Recent Articles
Patient hand offs more about skills than checklists
As I continue to research patient hand offs for an upcoming article in Hospitalist Leadership Advisor, I’ve realized that hand offs are less about forms, tools, and checklists and more about having good communication skills.
I know I’m guilty of assuming that other people can read my mind from time to time—we all are. I recall asking my husband if we could go to the curtain store one day to pick out some shades for the dining room. We were on the highway for quite some time before he asked, “Where’s the curtain store?” Of course! I know where it is because I’m a home deco diva, but he had never been there before. I assumed that because I knew, he knew, and I probably would have been mad when he blew by the exit. Sounds trivial, but when it comes to patient care and physician relationships, these details are critical.
Here are three tips that I’ve picked up from my sources that will not only help practicing hospitalists improve the quality of patient hand offs, but also help leaders brush up their every day communication skills.
Explain your rationale: When handing patients off to another hospitalist, explain what symptoms prompted you to order certain tests, and be sure to tell the hospitalist taking over the care of your patient exactly what they need to look for when the test results come back. Don’t just say “Order texts X, Y, Z.”
Repeat back information: To ensure that your understanding of an issue matches the other person’s intended meaning, repeat back what they’ve said to you. You do this with driving directions, right? (So, I’m taking a left on to Mason St. and a right at the blinking red light.) So why not incorporate this strategy into your clinical work or leadership activities? “Repeat-backs have not only been shown to improve patient safety and prevent errors, but they also enhance memory,” says Vineet Arora, MD, MAPP, Assistant Professor of Medicine, Associate Director Internal Medicine Residency, and Assistant Dean Scholarship & Discovery at the Pritzker School of Medicine, University of Chicago.
Don’t assume a note will suffice: If you’ve ever left a note for a family member to pick up milk, you’ve probably been disappointed. That person either never got the note or didn’t know whether you wanted skim, 2%, or whole. “You are able to communicate better, richer information more effectively through the verbal communication channel than any other communication channel,” says Arpana Vidyarthi, MD, Director of Quality and Safety in the Division of Hospital Medicine, Director of Patient Safety and Quality Programs GME, Director of the Institute for Physician Leadership, and Associate Professor of Clinical Medicine at the University of California, San Francisco.
For more tips and advice for improving patient hand offs, look for your January issue of Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing.
Greeley Medical Staff Institute and bundled payments
I recently had the privilege of speaking at the Greeley Medical Staff Institute Symposium in Naples, Florida, November 8-9, and found the experience to be both very enjoyable and educational. I really enjoyed serving on the opening plenary session panel discussion regarding healthcare reform. I was amazed at the prophetic abilities of the organizers in having the panel speak about reform exactly nine hours after the House of Representatives passed the 1,990-page bill! I had the honor of sharing the podium with Dr. Jon Burroughs of the Greeley Company and Dr. John Maa, one of the nations thought leaders on surgicalists. The session was moderated by Dr. Rick Sheff, executive director of the Greeley Company.
One of the questions posed was regarding the effect of the proposed “bundled payments.” Predictably, this has proven to be a very volatile topic amongst physicians. The Phoenix Group, of which I am a member, published a white paper earlier this year on the topic. The first draft stated that “healthcare reform legislation holds the potential for a cataclysmic uprooting of the traditional fee-for-service payment system.” In final form the word cataclysmic was removed. I suppose “cataclysmic” is in the eye of the beholder, but one thing is clear: The current bill is designed to change how providers get paid, and even how their businesses are structured and aligned and, ultimately, how care is rationed. Consider the following:
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GMSI: More photos from the hospitalist track
Here are some more photos from the wonderful speakers in the hospitalist track at the Greeley Medical Staff Institute Symposium, Naples, FL, this month.
John Nelson, MD, FACPE, FHM, speaks on the surgical hospitalist movement. (HospitalistLeadership.com Photo / Karen M. Cheung)
John Maa, MD, FACS, discusses the important of surgical hospitalists in today's reform climate. (HospitalistLeadership.com Photo / Karen M. Cheung)
Kirk Mathews, MBA, provides tips on hospitalist recruitment and retention. (HospitalistLeadership.com Photo / Karen M. Cheung)
Internet playing increasing role in physician job searches
More physicians are ditching the fancy resume paper and stamps in favor of Internet searches, according to a recent American Medical News article. In addition, physician recruiters are relying less on expensive search firms and more on the Internet and word of mouth to get physicians on board. The article states that in 2009, the number of inhouse recruiters who regularly used external search firms dropped to 49% from 55.1% in 2008. Take the poll below to share how your hospitalist program handles recruitment searches.
I can’t get no sa-tis-fac-tion
Patient satisfaction is going to emerge soon as an issue for hospitalists. Communication with doctors is one of the components of the federally-mandated HCAHPS surveys for hospitals, and payment may eventually be linked to that measure.
Administrators are very sensitive to complaints, and more of them seem to be generated by hospitalist service patients than other services. The reasons are not hard to understand; the hospitalist usually has no prior relationship with the patient, may not know the preferred communication style for that patient, and is under pressure to reduce length of stay and conserve hospital resources.
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More OB hospitalists share their thoughts on program development
Jodie M. Horton, MD, medical director of the OB hospitalist department at Inova Loudoun Hospital in Leesburg, VA, shares her thoughts about OB hospitalist program development in response to our October 20 blog post. Here are her answers to our two most pressing questions:
As an OB hospitalist, what do your responsibilities entail?
OB hospitalist programs usually take 24-hour call shifts, although there are programs that do 12-hour shifts. We see a wide range of problems, including gynecological emergencies, surgery, triage, and C-sections.
GMSI Live: Photo spotlight on hospitalist track
The attendees of The Greeley Medical Staff Institute (GMSI) Symposium have the option to switch between the four tracks of:
- Physician-hospital alignment
- Peer review and physician performance
- Health Law, bylaws, and regulatory issues
- Hospitalist program management
Here are some of the photos that highlight our great hospitalist speakers from today’s sessions:
Martin B. Buser, MPH, FACHE, partner of Hospitalist Management Resources, LLC, talks on the specialty "ist" movement. (HospitalistLeadership.com Photo / Karen M. Cheung)
Roger Heroux, MHA, PhD, FACHE, partner of Hospitalist Leadership Resources, LLC, talkes about designing a "fourth-generation program." (HospitalistLeadership.com Photo / Karen M. Cheung)
Hussein Akl, MD, director of inpatient and regional medicine at Bronson Methodist Hospital, explains strategies for aligning incentatives. (HospitalistLeadership.com Photo / Karen M. Cheung
Robert J. Holloway, MD, FACP, FHM, CEO and CMO at InCompass Health, names various hospitalist ROI strategies to maximize value of the program. (HospitalistLeadership.com Photo / Karen M. Cheung)
Rest up tonight, and check back tomorrow for the final day of GMSI.
GMSI Live: Health reform panel talks on new bill passed by House
The Greeley Medical Staff Institute (GMSI) Symposium opened its doors this morning to attendees of the plenary session, “Healthcare reform: What it means for hospitals and physicians.” Just hours after the House of Representatives voted to pass its version of the healthcare reform bill, otherwise known as HR 3962, the Affordable Health Care for America Act, moderator Richard A. Sheff, MD, CMSL, chair and executive director of The Greeley Company joked that many sleepy-eyed attendees, like him, may have also stayed up to watch the House vote of 220-215. The hotly debated issue shocked many as both Republicans and Democrats came to a final vote.
Panelists Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, John Maa, MD, FACS, and Kirk Mathews, MBA, debate what healthcare reform will look like in the coming months. (HospitalistLeadership.com Photo / Karen M. Cheung)
With panelists Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, John Maa, MD, FACS, and Kirk Mathews, MBA, the GMSI Symposium opening session similarly focused on the issues of bundled payments, a public option, and what and when to expect healthcare reform.
Although unclear when the Senate will vote on the healthcare reform bill, many wait with held breathes for reform to become reality.
GMSI Live: Symposium kicks off
The Greeley Medical Staff Institute Symposium takes place at the Ritz-Carlton, Naples, FL. (HospitalistLeadership.com Photo / Karen M. Cheung)
We’re here in beautiful Naples, FL, at the Ritz-Carlton!
The Greeley Medical Staff Institute Symposium Pre-conference kicked off today with attendees in the three tracks of ED Call, Medical Staff Bylaws, and Physician Performance Measurement for intimate, interactive workshops.
Led by speakers, Richard A. Sheff, MD, CMSL, Michael R. Callahan, Esq., Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, and Robert J. Marder, MD, CMSL, the workshops were a three-hour intensive, chock-full of good information.
Particularly interesting was Marder’s session on how to select indicators and targets for the six general competencies and OPPE.
“Who’s a mediocre physician?,” asked Marder for a show of hands in the room of medical staff leaders who chuckled. Most people simply use data to distinguish between acceptable and not acceptable performance. Instead, Marder explained, medical staffs need to have targets to distinguish between excellent, average, and not average performance, and not simply the traditional acceptable/nonacceptable data. Physicians should be distinguished between mediocre and those who go above and beyond. Therefore, set targets.
“If you don’t have targets, it’s not a performance measurement; it’s just data,” said Marder.
Get some rest tonight for a full day tomorrow as we dive into the programs of Physician-Hospital Alignment, Peer Review and Physician Performance, Hospitalist Program Management, and Health Law, Bylaws, and Regulatory Issues. Keep a look at for more stories and pictures from GMSI Live!
The Ritz-Carlton features balconies that overlook Naples, FL. (HospitalistLeadership.com Photo / Karen M. Cheung)
See you in Naples!
HCPro and Greeley are gearing up and flying out to Naples, FL for The Greeley Medical Staff Institute Symposium (November 8-9, Naples, FL)!
Will you be joining us this weekend? Come over and say hello to me or another HCPro or Greeley representative. All the speakers would love to see you too. We’d love to meet you!
Can’t join this year? Don’t worry; you can still follow the action right here on HospitalistLeadership.com for stories and photos. Remember, you can always follow me on Twitter.
The “one-visit follow-up clinic”
A frequent impediment to reducing length of stay with the unassigned (or “no-doc”) patients is the lack of an outpatient physician with whom the patient can get an appointment. In many, many places around the country, primary care physicians have overflowing practices and cannot take on the unassigned patient very easily.
One solution to this dilemma is what I call the “one-visit follow-up clinic”. At Inpatient Management Inc., we are about to launch our first such clinic. The idea works like this: we, as the hospitalist team, will provide one follow-up visit to patients who do not have a primary care physician. The clinic might see patients two half-days per week, depending on volume, and can be staffed by a nurse practitioner with supervision from one of the hospitalists.
