Daniel Bitetto, MD

What makes some groups better to work with than others? What makes the work dynamic in some groups more optimistic?

It starts with leadership. Leaders must first know themselves. They must first know their limits and their strengths. They must work on the former while celebrating the latter. A leader must lead. At times a leader can be (and should be) an advocate for the group. But simply advocating for a group is not enough. A leader must take the group down new avenues. A leader must coach the group to better practices. A leader must be the one pioneering new ways of doing things with the intent of improving patient care and provider satisfaction.

Leaders need to be clear with their expectations for hospital medicine. This gives the group the ability to make a conscious choice as to whether or not they wish to stay within the group. If they stay, then it provides the structure for which the group functions. Examples can range from small to big: I expect that you will be at meetings on time; it’s our group’s expectation that you will greet each patient with a smile, handshake, and business card for the first meeting. With the group understanding these expectations, a leader can manage performance and hold providers accountable.

Clear expectations and objectives should be communicated early. They need to be communicated often. In certain instances goals may change. It may be institutional change or changes with Medicare. I often will communicate this change in person once; send an e-mail once and then have a follow-up communication over lunch to answer any questions regarding the change and its implementation. This trio of communication allows me to get the majority of the audience that I need to reach. It gives the audience a “hard copy” in the form of an e-mail to read and also gives the opportunity to answer any questions that I may have overlooked or was not clear with in the other forms of communication.

Ideally, the best time to communicate expectations and objectives is when new providers are hired. New physicians starting in practice need to be trained and adjusted into the team. They need on-boarding, mentors, career coaches, and the opportunity to practice applicable CME early on in the new job. These new additions need to be challenged about their future goals and supported in attaining them. Usually new hospitalists want to get involved in education (medical students or residents), administration, and quality care, or sometimes they just want to practice at becoming better physicians. We all should strive to do the latter always, but some may only want to be clinicians. Either way, all of these goals should be nurtured.

Good training leads to physician participation as an expectation. Participation should not be the stick for which the carrot hangs. Hospitalists need to be on committees and need to have representation at all levels of hospital logistics and tasks. This is how respect and autonomy are gained. And if done properly, this autonomy will receive the support from the highest levels of hospital administration.

With each individual supporting the team (because they are expected to speak on behalf of the group and report back to the group about their findings), the bunch of individuals will start to form a team. What does that mean? An individual hospitalist has her own set of beliefs and practices that makes her unique. If you take a random sampling of hospitalists from many different backgrounds and educational experiences from all over the country (which is any typical hospitalist group), you will have a bunch of individuals. Each hospitalist will come equipped with their own talents and struggles. Now if you take that bunch of individuals and train them in the ways of best practices with good leadership, you can begin to build a functional team. I want to avoid sports analogies, but I think the picture is clearer now than before. See Bad News Bears or Coach Carter. Any team that has clearly stated objectives (expectations/mission statement), that also has good on-boarding and training, will be successful. When the on-boarding process involves mentoring and coaching to help individuals become better administrators, leaders, educators, quality improvers et cetera the team develops together.

One thing that I’ve left out is the logistics of having a good team. Great teams have things like salary, time off, and other benefits included as part of the package. With money and benefits taken off of the table as an issue, the group can focus on things they’ve been trained to focus on: quality patient care. It’s been my opinion that using money to motivate anyone will get the bare minimum performance needed to get the result that leads to the money. So why not take that form of motivation out of the equation? If groups invest in their members, the rewards are greater than rewarding individuals for how many widgets they can churn out of a factory.

With these tools of good leadership, team training and development, excellent communication, and a good salary with benefits, then the expectation of participation and positive feedback should be the norm. A good positive dynamic will develop, and the team will work to support itself. Eventually, a team like this one could become a work-family that could be deployed for specialty care (such as head bleeds and gunshot wounds) as the institution needs it to be deployed. This is provided that this kind of work-family already vetted its concerns and could adapt to those needs. These work-families rely less on the leader to hold everyone accountable and allows the unit to relax together and venture off into creative endeavors for the future. That article is for another time.

Dr. Bitetto is chief for the section of Hospital Medicine at Lehigh Valley Hospital, Allentown, Pa.

What makes some groups better to work with than others? What makes the work dynamic in some groups more optimistic?

It starts with leadership. Leaders must first know themselves. They must first know their limits and their strengths. They must work on the former while celebrating the latter. A leader must lead. At times a leader can be (and should be) an advocate for the group. But simply advocating for a group is not enough. A leader must take the group down new avenues. A leader must coach the group to better practices. A leader must be the one pioneering new ways of doing things with the intent of improving patient care and provider satisfaction.

Leaders need to be clear with their expectations for hospital medicine. This gives the group the ability to make a conscious choice as to whether or not they wish to stay within the group. If they stay, then it provides the structure for which the group functions. Examples can range from small to big: I expect that you will be at meetings on time; it’s our group’s expectation that you will greet each patient with a smile, handshake, and business card for the first meeting. With the group understanding these expectations, a leader can manage performance and hold providers accountable.

Clear expectations and objectives should be communicated early. They need to be communicated often. In certain instances goals may change. It may be institutional change or changes with Medicare. I often will communicate this change in person once; send an e-mail once and then have a follow-up communication over lunch to answer any questions regarding the change and its implementation. This trio of communication allows me to get the majority of the audience that I need to reach. It gives the audience a “hard copy” in the form of an e-mail to read and also gives the opportunity to answer any questions that I may have overlooked or was not clear with in the other forms of communication.

Ideally, the best time to communicate expectations and objectives is when new providers are hired. New physicians starting in practice need to be trained and adjusted into the team. They need on-boarding, mentors, career coaches, and the opportunity to practice applicable CME early on in the new job. These new additions need to be challenged about their future goals and supported in attaining them. Usually new hospitalists want to get involved in education (medical students or residents), administration, and quality care, or sometimes they just want to practice at becoming better physicians. We all should strive to do the latter always, but some may only want to be clinicians. Either way, all of these goals should be nurtured.

Good training leads to physician participation as an expectation. Participation should not be the stick for which the carrot hangs. Hospitalists need to be on committees and need to have representation at all levels of hospital logistics and tasks. This is how respect and autonomy are gained. And if done properly, this autonomy will receive the support from the highest levels of hospital administration.

With each individual supporting the team (because they are expected to speak on behalf of the group and report back to the group about their findings), the bunch of individuals will start to form a team. What does that mean? An individual hospitalist has her own set of beliefs and practices that makes her unique. If you take a random sampling of hospitalists from many different backgrounds and educational experiences from all over the country (which is any typical hospitalist group), you will have a bunch of individuals. Each hospitalist will come equipped with their own talents and struggles. Now if you take that bunch of individuals and train them in the ways of best practices with good leadership, you can begin to build a functional team. I want to avoid sports analogies, but I think the picture is clearer now than before. See Bad News Bears or Coach Carter. Any team that has clearly stated objectives (expectations/mission statement), that also has good on-boarding and training, will be successful. When the on-boarding process involves mentoring and coaching to help individuals become better administrators, leaders, educators, quality improvers et cetera the team develops together.

One thing that I’ve left out is the logistics of having a good team. Great teams have things like salary, time off, and other benefits included as part of the package. With money and benefits taken off of the table as an issue, the group can focus on things they’ve been trained to focus on: quality patient care. It’s been my opinion that using money to motivate anyone will get the bare minimum performance needed to get the result that leads to the money. So why not take that form of motivation out of the equation? If groups invest in their members, the rewards are greater than rewarding individuals for how many widgets they can churn out of a factory.

With these tools of good leadership, team training and development, excellent communication, and a good salary with benefits, then the expectation of participation and positive feedback should be the norm. A good positive dynamic will develop, and the team will work to support itself. Eventually, a team like this one could become a work-family that could be deployed for specialty care (such as head bleeds and gunshot wounds) as the institution needs it to be deployed. This is provided that this kind of work-family already vetted its concerns and could adapt to those needs. These work-families rely less on the leader to hold everyone accountable and allows the unit to relax together and venture off into creative endeavors for the future. That article is for another time.

Dr. Bitetto is chief for the section of Hospital Medicine at Lehigh Valley Hospital, Allentown, Pa.

What makes some groups better to work with than others? What makes the work dynamic in some groups more optimistic?

It starts with leadership. Leaders must first know themselves. They must first know their limits and their strengths. They must work on the former while celebrating the latter. A leader must lead. At times a leader can be (and should be) an advocate for the group. But simply advocating for a group is not enough. A leader must take the group down new avenues. A leader must coach the group to better practices. A leader must be the one pioneering new ways of doing things with the intent of improving patient care and provider satisfaction.

Leaders need to be clear with their expectations for hospital medicine. This gives the group the ability to make a conscious choice as to whether or not they wish to stay within the group. If they stay, then it provides the structure for which the group functions. Examples can range from small to big: I expect that you will be at meetings on time; it’s our group’s expectation that you will greet each patient with a smile, handshake, and business card for the first meeting. With the group understanding these expectations, a leader can manage performance and hold providers accountable.

Clear expectations and objectives should be communicated early. They need to be communicated often. In certain instances goals may change. It may be institutional change or changes with Medicare. I often will communicate this change in person once; send an e-mail once and then have a follow-up communication over lunch to answer any questions regarding the change and its implementation. This trio of communication allows me to get the majority of the audience that I need to reach. It gives the audience a “hard copy” in the form of an e-mail to read and also gives the opportunity to answer any questions that I may have overlooked or was not clear with in the other forms of communication.

Ideally, the best time to communicate expectations and objectives is when new providers are hired. New physicians starting in practice need to be trained and adjusted into the team. They need on-boarding, mentors, career coaches, and the opportunity to practice applicable CME early on in the new job. These new additions need to be challenged about their future goals and supported in attaining them. Usually new hospitalists want to get involved in education (medical students or residents), administration, and quality care, or sometimes they just want to practice at becoming better physicians. We all should strive to do the latter always, but some may only want to be clinicians. Either way, all of these goals should be nurtured.

Good training leads to physician participation as an expectation. Participation should not be the stick for which the carrot hangs. Hospitalists need to be on committees and need to have representation at all levels of hospital logistics and tasks. This is how respect and autonomy are gained. And if done properly, this autonomy will receive the support from the highest levels of hospital administration.

With each individual supporting the team (because they are expected to speak on behalf of the group and report back to the group about their findings), the bunch of individuals will start to form a team. What does that mean? An individual hospitalist has her own set of beliefs and practices that makes her unique. If you take a random sampling of hospitalists from many different backgrounds and educational experiences from all over the country (which is any typical hospitalist group), you will have a bunch of individuals. Each hospitalist will come equipped with their own talents and struggles. Now if you take that bunch of individuals and train them in the ways of best practices with good leadership, you can begin to build a functional team. I want to avoid sports analogies, but I think the picture is clearer now than before. See Bad News Bears or Coach Carter. Any team that has clearly stated objectives (expectations/mission statement), that also has good on-boarding and training, will be successful. When the on-boarding process involves mentoring and coaching to help individuals become better administrators, leaders, educators, quality improvers et cetera the team develops together.

One thing that I’ve left out is the logistics of having a good team. Great teams have things like salary, time off, and other benefits included as part of the package. With money and benefits taken off of the table as an issue, the group can focus on things they’ve been trained to focus on: quality patient care. It’s been my opinion that using money to motivate anyone will get the bare minimum performance needed to get the result that leads to the money. So why not take that form of motivation out of the equation? If groups invest in their members, the rewards are greater than rewarding individuals for how many widgets they can churn out of a factory.

With these tools of good leadership, team training and development, excellent communication, and a good salary with benefits, then the expectation of participation and positive feedback should be the norm. A good positive dynamic will develop, and the team will work to support itself. Eventually, a team like this one could become a work-family that could be deployed for specialty care (such as head bleeds and gunshot wounds) as the institution needs it to be deployed. This is provided that this kind of work-family already vetted its concerns and could adapt to those needs. These work-families rely less on the leader to hold everyone accountable and allows the unit to relax together and venture off into creative endeavors for the future. That article is for another time.

Dr. Bitetto is chief for the section of Hospital Medicine at Lehigh Valley Hospital, Allentown, Pa.