivalent is the MHM recognition. I have done a lot for SHM, but the MHM designation obligates me to do even more. Honoring that obligation is what I plan to do with my career.
How did you become involved with SHM’s Leadership Academy, and how has the program developed over the years?
I started doing a 1-hour talk when the Mastering Teamwork course started. I did that for a couple of years but, as my career was evolving into higher-level institutional and hospital leadership, there was much more to talk about than I could fit into 1 hour.
The core of my leadership message is based in the “character ethic” (being better than who you are) and not the popular “personality ethic” (looking better than you are). So it’s that … plus all of the leadership mistakes I have made along the way. And that’s a lot of mistakes … enough to fill 9 hours of Mastering Teamwork.
In your opinion, what are some of the main takeaways for those who participate in SHM’s Leadership Academy?
Two of the three core components of great leadership are having a mission and purpose and being sincere. Leadership Academy can’t deliver the first two, so participants do have to come prepared to be trained.
Understanding people is the third core component, and mastering that skill is really complex. It is not something you can do with a clever slogan and a new lapel pin. It comes in many forms: teamwork, communication, networking, dealing with crisis, orchestrating change, etc. But at its core, Leadership Academy is all about training future leaders in how to understand people … and to develop the skills to inspire, motivate, and move their team to greater heights. Because at its core, leadership is about getting people to go places they otherwise didn’t want to go and to do things that they didn’t already want to do. And, to do that, you have to understand people.
As an active SHM member of many years, what advice do you have for members who wish to get more involved?
You have to start somewhere, and you have to see the entry level years as investing in yourself. There will be sacrifice involved, so don’t expect immediate returns on the investment, and the first few years might not be that fun.
Every year, there is a call for committee membership, and you need to get involved in one or more of those committees. Find the most senior hospitalist, who is the most involved in SHM, and tell her that you want to be on an SHM committee, and could she nominate you? If you do not have that luxury, then pay attention at the SHM annual conference. The SHM president-elect is responsible for building out the SHM committee nominees; as president, you are always looking to find enthusiastic people to be on the committees. Receiving emails from enthusiastic members is more welcome than you might think. As soon as that person is announced, find her email and start making the request to be on a committee. Be open to the assignment: Even if it is not your favorite committee, being there is more important than not.
But remember, networking and reputation are “two tailed.” You can improve your reputation by meaningful and consistent participation on a committee (leading to higher and better leadership opportunities), but you can also tarnish it by being assigned to a committee and not doing anything. You do that once, and there is a high probability that you will not be asked back again.
Great strategy, at the end of the day, is always putting yourself in a position with the maximum number of options. The key to personal development strategy is networking. The more people you know, the higher the probability that your email box will light up with the “Hey, do you want to collaborate on this project together?” sort of emails. Attend the annual conferences, attend the SHM Academies (Leadership, Quality and Safety Educators Academy, Academic Hospitalist Academy, etc.). Build genuine relationships with the people you meet there, and the rest will work out just fine.
Ms. Steele is the marketing communications specialist at the Society of Hospital Medicine.
Emphasizing an entrepreneurial spirit: Raman Palabindala, MD
Venkatraraman “Raman” Palabindala, MD, FACP, SFHM, was destined to be a doctor since his first breath. Born in India, his father decided Dr. Palabindala would take the mantle as the doctor of the family, while his siblings took to other professions like engineering.
Eager to be in the thick of things, Dr. Palabindala has voraciously pursued leadership positions, leading to his current role as chief of the Division of Hospital Medicine at the University of Mississippi Medical Center, Jackson.
Dr. Palabindala is enthusiastic about his role as one of the eight new members of The Hospitalist editorial advisory board, and took time to tell us more about himself in a recent interview.
Q: How did you get into medicine?
A: It’s all because of my dad’s motivation. My father believed in education, so when I was born, he said, “He’s going to be a doctor,” and as I grew up, I just worked towards being a physician and nothing else. I didn’t even have an option of choosing anything else. My dad said that I would be a doctor, and I am a doctor. I feel like that was the best thing that happened to me, though; it worked out well.
Q: How and when did you decide to go into hospital medicine?
A: After I came to the U.S., I joined residency in internal medicine at GBMC – that’s Greater Baltimore Medical Center – it’s affiliated with Johns Hopkins. I always wanted to be an internist, but my experiences in the clinic world were not so great. But I really enjoyed inpatient medicine, so in my 3rd year, when I was doing my chief residency year, I did get opportunities to join a fellowship, but I decided just to be a hospitalist at that time.
Q: What do you find to be rewarding about hospital medicine?
Q: What is one of the biggest challenges in hospital medicine?
A: I think talking about the business aspect of medicine, because it is like a taboo. We don’t really want to talk about whether the patient is covered or not covered by insurance, how much we are billing, and why we must discuss business issues while we are trying to focus on patient care, but these things are going to indirectly affect patient care, too. If you didn’t note the patient status accurately, they are going to get an inappropriate bill.
Q: What’s the best advice you have received that you try to pass on to your students?
A: Do the rounds at the bedside. We have the tendency of doing everything outside and then going in the room and just telling the patient what we are going to do. Instead, I encourage everyone to be at the bedside. Even without students, I go and sit at the bedside and then review the data in terms the patient can understand, and then explain the care plan, so they actually feel like we are at the bedside for a longer time. We are with the patient for at least 10 to 15 minutes, but at the same time, we are getting things done. I encourage my students and residents to do this.
Q: What is the worst advice you’ve received?
A: I don’t know if this is the “worst” advice, but in my second year, I was trying to take some leadership positions and was told I should wait, that leadership skills come with experience. I do think that’s a bad piece of advice. It’s all about learning how hard you work and then how fast you learn, and then how fast you implement. People who work, learn, and implement quickly can make a difference.
Q: Outside of patient care, what other career interests do you have?
A: I’m interested in smart clinics, and I actually have a patent for smart clinic chains. I’m a big fan of primary care, because, like hospitalists revolutionized inpatient care, I think we can revolutionize the outpatient care experience as well. I don’t think we are being very efficient with outpatient care.
But if I was not practicing medicine, I probably would be a chef. I like to cook, and I would open up my own restaurant if I was not doing this.
Q: Where do you see yourself in 10 years?
A: I want to be a consultant, evaluating hospitalist programs and guiding programs to grow and be more efficient. That, I think, would be the primary job that I would like to be doing, along with giving lectures and teaching about patient safety and quality, and educating younger physicians about the business of medicine.
Q: What experience with SHM has made the most lasting impact on you?
A: I would say the best impression was from the Academic Hospitalist Academy meeting I attended in Denver. I think that was helpful, because it was like a boot camp where you have only a limited number of attendees with a dedicated mentor. That was amazing, and I learned a lot. It helped me in redesigning my approach to where I would like to be both short- and long-term. I implemented at least 50 percent of what I learned at that meeting.
Q: What’s the best book that you’ve read recently and why was it the best?
A: Being Mortal by Atul Gawande. It’s a really beautiful book.
[email protected]
On Twitter @eaztweets
Venkatraraman “Raman” Palabindala, MD, FACP, SFHM, was destined to be a doctor since his first breath. Born in India, his father decided Dr. Palabindala would take the mantle as the doctor of the family, while his siblings took to other professions like engineering.
Eager to be in the thick of things, Dr. Palabindala has voraciously pursued leadership positions, leading to his current role as chief of the Division of Hospital Medicine at the University of Mississippi Medical Center, Jackson.
Dr. Palabindala is enthusiastic about his role as one of the eight new members of The Hospitalist editorial advisory board, and took time to tell us more about himself in a recent interview.
Q: How did you get into medicine?
A: It’s all because of my dad’s motivation. My father believed in education, so when I was born, he said, “He’s going to be a doctor,” and as I grew up, I just worked towards being a physician and nothing else. I didn’t even have an option of choosing anything else. My dad said that I would be a doctor, and I am a doctor. I feel like that was the best thing that happened to me, though; it worked out well.
Q: How and when did you decide to go into hospital medicine?
A: After I came to the U.S., I joined residency in internal medicine at GBMC – that’s Greater Baltimore Medical Center – it’s affiliated with Johns Hopkins. I always wanted to be an internist, but my experiences in the clinic world were not so great. But I really enjoyed inpatient medicine, so in my 3rd year, when I was doing my chief residency year, I did get opportunities to join a fellowship, but I decided just to be a hospitalist at that time.
Q: What do you find to be rewarding about hospital medicine?
Q: What is one of the biggest challenges in hospital medicine?
A: I think talking about the business aspect of medicine, because it is like a taboo. We don’t really want to talk about whether the patient is covered or not covered by insurance, how much we are billing, and why we must discuss business issues while we are trying to focus on patient care, but these things are going to indirectly affect patient care, too. If you didn’t note the patient status accurately, they are going to get an inappropriate bill.
Q: What’s the best advice you have received that you try to pass on to your students?
A: Do the rounds at the bedside. We have the tendency of doing everything outside and then going in the room and just telling the patient what we are going to do. Instead, I encourage everyone to be at the bedside. Even without students, I go and sit at the bedside and then review the data in terms the patient can understand, and then explain the care plan, so they actually feel like we are at the bedside for a longer time. We are with the patient for at least 10 to 15 minutes, but at the same time, we are getting things done. I encourage my students and residents to do this.
Q: What is the worst advice you’ve received?
A: I don’t know if this is the “worst” advice, but in my second year, I was trying to take some leadership positions and was told I should wait, that leadership skills come with experience. I do think that’s a bad piece of advice. It’s all about learning how hard you work and then how fast you learn, and then how fast you implement. People who work, learn, and implement quickly can make a difference.
Q: Outside of patient care, what other career interests do you have?
A: I’m interested in smart clinics, and I actually have a patent for smart clinic chains. I’m a big fan of primary care, because, like hospitalists revolutionized inpatient care, I think we can revolutionize the outpatient care experience as well. I don’t think we are being very efficient with outpatient care.
But if I was not practicing medicine, I probably would be a chef. I like to cook, and I would open up my own restaurant if I was not doing this.
Q: Where do you see yourself in 10 years?
A: I want to be a consultant, evaluating hospitalist programs and guiding programs to grow and be more efficient. That, I think, would be the primary job that I would like to be doing, along with giving lectures and teaching about patient safety and quality, and educating younger physicians about the business of medicine.
Q: What experience with SHM has made the most lasting impact on you?
A: I would say the best impression was from the Academic Hospitalist Academy meeting I attended in Denver. I think that was helpful, because it was like a boot camp where you have only a limited number of attendees with a dedicated mentor. That was amazing, and I learned a lot. It helped me in redesigning my approach to where I would like to be both short- and long-term. I implemented at least 50 percent of what I learned at that meeting.
Q: What’s the best book that you’ve read recently and why was it the best?
A: Being Mortal by Atul Gawande. It’s a really beautiful book.
[email protected]
On Twitter @eaztweets
Venkatraraman “Raman” Palabindala, MD, FACP, SFHM, was destined to be a doctor since his first breath. Born in India, his father decided Dr. Palabindala would take the mantle as the doctor of the family, while his siblings took to other professions like engineering.
Eager to be in the thick of things, Dr. Palabindala has voraciously pursued leadership positions, leading to his current role as chief of the Division of Hospital Medicine at the University of Mississippi Medical Center, Jackson.
Dr. Palabindala is enthusiastic about his role as one of the eight new members of The Hospitalist editorial advisory board, and took time to tell us more about himself in a recent interview.
Q: How did you get into medicine?
A: It’s all because of my dad’s motivation. My father believed in education, so when I was born, he said, “He’s going to be a doctor,” and as I grew up, I just worked towards being a physician and nothing else. I didn’t even have an option of choosing anything else. My dad said that I would be a doctor, and I am a doctor. I feel like that was the best thing that happened to me, though; it worked out well.
Q: How and when did you decide to go into hospital medicine?
A: After I came to the U.S., I joined residency in internal medicine at GBMC – that’s Greater Baltimore Medical Center – it’s affiliated with Johns Hopkins. I always wanted to be an internist, but my experiences in the clinic world were not so great. But I really enjoyed inpatient medicine, so in my 3rd year, when I was doing my chief residency year, I did get opportunities to join a fellowship, but I decided just to be a hospitalist at that time.
Q: What do you find to be rewarding about hospital medicine?
Q: What is one of the biggest challenges in hospital medicine?
A: I think talking about the business aspect of medicine, because it is like a taboo. We don’t really want to talk about whether the patient is covered or not covered by insurance, how much we are billing, and why we must discuss business issues while we are trying to focus on patient care, but these things are going to indirectly affect patient care, too. If you didn’t note the patient status accurately, they are going to get an inappropriate bill.
Q: What’s the best advice you have received that you try to pass on to your students?
A: Do the rounds at the bedside. We have the tendency of doing everything outside and then going in the room and just telling the patient what we are going to do. Instead, I encourage everyone to be at the bedside. Even without students, I go and sit at the bedside and then review the data in terms the patient can understand, and then explain the care plan, so they actually feel like we are at the bedside for a longer time. We are with the patient for at least 10 to 15 minutes, but at the same time, we are getting things done. I encourage my students and residents to do this.
Q: What is the worst advice you’ve received?
A: I don’t know if this is the “worst” advice, but in my second year, I was trying to take some leadership positions and was told I should wait, that leadership skills come with experience. I do think that’s a bad piece of advice. It’s all about learning how hard you work and then how fast you learn, and then how fast you implement. People who work, learn, and implement quickly can make a difference.
Q: Outside of patient care, what other career interests do you have?
A: I’m interested in smart clinics, and I actually have a patent for smart clinic chains. I’m a big fan of primary care, because, like hospitalists revolutionized inpatient care, I think we can revolutionize the outpatient care experience as well. I don’t think we are being very efficient with outpatient care.
But if I was not practicing medicine, I probably would be a chef. I like to cook, and I would open up my own restaurant if I was not doing this.
Q: Where do you see yourself in 10 years?
A: I want to be a consultant, evaluating hospitalist programs and guiding programs to grow and be more efficient. That, I think, would be the primary job that I would like to be doing, along with giving lectures and teaching about patient safety and quality, and educating younger physicians about the business of medicine.
Q: What experience with SHM has made the most lasting impact on you?
A: I would say the best impression was from the Academic Hospitalist Academy meeting I attended in Denver. I think that was helpful, because it was like a boot camp where you have only a limited number of attendees with a dedicated mentor. That was amazing, and I learned a lot. It helped me in redesigning my approach to where I would like to be both short- and long-term. I implemented at least 50 percent of what I learned at that meeting.
Q: What’s the best book that you’ve read recently and why was it the best?
A: Being Mortal by Atul Gawande. It’s a really beautiful book.
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Research projects aid clinical knowledge
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
One of my favorite aspects of research is how reading a paper or working on a project will inevitably augment my clinical knowledge as well.
In terms of my current project, I am pleased to say that I am on track to complete it within the dedicated ten week time period. I am now in writing mode, typing away furiously to complete an abstract to showcase my work, and eventually a manuscript to publish in an academic journal. I believe careful planning and prioritization has helped me stay on track with such a short deadline.
The one problem I have faced in the last couple of weeks has been figuring out how to display my data graphically. Unfortunately, the nature of the data lends itself to tables rather than figurers. Although a figure by itself won’t change the results, I personally enjoy reading papers with interesting figures more than those without them. However, I also don’t want to create meaningless figures just for the sake of having them, so it’s been a challenge figuring out how to display data in a way that will assist readers in interpreting the data.
Overall, this experience has encouraged me to participate in future research projects. I now know the importance of mentors in guiding a successful research project, and the impact preparation and planning can have on the outcome of the project. I am enthusiastic about incorporating clinical research into my medical career.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
One of my favorite aspects of research is how reading a paper or working on a project will inevitably augment my clinical knowledge as well.
In terms of my current project, I am pleased to say that I am on track to complete it within the dedicated ten week time period. I am now in writing mode, typing away furiously to complete an abstract to showcase my work, and eventually a manuscript to publish in an academic journal. I believe careful planning and prioritization has helped me stay on track with such a short deadline.
The one problem I have faced in the last couple of weeks has been figuring out how to display my data graphically. Unfortunately, the nature of the data lends itself to tables rather than figurers. Although a figure by itself won’t change the results, I personally enjoy reading papers with interesting figures more than those without them. However, I also don’t want to create meaningless figures just for the sake of having them, so it’s been a challenge figuring out how to display data in a way that will assist readers in interpreting the data.
Overall, this experience has encouraged me to participate in future research projects. I now know the importance of mentors in guiding a successful research project, and the impact preparation and planning can have on the outcome of the project. I am enthusiastic about incorporating clinical research into my medical career.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
One of my favorite aspects of research is how reading a paper or working on a project will inevitably augment my clinical knowledge as well.
In terms of my current project, I am pleased to say that I am on track to complete it within the dedicated ten week time period. I am now in writing mode, typing away furiously to complete an abstract to showcase my work, and eventually a manuscript to publish in an academic journal. I believe careful planning and prioritization has helped me stay on track with such a short deadline.
The one problem I have faced in the last couple of weeks has been figuring out how to display my data graphically. Unfortunately, the nature of the data lends itself to tables rather than figurers. Although a figure by itself won’t change the results, I personally enjoy reading papers with interesting figures more than those without them. However, I also don’t want to create meaningless figures just for the sake of having them, so it’s been a challenge figuring out how to display data in a way that will assist readers in interpreting the data.
Overall, this experience has encouraged me to participate in future research projects. I now know the importance of mentors in guiding a successful research project, and the impact preparation and planning can have on the outcome of the project. I am enthusiastic about incorporating clinical research into my medical career.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Research progress in a short time window
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-2018 year, offering two options for students to receive funding and engage in scholarly work during their first, second, and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
My research experience this summer has been full of learning both clinical and academic aspects of medicine. I had the opportunity to observe my mentor plus other hospitalists rounding on patients, and sit in on presentations to hear about the spectacular work that different faculty members are implementing. This has helped me gain a better understanding of hospital medicine, and really sparked my interest in the field.
I love that hospitalists can play a major role in treating the sickest of patients, while at the same time work to investigate ways to make the patients’ time at a hospital a better experience.
My mentor, Dr. Patrick Brady, has been very helpful giving me insight on research methods for our project and how best to use the data we have collected. We were able to make some adjustments in our exclusion criteria for the patients included in the retrospective case control study, so that I have time to collect several clinical characteristics of each patient who underwent an emergency transfer. While going over several emergency transfer cases, I have learned quite a bit of clinical information. One example of what I’ve learned involves rapid sequence intubation drugs when endotracheal intubation procedures are done. The procedure requires quick onset sedatives and pain medications in addition to neuromuscular blocking agents to rapidly numb and sedate the patient in order to put in the tube.
We are wrapping up this week and beginning to run some simple statistical analyses on the data. I hope to have some insight on the incidence and descriptors of emergency transfer cases in Cincinnati Children’s Hospital by the end of the week. I am preparing to begin writing and creating presentations for dissemination.
Reflecting back on my work this summer, I am encouraged by the amount of progress that I was able to make in the short period of time. Completing a research project over a nine-week period is a very challenging task as it comes with many limitations. However, Dr. Brady helped me realize that important questions can still be answered if the project is designed efficiently. I could see myself doing similar research in my future as a physician. I very much like the idea of studying what is clinically right in front of you.
Farah Hussain is a 2nd-year medical student at University of Cincinnati College of Medicine and student researcher at Cincinnati Children’s Hospital Medical Center. Her research interests involve bettering patient care to vulnerable populations.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-2018 year, offering two options for students to receive funding and engage in scholarly work during their first, second, and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
My research experience this summer has been full of learning both clinical and academic aspects of medicine. I had the opportunity to observe my mentor plus other hospitalists rounding on patients, and sit in on presentations to hear about the spectacular work that different faculty members are implementing. This has helped me gain a better understanding of hospital medicine, and really sparked my interest in the field.
I love that hospitalists can play a major role in treating the sickest of patients, while at the same time work to investigate ways to make the patients’ time at a hospital a better experience.
My mentor, Dr. Patrick Brady, has been very helpful giving me insight on research methods for our project and how best to use the data we have collected. We were able to make some adjustments in our exclusion criteria for the patients included in the retrospective case control study, so that I have time to collect several clinical characteristics of each patient who underwent an emergency transfer. While going over several emergency transfer cases, I have learned quite a bit of clinical information. One example of what I’ve learned involves rapid sequence intubation drugs when endotracheal intubation procedures are done. The procedure requires quick onset sedatives and pain medications in addition to neuromuscular blocking agents to rapidly numb and sedate the patient in order to put in the tube.
We are wrapping up this week and beginning to run some simple statistical analyses on the data. I hope to have some insight on the incidence and descriptors of emergency transfer cases in Cincinnati Children’s Hospital by the end of the week. I am preparing to begin writing and creating presentations for dissemination.
Reflecting back on my work this summer, I am encouraged by the amount of progress that I was able to make in the short period of time. Completing a research project over a nine-week period is a very challenging task as it comes with many limitations. However, Dr. Brady helped me realize that important questions can still be answered if the project is designed efficiently. I could see myself doing similar research in my future as a physician. I very much like the idea of studying what is clinically right in front of you.
Farah Hussain is a 2nd-year medical student at University of Cincinnati College of Medicine and student researcher at Cincinnati Children’s Hospital Medical Center. Her research interests involve bettering patient care to vulnerable populations.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-2018 year, offering two options for students to receive funding and engage in scholarly work during their first, second, and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
My research experience this summer has been full of learning both clinical and academic aspects of medicine. I had the opportunity to observe my mentor plus other hospitalists rounding on patients, and sit in on presentations to hear about the spectacular work that different faculty members are implementing. This has helped me gain a better understanding of hospital medicine, and really sparked my interest in the field.
I love that hospitalists can play a major role in treating the sickest of patients, while at the same time work to investigate ways to make the patients’ time at a hospital a better experience.
My mentor, Dr. Patrick Brady, has been very helpful giving me insight on research methods for our project and how best to use the data we have collected. We were able to make some adjustments in our exclusion criteria for the patients included in the retrospective case control study, so that I have time to collect several clinical characteristics of each patient who underwent an emergency transfer. While going over several emergency transfer cases, I have learned quite a bit of clinical information. One example of what I’ve learned involves rapid sequence intubation drugs when endotracheal intubation procedures are done. The procedure requires quick onset sedatives and pain medications in addition to neuromuscular blocking agents to rapidly numb and sedate the patient in order to put in the tube.
We are wrapping up this week and beginning to run some simple statistical analyses on the data. I hope to have some insight on the incidence and descriptors of emergency transfer cases in Cincinnati Children’s Hospital by the end of the week. I am preparing to begin writing and creating presentations for dissemination.
Reflecting back on my work this summer, I am encouraged by the amount of progress that I was able to make in the short period of time. Completing a research project over a nine-week period is a very challenging task as it comes with many limitations. However, Dr. Brady helped me realize that important questions can still be answered if the project is designed efficiently. I could see myself doing similar research in my future as a physician. I very much like the idea of studying what is clinically right in front of you.
Farah Hussain is a 2nd-year medical student at University of Cincinnati College of Medicine and student researcher at Cincinnati Children’s Hospital Medical Center. Her research interests involve bettering patient care to vulnerable populations.
Thinking about the basic science of quality improvement
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I reviewed recent literature about my research topic, which is clinical pathways for hospitalized injection drug users due to injection-related infection sequelae and came up with my research proposal. As part of a scholarly pursuit, I believe having a theoretical background of quality improvement to be important. Before further diving into the research topic, I also generated a small reading list of the “basic science” of quality improvement, which covers topics of general operational science and those in health care applications.
What makes standardization in health care difficult? In my operations class at Tuck School of Business, we watched a video showing former Soviet Union ophthalmologists performing “assembly line” cataract surgery. It includes multiple surgeons sitting around multiple rotating tables, each surgeon performing exactly one step of the cataract surgery. I recall all my classmates were amused by the video, because it appeared both impractical (as one surgeon was almost chasing the table) as well as slightly de-humanizing. In the health care setting, standardization can be difficult. The service is intrinsically complex, it is difficult to define processes and to measure outcomes, and standardization can create tension secondary to physician autonomy and organizational culture.
In service delivery, the person (the patient in health care organizations) is part of the production process. Patients by nature are not standard inputs. They assume different pre-existing conditions and have different preferences for clinical and non-clinical services/processes. The medical service itself, consisting of both clinical and operational processes, sometimes can be difficult to qualify and measure. A hospital can control patient flow by managing appointment and beds allocation. Clinical pathways can be defined for different diseases. However, patients can encounter undiscovered diseases or complications during the treatment, making the clinical service different and unpredictable.
Lastly standardization can encounter resistance from physicians and other health care providers. “Patients are not cars” is a phrase commonly used when discussing standardization. A health care organization needs to have not only tools, but also the cultural and managerial foundations to carry out changes. I am looking forward to using this project opportunity to further explore the local application of quality improvement.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I reviewed recent literature about my research topic, which is clinical pathways for hospitalized injection drug users due to injection-related infection sequelae and came up with my research proposal. As part of a scholarly pursuit, I believe having a theoretical background of quality improvement to be important. Before further diving into the research topic, I also generated a small reading list of the “basic science” of quality improvement, which covers topics of general operational science and those in health care applications.
What makes standardization in health care difficult? In my operations class at Tuck School of Business, we watched a video showing former Soviet Union ophthalmologists performing “assembly line” cataract surgery. It includes multiple surgeons sitting around multiple rotating tables, each surgeon performing exactly one step of the cataract surgery. I recall all my classmates were amused by the video, because it appeared both impractical (as one surgeon was almost chasing the table) as well as slightly de-humanizing. In the health care setting, standardization can be difficult. The service is intrinsically complex, it is difficult to define processes and to measure outcomes, and standardization can create tension secondary to physician autonomy and organizational culture.
In service delivery, the person (the patient in health care organizations) is part of the production process. Patients by nature are not standard inputs. They assume different pre-existing conditions and have different preferences for clinical and non-clinical services/processes. The medical service itself, consisting of both clinical and operational processes, sometimes can be difficult to qualify and measure. A hospital can control patient flow by managing appointment and beds allocation. Clinical pathways can be defined for different diseases. However, patients can encounter undiscovered diseases or complications during the treatment, making the clinical service different and unpredictable.
Lastly standardization can encounter resistance from physicians and other health care providers. “Patients are not cars” is a phrase commonly used when discussing standardization. A health care organization needs to have not only tools, but also the cultural and managerial foundations to carry out changes. I am looking forward to using this project opportunity to further explore the local application of quality improvement.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
I reviewed recent literature about my research topic, which is clinical pathways for hospitalized injection drug users due to injection-related infection sequelae and came up with my research proposal. As part of a scholarly pursuit, I believe having a theoretical background of quality improvement to be important. Before further diving into the research topic, I also generated a small reading list of the “basic science” of quality improvement, which covers topics of general operational science and those in health care applications.
What makes standardization in health care difficult? In my operations class at Tuck School of Business, we watched a video showing former Soviet Union ophthalmologists performing “assembly line” cataract surgery. It includes multiple surgeons sitting around multiple rotating tables, each surgeon performing exactly one step of the cataract surgery. I recall all my classmates were amused by the video, because it appeared both impractical (as one surgeon was almost chasing the table) as well as slightly de-humanizing. In the health care setting, standardization can be difficult. The service is intrinsically complex, it is difficult to define processes and to measure outcomes, and standardization can create tension secondary to physician autonomy and organizational culture.
In service delivery, the person (the patient in health care organizations) is part of the production process. Patients by nature are not standard inputs. They assume different pre-existing conditions and have different preferences for clinical and non-clinical services/processes. The medical service itself, consisting of both clinical and operational processes, sometimes can be difficult to qualify and measure. A hospital can control patient flow by managing appointment and beds allocation. Clinical pathways can be defined for different diseases. However, patients can encounter undiscovered diseases or complications during the treatment, making the clinical service different and unpredictable.
Lastly standardization can encounter resistance from physicians and other health care providers. “Patients are not cars” is a phrase commonly used when discussing standardization. A health care organization needs to have not only tools, but also the cultural and managerial foundations to carry out changes. I am looking forward to using this project opportunity to further explore the local application of quality improvement.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Walking the halls of power
Hospital medicine may be a young specialty, but it is already playing a significant role in both front-line patient care and, increasingly, in shaping public policy. Case in point: Two hospitalists serving currently in key roles in the federal government, and two former top civil servants, each of whom are examples of the growing influence of the hospitalist perspective.
“The hospitalist viewpoint of the health care system is a unique one, and it lends itself very well to the challenges of our current delivery system reform. We’re reforming the health care system to deliver care more cost effectively,” said Ron Greeno, MD, FCCP, MHM, SHM president and chair of the SHM Public Policy committee. “Hospitalists are trained to do that – they go to work every day to do that.”
Leading the FDA
“He’s the perfect person for that job and is looking to shake things up,” Dr. Greeno said. “There are a lot of things that can improve in terms of how drugs get to market, including lower cost generic drugs.” That’s an issue Dr. Gottlieb has been championing for years, and his understanding of the issue also makes him well prepared to take this position now, Dr. Greeno said.
“Dr. Gottlieb’s nomination comes at a momentous time for the agency, which Mr. Trump has promised to significantly remake,” the New York Times wrote on March 29, prior to his confirmation. “The next commissioner will be charged with putting into practice a far-reaching law, passed in December, aimed at bringing drugs to market more quickly.”
In addition to his work at the AEI, Dr. Gottlieb served on SHM’s Public Policy committee. He was a clinical assistant professor at New York University School of Medicine and advised the U.S. Department of Health and Human Services as a member of the Federal Health IT Policy committee.
Steering national quality programs
Kate Goodrich’s preparation for her government role included experience with several sides of the health care system: Dr. Goodrich, MD, MHS, was the director of the Division of Hospital Medicine at George Washington University Hospital, one of the first hospitalist programs in the Washington area. She worked at an inpatient rehab facility and has practiced in ambulatory care.
Now, as chief medical officer of CMS and director of the Center for Clinical Standards and Quality (CCSQ), she’s helping drive those policy decisions, overseeing multiple quality measurement and value-based purchasing programs and health and safety standards for hospitals.
Dr. Goodrich still makes rounds at George Washington Hospital on weekends. “It allows me to have a sort of in-your-bones understanding of the challenges of frontline providers,” she said. “I’m able to understand the clinician point of view in our policy decisions.” She’s also able to see first-hand the effects of those policy decisions on clinicians, patients, and health care systems.
As physician leaders within their organizations, hospitalists fit naturally into other leadership positions, she said. “Hospitalists often take leadership roles around quality of care and efficiency and flow and those sorts of thing,” Dr. Goodrich said. “I think it is a very natural progression for hospitalists to get interested in health care and medicine from that viewpoint, which then might allow them to make a leap into another type of field.”
An innovator at CMS
Until very recently, pediatric hospitalist Patrick Conway, MD, FAAP, MHM, served as deputy administrator for Innovation and Quality at the Centers for Medicare & Medicaid Services and director of the Center for Medicare and Medicaid Innovation. On Oct. 1, he took on a new challenge, becoming president and CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Dr. Conway was selected as a Master of Hospital Medicine by SHM, and received the HHS Secretary’s Award for Distinguished Service, the Secretary’s highest distinction for excellence. The Patient Safety Movement Foundation gave him their Humanitarian Award, and in February 2017, he received the AMA’s Dr. Nathan Davis Award for Outstanding Government Service. He also was elected to the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine in 2014.
Prior to joining CMS, Dr. Conway oversaw clinical operations and research at Cincinnati Children’s Hospital Medical Center as director of hospital medicine, with a focus on improving patient outcomes across the health system.
Improving the country’s health
Obesity, tobacco-related disease, mental illness, and addiction are some of the issues Vivek H. Murthy, MD, MBA, targeted while serving as the 19th U.S. Surgeon General. He was appointed to the position by President Obama in 2014, and was relieved of his duties by President Trump in April 2017.
Dr. Murthy has said that addiction should be seen as a chronic illness, not a character flaw, and last year sent a letter to 2.3 million health care providers nationwide, encouraging them to join a national effort to reform prescribing practices.
According to Dr. Greeno, each of these hospitalists illuminates new paths for others in the field. “I think for young people who are trying to identify what career path they want to pursue, this is something that can’t be anything but good for our specialty – and good for the health system,” he said. “Hospitalists have the perfect clinical background and mindset to help our health care system get to where it needs to go. It’s a huge challenge. It’s going to be a ton of work, and the stakes are very, very high.”
Reference
1. Thomas K. F.D.A. Nominee, Paid Millions by Industry, Says He’ll Recuse Himself if Needed. New York Times. March 29, 2017. https://www.nytimes.com/2017/03/29/health/fda-nominee-scott-gottlieb-recuse-conflicts.html?_r=0. Accessed March 31, 2017.
Hospital medicine may be a young specialty, but it is already playing a significant role in both front-line patient care and, increasingly, in shaping public policy. Case in point: Two hospitalists serving currently in key roles in the federal government, and two former top civil servants, each of whom are examples of the growing influence of the hospitalist perspective.
“The hospitalist viewpoint of the health care system is a unique one, and it lends itself very well to the challenges of our current delivery system reform. We’re reforming the health care system to deliver care more cost effectively,” said Ron Greeno, MD, FCCP, MHM, SHM president and chair of the SHM Public Policy committee. “Hospitalists are trained to do that – they go to work every day to do that.”
Leading the FDA
“He’s the perfect person for that job and is looking to shake things up,” Dr. Greeno said. “There are a lot of things that can improve in terms of how drugs get to market, including lower cost generic drugs.” That’s an issue Dr. Gottlieb has been championing for years, and his understanding of the issue also makes him well prepared to take this position now, Dr. Greeno said.
“Dr. Gottlieb’s nomination comes at a momentous time for the agency, which Mr. Trump has promised to significantly remake,” the New York Times wrote on March 29, prior to his confirmation. “The next commissioner will be charged with putting into practice a far-reaching law, passed in December, aimed at bringing drugs to market more quickly.”
In addition to his work at the AEI, Dr. Gottlieb served on SHM’s Public Policy committee. He was a clinical assistant professor at New York University School of Medicine and advised the U.S. Department of Health and Human Services as a member of the Federal Health IT Policy committee.
Steering national quality programs
Kate Goodrich’s preparation for her government role included experience with several sides of the health care system: Dr. Goodrich, MD, MHS, was the director of the Division of Hospital Medicine at George Washington University Hospital, one of the first hospitalist programs in the Washington area. She worked at an inpatient rehab facility and has practiced in ambulatory care.
Now, as chief medical officer of CMS and director of the Center for Clinical Standards and Quality (CCSQ), she’s helping drive those policy decisions, overseeing multiple quality measurement and value-based purchasing programs and health and safety standards for hospitals.
Dr. Goodrich still makes rounds at George Washington Hospital on weekends. “It allows me to have a sort of in-your-bones understanding of the challenges of frontline providers,” she said. “I’m able to understand the clinician point of view in our policy decisions.” She’s also able to see first-hand the effects of those policy decisions on clinicians, patients, and health care systems.
As physician leaders within their organizations, hospitalists fit naturally into other leadership positions, she said. “Hospitalists often take leadership roles around quality of care and efficiency and flow and those sorts of thing,” Dr. Goodrich said. “I think it is a very natural progression for hospitalists to get interested in health care and medicine from that viewpoint, which then might allow them to make a leap into another type of field.”
An innovator at CMS
Until very recently, pediatric hospitalist Patrick Conway, MD, FAAP, MHM, served as deputy administrator for Innovation and Quality at the Centers for Medicare & Medicaid Services and director of the Center for Medicare and Medicaid Innovation. On Oct. 1, he took on a new challenge, becoming president and CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Dr. Conway was selected as a Master of Hospital Medicine by SHM, and received the HHS Secretary’s Award for Distinguished Service, the Secretary’s highest distinction for excellence. The Patient Safety Movement Foundation gave him their Humanitarian Award, and in February 2017, he received the AMA’s Dr. Nathan Davis Award for Outstanding Government Service. He also was elected to the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine in 2014.
Prior to joining CMS, Dr. Conway oversaw clinical operations and research at Cincinnati Children’s Hospital Medical Center as director of hospital medicine, with a focus on improving patient outcomes across the health system.
Improving the country’s health
Obesity, tobacco-related disease, mental illness, and addiction are some of the issues Vivek H. Murthy, MD, MBA, targeted while serving as the 19th U.S. Surgeon General. He was appointed to the position by President Obama in 2014, and was relieved of his duties by President Trump in April 2017.
Dr. Murthy has said that addiction should be seen as a chronic illness, not a character flaw, and last year sent a letter to 2.3 million health care providers nationwide, encouraging them to join a national effort to reform prescribing practices.
According to Dr. Greeno, each of these hospitalists illuminates new paths for others in the field. “I think for young people who are trying to identify what career path they want to pursue, this is something that can’t be anything but good for our specialty – and good for the health system,” he said. “Hospitalists have the perfect clinical background and mindset to help our health care system get to where it needs to go. It’s a huge challenge. It’s going to be a ton of work, and the stakes are very, very high.”
Reference
1. Thomas K. F.D.A. Nominee, Paid Millions by Industry, Says He’ll Recuse Himself if Needed. New York Times. March 29, 2017. https://www.nytimes.com/2017/03/29/health/fda-nominee-scott-gottlieb-recuse-conflicts.html?_r=0. Accessed March 31, 2017.
Hospital medicine may be a young specialty, but it is already playing a significant role in both front-line patient care and, increasingly, in shaping public policy. Case in point: Two hospitalists serving currently in key roles in the federal government, and two former top civil servants, each of whom are examples of the growing influence of the hospitalist perspective.
“The hospitalist viewpoint of the health care system is a unique one, and it lends itself very well to the challenges of our current delivery system reform. We’re reforming the health care system to deliver care more cost effectively,” said Ron Greeno, MD, FCCP, MHM, SHM president and chair of the SHM Public Policy committee. “Hospitalists are trained to do that – they go to work every day to do that.”
Leading the FDA
“He’s the perfect person for that job and is looking to shake things up,” Dr. Greeno said. “There are a lot of things that can improve in terms of how drugs get to market, including lower cost generic drugs.” That’s an issue Dr. Gottlieb has been championing for years, and his understanding of the issue also makes him well prepared to take this position now, Dr. Greeno said.
“Dr. Gottlieb’s nomination comes at a momentous time for the agency, which Mr. Trump has promised to significantly remake,” the New York Times wrote on March 29, prior to his confirmation. “The next commissioner will be charged with putting into practice a far-reaching law, passed in December, aimed at bringing drugs to market more quickly.”
In addition to his work at the AEI, Dr. Gottlieb served on SHM’s Public Policy committee. He was a clinical assistant professor at New York University School of Medicine and advised the U.S. Department of Health and Human Services as a member of the Federal Health IT Policy committee.
Steering national quality programs
Kate Goodrich’s preparation for her government role included experience with several sides of the health care system: Dr. Goodrich, MD, MHS, was the director of the Division of Hospital Medicine at George Washington University Hospital, one of the first hospitalist programs in the Washington area. She worked at an inpatient rehab facility and has practiced in ambulatory care.
Now, as chief medical officer of CMS and director of the Center for Clinical Standards and Quality (CCSQ), she’s helping drive those policy decisions, overseeing multiple quality measurement and value-based purchasing programs and health and safety standards for hospitals.
Dr. Goodrich still makes rounds at George Washington Hospital on weekends. “It allows me to have a sort of in-your-bones understanding of the challenges of frontline providers,” she said. “I’m able to understand the clinician point of view in our policy decisions.” She’s also able to see first-hand the effects of those policy decisions on clinicians, patients, and health care systems.
As physician leaders within their organizations, hospitalists fit naturally into other leadership positions, she said. “Hospitalists often take leadership roles around quality of care and efficiency and flow and those sorts of thing,” Dr. Goodrich said. “I think it is a very natural progression for hospitalists to get interested in health care and medicine from that viewpoint, which then might allow them to make a leap into another type of field.”
An innovator at CMS
Until very recently, pediatric hospitalist Patrick Conway, MD, FAAP, MHM, served as deputy administrator for Innovation and Quality at the Centers for Medicare & Medicaid Services and director of the Center for Medicare and Medicaid Innovation. On Oct. 1, he took on a new challenge, becoming president and CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Dr. Conway was selected as a Master of Hospital Medicine by SHM, and received the HHS Secretary’s Award for Distinguished Service, the Secretary’s highest distinction for excellence. The Patient Safety Movement Foundation gave him their Humanitarian Award, and in February 2017, he received the AMA’s Dr. Nathan Davis Award for Outstanding Government Service. He also was elected to the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine in 2014.
Prior to joining CMS, Dr. Conway oversaw clinical operations and research at Cincinnati Children’s Hospital Medical Center as director of hospital medicine, with a focus on improving patient outcomes across the health system.
Improving the country’s health
Obesity, tobacco-related disease, mental illness, and addiction are some of the issues Vivek H. Murthy, MD, MBA, targeted while serving as the 19th U.S. Surgeon General. He was appointed to the position by President Obama in 2014, and was relieved of his duties by President Trump in April 2017.
Dr. Murthy has said that addiction should be seen as a chronic illness, not a character flaw, and last year sent a letter to 2.3 million health care providers nationwide, encouraging them to join a national effort to reform prescribing practices.
According to Dr. Greeno, each of these hospitalists illuminates new paths for others in the field. “I think for young people who are trying to identify what career path they want to pursue, this is something that can’t be anything but good for our specialty – and good for the health system,” he said. “Hospitalists have the perfect clinical background and mindset to help our health care system get to where it needs to go. It’s a huge challenge. It’s going to be a ton of work, and the stakes are very, very high.”
Reference
1. Thomas K. F.D.A. Nominee, Paid Millions by Industry, Says He’ll Recuse Himself if Needed. New York Times. March 29, 2017. https://www.nytimes.com/2017/03/29/health/fda-nominee-scott-gottlieb-recuse-conflicts.html?_r=0. Accessed March 31, 2017.
Research mentors an invaluable resource to students
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
As a medical student, the summer is an excellent time to pursue extracurricular activities. While some people take these weeks to learn new skills in basic science laboratories or travel abroad for international electives, many will assume the role of a student researcher. But, with only 10 weeks of dedicated research time in the summer it can be challenging to see a project from start to finish.
The greatest challenge, however, is not in identifying a project that is possible to complete in 10 weeks. Instead, it has to do with the fact that as students we are inexperienced researchers, and such a short timeline leaves little room to troubleshoot problems when they inevitably arise. This, among other reasons, is why research mentors are an invaluable resource to students.
While my research mentor has helped tremendously in logistical tasks, such as helping me write a research proposal and navigate the IRB process, it’s his experience and knowledge of the research process that I’ve found to be most critical during this 10 week period. During the planning of the project he helped me identify pitfalls and weaknesses in our methods, which has helped me avoid major setbacks during the execution of the project. As a result, the project has been running smoothly and I have yet to run into any significant problems.
Reflecting on this fact has reminded me of the importance of planning ahead. We started outlining and planning this project about 6 months before my research period officially began, when we could both mull over the details without the pressure of time. Though unforeseen problems may still arise, I think this strategy has made all the difference and it’s a lesson I will take with me for future projects.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
As a medical student, the summer is an excellent time to pursue extracurricular activities. While some people take these weeks to learn new skills in basic science laboratories or travel abroad for international electives, many will assume the role of a student researcher. But, with only 10 weeks of dedicated research time in the summer it can be challenging to see a project from start to finish.
The greatest challenge, however, is not in identifying a project that is possible to complete in 10 weeks. Instead, it has to do with the fact that as students we are inexperienced researchers, and such a short timeline leaves little room to troubleshoot problems when they inevitably arise. This, among other reasons, is why research mentors are an invaluable resource to students.
While my research mentor has helped tremendously in logistical tasks, such as helping me write a research proposal and navigate the IRB process, it’s his experience and knowledge of the research process that I’ve found to be most critical during this 10 week period. During the planning of the project he helped me identify pitfalls and weaknesses in our methods, which has helped me avoid major setbacks during the execution of the project. As a result, the project has been running smoothly and I have yet to run into any significant problems.
Reflecting on this fact has reminded me of the importance of planning ahead. We started outlining and planning this project about 6 months before my research period officially began, when we could both mull over the details without the pressure of time. Though unforeseen problems may still arise, I think this strategy has made all the difference and it’s a lesson I will take with me for future projects.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
As a medical student, the summer is an excellent time to pursue extracurricular activities. While some people take these weeks to learn new skills in basic science laboratories or travel abroad for international electives, many will assume the role of a student researcher. But, with only 10 weeks of dedicated research time in the summer it can be challenging to see a project from start to finish.
The greatest challenge, however, is not in identifying a project that is possible to complete in 10 weeks. Instead, it has to do with the fact that as students we are inexperienced researchers, and such a short timeline leaves little room to troubleshoot problems when they inevitably arise. This, among other reasons, is why research mentors are an invaluable resource to students.
While my research mentor has helped tremendously in logistical tasks, such as helping me write a research proposal and navigate the IRB process, it’s his experience and knowledge of the research process that I’ve found to be most critical during this 10 week period. During the planning of the project he helped me identify pitfalls and weaknesses in our methods, which has helped me avoid major setbacks during the execution of the project. As a result, the project has been running smoothly and I have yet to run into any significant problems.
Reflecting on this fact has reminded me of the importance of planning ahead. We started outlining and planning this project about 6 months before my research period officially began, when we could both mull over the details without the pressure of time. Though unforeseen problems may still arise, I think this strategy has made all the difference and it’s a lesson I will take with me for future projects.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
New hospitalist unit has stellar patient satisfaction scores
It’s very unusual for hospitalists to achieve top quartile performance on the Physician Communication domain of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This is the story of a group that did just that for patients on one unit of a large hospital.
I’m not sure how reproducible this would be at other hospitals, or even on other units in the same hospital, and wonder whether performance will stay at this remarkably high level much longer than the current 5-month track record of success. Even so, five months of success suggests they’re on to something.
There is another hospitalist group at that hospital, but I’m discussing work done only by MedOne hospitalists, who together with hospital personnel, developed what they call the Comprehensive Medical Unit (CMU). Their goal was to involve multiple disciplines and use Lean principles to design a new approach to care on 5-Orange, a 20-bed unit in OhioHealth’s Riverside Methodist Hospital in Columbus. The CMU model went live in October 2016.
MedOne Hospital Physicians is a private hospitalist group of 35 physicians and 12 advanced practice clinicians, which comprise nurse practitioners (NPs) and physician assistants (PAs), constituting 46 full-time–equivalent clinical staffing. The group contracts with Riverside, which has approximately 710 staffed beds. MedOne also works in area skilled nursing facilities, helps a long-term acute care and rehabilitation hospital, and provides support to two other hospitals that are not part of OhioHealth.
Features of the model
At its core, this model is a variation of the increasingly common combination of geographically assigned hospitalists (who in this case don’t have patients elsewhere in the hospital) and multidisciplinary rounds (that is, the physician and NP hospitalists make bedside rounds with a nurse and pharmacist). But their model also incorporates a few less-common features.
Only 4 of the 35 MedOne hospitalists are eligible to provide care on the CMU, and each still spends a significant portion of time in the regular hospitalist rotation working in the rest of the hospital. These doctors weren’t selected as the highest performers or because they had the best patient satisfaction track record. Instead, five MedOne doctors volunteered to work on the unit, and four were chosen. A MedOne hospitalist NP also works on the unit, since any NP in the group is eligible to work there.
This is a hospitalist-only unit; no non–hospitalist patients are placed on the unit. There is no deliberate attempt to assign patients to the unit based on how sick they are or complicated their cases are. All are general medicine patients, including up to six intermediate care patients (e.g., “ICU step-down” patients requiring mask ventilation, etc.). While configured for 20 patients, the unit can flex to as many as 24 patients and has done so numerous times. The hospitalists (physician and NP combined) have averaged 18.9 daily encounters since the CMU opened.
Nurse staffing on the unit was reconfigured to comprise bedside nurses – known as Clinical Nurses (CNs) – and more experienced RNs – in the role of Comprehensive Charge Nurses (CCNs), who attend rounds and coordinate the patients’ hospitalizations rather than doing bedside care. 5-Orange has one more Charge Nurse than is typical for other units in the hospital, so total RN-to-patient staffing levels and nurse staffing costs are higher. But the CNs care for the same number of patients as do their counterparts in other hospital units.
In order to try to discharge patients early in the day, the NP sees only the patients who are being discharged, while the physician makes all other visits. When possible, I think it’s best to minimize the incidence of a provider’s first visit with a patient being a discharge visit; this may increase the risk of misunderstandings and errors. Instead, in this model, the physician working on the CMU will already know the patient from the preceding days and will be on the unit and readily accessible to the NP all day, which might mitigate some of these concerns.
Outcomes
I think the most notable outcome is the top quartile patient satisfaction scores from the 37 patients cared for on the unit who returned a survey, some of whom have asked to return to the CMU if they’re hospitalized again. Specifically, 86% of responses were “top box,” which places the hospitalists at the 84th percentile of performance for all hospitals. Physician Communication scores on the HCAHPS survey for hospitalists on other units at this hospital are in the bottom deciles, which is more typical for hospitalists.
Length of stay is half a day shorter than comparable units with similar readmission rates, and more patients are discharged earlier in the day. The four hospitalists who work on the unit report higher satisfaction, in part because they get an average of only 1 page a day – compared with the typical 15-40 pages their colleagues get working elsewhere in the hospital.
Cautions
I’m not sure why the MedOne model has yielded such impressive patient satisfaction and other results. While there are some relatively unique features of their model – only four hospitalists are eligible to work there and nursing roles have been reconfigured – I wouldn’t expect these to yield such remarkable results. So far, they have roughly 5 months of data and just 37 returned patient satisfaction surveys, so it’s possible that random variation and/or the Hawthorne effect are playing a meaningful role. It will be really informative to see their outcomes a year or 2 from now and to gauge how they fare if and when they implement the same model in other units of the hospital.
I suspect MedOne’s precise configuration for staffing and roles of nurses, NPs, and physicians is important, but I’m guessing the most valuable thing they implemented was the creation of a powerful sense of teamwork and shared purpose among those working on the unit. The interpersonal bonding and feeling of shared purpose that likely occurred as they worked to devise and go live with the model, as well as the tremendous satisfaction at seeing their early results, have probably led to terrific enthusiasm within their team.
That enthusiasm may be the key ingredient contributing to their early success.
Dr. Nelson has been working in clinical practice as a hospitalist since 1988. He is a cofounder and past president of Society of Hospital Medicine and a principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice-management courses. Contact him at [email protected]
It’s very unusual for hospitalists to achieve top quartile performance on the Physician Communication domain of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This is the story of a group that did just that for patients on one unit of a large hospital.
I’m not sure how reproducible this would be at other hospitals, or even on other units in the same hospital, and wonder whether performance will stay at this remarkably high level much longer than the current 5-month track record of success. Even so, five months of success suggests they’re on to something.
There is another hospitalist group at that hospital, but I’m discussing work done only by MedOne hospitalists, who together with hospital personnel, developed what they call the Comprehensive Medical Unit (CMU). Their goal was to involve multiple disciplines and use Lean principles to design a new approach to care on 5-Orange, a 20-bed unit in OhioHealth’s Riverside Methodist Hospital in Columbus. The CMU model went live in October 2016.
MedOne Hospital Physicians is a private hospitalist group of 35 physicians and 12 advanced practice clinicians, which comprise nurse practitioners (NPs) and physician assistants (PAs), constituting 46 full-time–equivalent clinical staffing. The group contracts with Riverside, which has approximately 710 staffed beds. MedOne also works in area skilled nursing facilities, helps a long-term acute care and rehabilitation hospital, and provides support to two other hospitals that are not part of OhioHealth.
Features of the model
At its core, this model is a variation of the increasingly common combination of geographically assigned hospitalists (who in this case don’t have patients elsewhere in the hospital) and multidisciplinary rounds (that is, the physician and NP hospitalists make bedside rounds with a nurse and pharmacist). But their model also incorporates a few less-common features.
Only 4 of the 35 MedOne hospitalists are eligible to provide care on the CMU, and each still spends a significant portion of time in the regular hospitalist rotation working in the rest of the hospital. These doctors weren’t selected as the highest performers or because they had the best patient satisfaction track record. Instead, five MedOne doctors volunteered to work on the unit, and four were chosen. A MedOne hospitalist NP also works on the unit, since any NP in the group is eligible to work there.
This is a hospitalist-only unit; no non–hospitalist patients are placed on the unit. There is no deliberate attempt to assign patients to the unit based on how sick they are or complicated their cases are. All are general medicine patients, including up to six intermediate care patients (e.g., “ICU step-down” patients requiring mask ventilation, etc.). While configured for 20 patients, the unit can flex to as many as 24 patients and has done so numerous times. The hospitalists (physician and NP combined) have averaged 18.9 daily encounters since the CMU opened.
Nurse staffing on the unit was reconfigured to comprise bedside nurses – known as Clinical Nurses (CNs) – and more experienced RNs – in the role of Comprehensive Charge Nurses (CCNs), who attend rounds and coordinate the patients’ hospitalizations rather than doing bedside care. 5-Orange has one more Charge Nurse than is typical for other units in the hospital, so total RN-to-patient staffing levels and nurse staffing costs are higher. But the CNs care for the same number of patients as do their counterparts in other hospital units.
In order to try to discharge patients early in the day, the NP sees only the patients who are being discharged, while the physician makes all other visits. When possible, I think it’s best to minimize the incidence of a provider’s first visit with a patient being a discharge visit; this may increase the risk of misunderstandings and errors. Instead, in this model, the physician working on the CMU will already know the patient from the preceding days and will be on the unit and readily accessible to the NP all day, which might mitigate some of these concerns.
Outcomes
I think the most notable outcome is the top quartile patient satisfaction scores from the 37 patients cared for on the unit who returned a survey, some of whom have asked to return to the CMU if they’re hospitalized again. Specifically, 86% of responses were “top box,” which places the hospitalists at the 84th percentile of performance for all hospitals. Physician Communication scores on the HCAHPS survey for hospitalists on other units at this hospital are in the bottom deciles, which is more typical for hospitalists.
Length of stay is half a day shorter than comparable units with similar readmission rates, and more patients are discharged earlier in the day. The four hospitalists who work on the unit report higher satisfaction, in part because they get an average of only 1 page a day – compared with the typical 15-40 pages their colleagues get working elsewhere in the hospital.
Cautions
I’m not sure why the MedOne model has yielded such impressive patient satisfaction and other results. While there are some relatively unique features of their model – only four hospitalists are eligible to work there and nursing roles have been reconfigured – I wouldn’t expect these to yield such remarkable results. So far, they have roughly 5 months of data and just 37 returned patient satisfaction surveys, so it’s possible that random variation and/or the Hawthorne effect are playing a meaningful role. It will be really informative to see their outcomes a year or 2 from now and to gauge how they fare if and when they implement the same model in other units of the hospital.
I suspect MedOne’s precise configuration for staffing and roles of nurses, NPs, and physicians is important, but I’m guessing the most valuable thing they implemented was the creation of a powerful sense of teamwork and shared purpose among those working on the unit. The interpersonal bonding and feeling of shared purpose that likely occurred as they worked to devise and go live with the model, as well as the tremendous satisfaction at seeing their early results, have probably led to terrific enthusiasm within their team.
That enthusiasm may be the key ingredient contributing to their early success.
Dr. Nelson has been working in clinical practice as a hospitalist since 1988. He is a cofounder and past president of Society of Hospital Medicine and a principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice-management courses. Contact him at [email protected]
It’s very unusual for hospitalists to achieve top quartile performance on the Physician Communication domain of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This is the story of a group that did just that for patients on one unit of a large hospital.
I’m not sure how reproducible this would be at other hospitals, or even on other units in the same hospital, and wonder whether performance will stay at this remarkably high level much longer than the current 5-month track record of success. Even so, five months of success suggests they’re on to something.
There is another hospitalist group at that hospital, but I’m discussing work done only by MedOne hospitalists, who together with hospital personnel, developed what they call the Comprehensive Medical Unit (CMU). Their goal was to involve multiple disciplines and use Lean principles to design a new approach to care on 5-Orange, a 20-bed unit in OhioHealth’s Riverside Methodist Hospital in Columbus. The CMU model went live in October 2016.
MedOne Hospital Physicians is a private hospitalist group of 35 physicians and 12 advanced practice clinicians, which comprise nurse practitioners (NPs) and physician assistants (PAs), constituting 46 full-time–equivalent clinical staffing. The group contracts with Riverside, which has approximately 710 staffed beds. MedOne also works in area skilled nursing facilities, helps a long-term acute care and rehabilitation hospital, and provides support to two other hospitals that are not part of OhioHealth.
Features of the model
At its core, this model is a variation of the increasingly common combination of geographically assigned hospitalists (who in this case don’t have patients elsewhere in the hospital) and multidisciplinary rounds (that is, the physician and NP hospitalists make bedside rounds with a nurse and pharmacist). But their model also incorporates a few less-common features.
Only 4 of the 35 MedOne hospitalists are eligible to provide care on the CMU, and each still spends a significant portion of time in the regular hospitalist rotation working in the rest of the hospital. These doctors weren’t selected as the highest performers or because they had the best patient satisfaction track record. Instead, five MedOne doctors volunteered to work on the unit, and four were chosen. A MedOne hospitalist NP also works on the unit, since any NP in the group is eligible to work there.
This is a hospitalist-only unit; no non–hospitalist patients are placed on the unit. There is no deliberate attempt to assign patients to the unit based on how sick they are or complicated their cases are. All are general medicine patients, including up to six intermediate care patients (e.g., “ICU step-down” patients requiring mask ventilation, etc.). While configured for 20 patients, the unit can flex to as many as 24 patients and has done so numerous times. The hospitalists (physician and NP combined) have averaged 18.9 daily encounters since the CMU opened.
Nurse staffing on the unit was reconfigured to comprise bedside nurses – known as Clinical Nurses (CNs) – and more experienced RNs – in the role of Comprehensive Charge Nurses (CCNs), who attend rounds and coordinate the patients’ hospitalizations rather than doing bedside care. 5-Orange has one more Charge Nurse than is typical for other units in the hospital, so total RN-to-patient staffing levels and nurse staffing costs are higher. But the CNs care for the same number of patients as do their counterparts in other hospital units.
In order to try to discharge patients early in the day, the NP sees only the patients who are being discharged, while the physician makes all other visits. When possible, I think it’s best to minimize the incidence of a provider’s first visit with a patient being a discharge visit; this may increase the risk of misunderstandings and errors. Instead, in this model, the physician working on the CMU will already know the patient from the preceding days and will be on the unit and readily accessible to the NP all day, which might mitigate some of these concerns.
Outcomes
I think the most notable outcome is the top quartile patient satisfaction scores from the 37 patients cared for on the unit who returned a survey, some of whom have asked to return to the CMU if they’re hospitalized again. Specifically, 86% of responses were “top box,” which places the hospitalists at the 84th percentile of performance for all hospitals. Physician Communication scores on the HCAHPS survey for hospitalists on other units at this hospital are in the bottom deciles, which is more typical for hospitalists.
Length of stay is half a day shorter than comparable units with similar readmission rates, and more patients are discharged earlier in the day. The four hospitalists who work on the unit report higher satisfaction, in part because they get an average of only 1 page a day – compared with the typical 15-40 pages their colleagues get working elsewhere in the hospital.
Cautions
I’m not sure why the MedOne model has yielded such impressive patient satisfaction and other results. While there are some relatively unique features of their model – only four hospitalists are eligible to work there and nursing roles have been reconfigured – I wouldn’t expect these to yield such remarkable results. So far, they have roughly 5 months of data and just 37 returned patient satisfaction surveys, so it’s possible that random variation and/or the Hawthorne effect are playing a meaningful role. It will be really informative to see their outcomes a year or 2 from now and to gauge how they fare if and when they implement the same model in other units of the hospital.
I suspect MedOne’s precise configuration for staffing and roles of nurses, NPs, and physicians is important, but I’m guessing the most valuable thing they implemented was the creation of a powerful sense of teamwork and shared purpose among those working on the unit. The interpersonal bonding and feeling of shared purpose that likely occurred as they worked to devise and go live with the model, as well as the tremendous satisfaction at seeing their early results, have probably led to terrific enthusiasm within their team.
That enthusiasm may be the key ingredient contributing to their early success.
Dr. Nelson has been working in clinical practice as a hospitalist since 1988. He is a cofounder and past president of Society of Hospital Medicine and a principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice-management courses. Contact him at [email protected]
QI enthusiast to QI leader: Jonathan Bae, MD, SFHM
Editor’s Note: This SHM series highlights the professional pathways of quality improvement leaders. This month features the story of Jonathan Bae, MD, SFHM, associate chief medical officer for patient and clinical quality at Duke University Health System, Durham, N.C.
With a father and two sisters in medicine, Jonathan Bae was destined to become a physician – or something completely different, as he explains.
“Either outcome is common when you have a parent who is a doctor,” said Dr. Bae, who has two siblings who chose a different career path. But while Dr. Bae’s desire to be a clinician was set at an early age, his interest in quality improvement work came much later.
Twelve years ago, Dr. Bae matched in Duke’s Medicine-Pediatrics residency program because he wanted to be well equipped to treat patients across the age spectrum. Completing residency in 2009, Dr. Bae enjoyed providing clinical care as a hospitalist, but discovered that he also enjoyed teaching. To enhance his skills as a clinician educator, Dr. Bae enrolled in the Academic Hospitalist Academy, where the curriculum introduced him to quality improvement and patient safety, and some aspects of hospital administration. “Jeff Glasheen’s talk on the drivers of medicine, and how to find your unique voice and identity … brought together my interest in education and quality work,” Dr. Bae recalled.
“I left the meeting energized with new information, and then the opportunity came up to lead a QI initiative here,” he said. The project focused on improving improve care delivery to diabetic patients, specifically the completion of foot exams. “We saw our rates of screening go from less than 50% to greater than 80%,” Dr. Bae said. “I found it to be extremely gratifying to be involved in implementing changes that could lead to care improvement for patients.”
Once Dr. Bae made his interests in QI work known to colleagues and administrators, the projects came readily. Following his chief residency year, Dr. Bae remained with Duke Medicine Residency Program as an associate program director for QI, “which was a great platform for doing project work that aligned my interests in teaching and doing QI work,” he said. In addition to developing a residency curriculum in QI, Dr. Bae initiated a program to incentivize GME trainees across the health system in performance metrics such as readmissions, patient satisfaction, hand hygiene, and safety event reporting. The outcomes, Dr. Bae said, “have had an improved quality and safety impact on our organization.”
From there, Dr. Bae initiated multiple projects focused on reducing readmissions and mortality. Currently, he is standardizing the mortality review process across three hospitals in Duke’s health system. Consistent methodology and language will allow for more accurate analysis and comparison of factors contributing to patient mortality in the system, Dr. Bae said, adding, “We have already learned a lot about care delivery and operations, and measures that can be taken to reduce gaps in care delivery and keep patients safe.”
Looking back on the days when he only thought about providing care, Dr. Bae said, “my world view has changed but my desire to change the world hasn’t. I now do more quality work because I find it so gratifying. In the QI space, I’m affecting not one, but many people at a time.”
He encourages hospitalists with similar interests to seek out colleagues and leaders – internal and external to their institutions – that will help them initiate and implement projects that feed their passions. Getting to know the QI basics is the simple part, Dr. Bae said.
“There’s no magic behind PDSA cycles or models of improvement,” he said. “It’s the team and people you pull together that makes a project successful.”
His current work centers on understanding and building health care provider resiliency at Duke. “I feel this … is going to make a tremendous difference for our organization,” Dr. Bae said. “The system should be designed to promote well-being, not just prevent burnout.”
Claudia Stahl is content manager at the Society of Hospital Medicine.
Editor’s Note: This SHM series highlights the professional pathways of quality improvement leaders. This month features the story of Jonathan Bae, MD, SFHM, associate chief medical officer for patient and clinical quality at Duke University Health System, Durham, N.C.
With a father and two sisters in medicine, Jonathan Bae was destined to become a physician – or something completely different, as he explains.
“Either outcome is common when you have a parent who is a doctor,” said Dr. Bae, who has two siblings who chose a different career path. But while Dr. Bae’s desire to be a clinician was set at an early age, his interest in quality improvement work came much later.
Twelve years ago, Dr. Bae matched in Duke’s Medicine-Pediatrics residency program because he wanted to be well equipped to treat patients across the age spectrum. Completing residency in 2009, Dr. Bae enjoyed providing clinical care as a hospitalist, but discovered that he also enjoyed teaching. To enhance his skills as a clinician educator, Dr. Bae enrolled in the Academic Hospitalist Academy, where the curriculum introduced him to quality improvement and patient safety, and some aspects of hospital administration. “Jeff Glasheen’s talk on the drivers of medicine, and how to find your unique voice and identity … brought together my interest in education and quality work,” Dr. Bae recalled.
“I left the meeting energized with new information, and then the opportunity came up to lead a QI initiative here,” he said. The project focused on improving improve care delivery to diabetic patients, specifically the completion of foot exams. “We saw our rates of screening go from less than 50% to greater than 80%,” Dr. Bae said. “I found it to be extremely gratifying to be involved in implementing changes that could lead to care improvement for patients.”
Once Dr. Bae made his interests in QI work known to colleagues and administrators, the projects came readily. Following his chief residency year, Dr. Bae remained with Duke Medicine Residency Program as an associate program director for QI, “which was a great platform for doing project work that aligned my interests in teaching and doing QI work,” he said. In addition to developing a residency curriculum in QI, Dr. Bae initiated a program to incentivize GME trainees across the health system in performance metrics such as readmissions, patient satisfaction, hand hygiene, and safety event reporting. The outcomes, Dr. Bae said, “have had an improved quality and safety impact on our organization.”
From there, Dr. Bae initiated multiple projects focused on reducing readmissions and mortality. Currently, he is standardizing the mortality review process across three hospitals in Duke’s health system. Consistent methodology and language will allow for more accurate analysis and comparison of factors contributing to patient mortality in the system, Dr. Bae said, adding, “We have already learned a lot about care delivery and operations, and measures that can be taken to reduce gaps in care delivery and keep patients safe.”
Looking back on the days when he only thought about providing care, Dr. Bae said, “my world view has changed but my desire to change the world hasn’t. I now do more quality work because I find it so gratifying. In the QI space, I’m affecting not one, but many people at a time.”
He encourages hospitalists with similar interests to seek out colleagues and leaders – internal and external to their institutions – that will help them initiate and implement projects that feed their passions. Getting to know the QI basics is the simple part, Dr. Bae said.
“There’s no magic behind PDSA cycles or models of improvement,” he said. “It’s the team and people you pull together that makes a project successful.”
His current work centers on understanding and building health care provider resiliency at Duke. “I feel this … is going to make a tremendous difference for our organization,” Dr. Bae said. “The system should be designed to promote well-being, not just prevent burnout.”
Claudia Stahl is content manager at the Society of Hospital Medicine.
Editor’s Note: This SHM series highlights the professional pathways of quality improvement leaders. This month features the story of Jonathan Bae, MD, SFHM, associate chief medical officer for patient and clinical quality at Duke University Health System, Durham, N.C.
With a father and two sisters in medicine, Jonathan Bae was destined to become a physician – or something completely different, as he explains.
“Either outcome is common when you have a parent who is a doctor,” said Dr. Bae, who has two siblings who chose a different career path. But while Dr. Bae’s desire to be a clinician was set at an early age, his interest in quality improvement work came much later.
Twelve years ago, Dr. Bae matched in Duke’s Medicine-Pediatrics residency program because he wanted to be well equipped to treat patients across the age spectrum. Completing residency in 2009, Dr. Bae enjoyed providing clinical care as a hospitalist, but discovered that he also enjoyed teaching. To enhance his skills as a clinician educator, Dr. Bae enrolled in the Academic Hospitalist Academy, where the curriculum introduced him to quality improvement and patient safety, and some aspects of hospital administration. “Jeff Glasheen’s talk on the drivers of medicine, and how to find your unique voice and identity … brought together my interest in education and quality work,” Dr. Bae recalled.
“I left the meeting energized with new information, and then the opportunity came up to lead a QI initiative here,” he said. The project focused on improving improve care delivery to diabetic patients, specifically the completion of foot exams. “We saw our rates of screening go from less than 50% to greater than 80%,” Dr. Bae said. “I found it to be extremely gratifying to be involved in implementing changes that could lead to care improvement for patients.”
Once Dr. Bae made his interests in QI work known to colleagues and administrators, the projects came readily. Following his chief residency year, Dr. Bae remained with Duke Medicine Residency Program as an associate program director for QI, “which was a great platform for doing project work that aligned my interests in teaching and doing QI work,” he said. In addition to developing a residency curriculum in QI, Dr. Bae initiated a program to incentivize GME trainees across the health system in performance metrics such as readmissions, patient satisfaction, hand hygiene, and safety event reporting. The outcomes, Dr. Bae said, “have had an improved quality and safety impact on our organization.”
From there, Dr. Bae initiated multiple projects focused on reducing readmissions and mortality. Currently, he is standardizing the mortality review process across three hospitals in Duke’s health system. Consistent methodology and language will allow for more accurate analysis and comparison of factors contributing to patient mortality in the system, Dr. Bae said, adding, “We have already learned a lot about care delivery and operations, and measures that can be taken to reduce gaps in care delivery and keep patients safe.”
Looking back on the days when he only thought about providing care, Dr. Bae said, “my world view has changed but my desire to change the world hasn’t. I now do more quality work because I find it so gratifying. In the QI space, I’m affecting not one, but many people at a time.”
He encourages hospitalists with similar interests to seek out colleagues and leaders – internal and external to their institutions – that will help them initiate and implement projects that feed their passions. Getting to know the QI basics is the simple part, Dr. Bae said.
“There’s no magic behind PDSA cycles or models of improvement,” he said. “It’s the team and people you pull together that makes a project successful.”
His current work centers on understanding and building health care provider resiliency at Duke. “I feel this … is going to make a tremendous difference for our organization,” Dr. Bae said. “The system should be designed to promote well-being, not just prevent burnout.”
Claudia Stahl is content manager at the Society of Hospital Medicine.
