Danielle Scheurer

It’s great to be a Tennessee Volunteer. I said, It’s great to be a Tennessee Volunteer!

The crowd, a sea of orange, packs into Neyland Stadium in Knoxville, Tenn., brimming with pride, dedicated to the team they call the Vols. Neyland Stadium, built in 1921, comfortably seats more than 100,000 brash fans on most fall weekends during the college football season. These die-hard fans pack the stadium regularly, hoping to catch a glimpse of victory.

Throughout the decades of Tennessee Volunteers football, numerous coaches have spent countless hours thinking about how to realize those victories. And they have also spent a lot time thinking about how to keep their players safe. Each coach has had different styles and tactics, but all had one thing in common: They were clearly invested in keeping their players safe. A safe player is a good player, one who can make the full season without injury. As such, before each practice and each game, the players don the gear required to play the safest game possible.

This gear is expensive, difficult to put on, difficult to keep on, makes them run slower, and makes them sweat heavier. When you think about it, it is a wonder that they wear it at all—unless you consider the fact that each precisely placed article takes them one step closer to surviving the game intact, and making it to the next victory. Just like any other type of protective equipment, football equipment has evolved over the course of time. The helmet, for example, is now custom-fit for each player with calipers, and then subsequent additions are applied to ensure durability, shock resistance, and comfort. Relatively new additions include eye shields (to protect the eyes and reduce glare) and even radio devices (to allow the coach to relay last-minute critical information to the quarterback). These helmets are all customized to the players’ position, to allow for the best balance between protection and visibility.

And the helmet is just the beginning. The remaining bare minimum amount of gear needed for standard player safety includes a mouthpiece, jaw pads, neck roll, shoulder pads, shock pads, rib pads, hip pads, knee pads, and cleats. All told, the weight of all this equipment is between 10 and 25 pounds and takes up to an hour to fully gear up. But nonetheless, it has become such a mainstay, of centralized importance to the game, that each team has a dedicated equipment manager. They are charged with providing, maintaining, and transporting the best gear for every member of the team. The equipment manager is a vital resource for the team and the sport.

Despite the extra weight and inconvenience that their gear can burden them with, you don’t see a single football player “skimp” on it. And it would certainly be obvious to all those around them if they ran onto the field without their helmet. Over the years, the football industry has not abandoned gear that they thought was less than perfect, too heavy, too bulky, or made the player perform with less agility. They just made the gear better, lighter, more comfortable, and more protective.

You Can Do This

In a similar fashion, hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be? I would argue there are a number of coaches and equipment managers in the hospital setting whose mission is to keep their “players” safe. The players are both patients and providers, as generally a “safe provider” is one who makes and implements solid decisions, and who is housed within a safe, predictable, and highly-reliable system, is also one who can and will keep their patients safe.

We may not think of ourselves as such, but hospitalists can be extremely effective coaches and equipment managers. They can help create and maintain safe and effective gear for themselves and those patients and providers around them. They can be a mentor for displaying how vitally import this gear is and can work to improve it when it proves to be imperfect.

Although we don’t tend to think of these things as “safety gear,” these things do, in fact, keep us and our patients safe. Some of these include:

• Computerized physician order entry (CPOE) with decision support (or order sets without CPOE);
• Checklists;
• Procedural time-outs;
• Protocols;
• Medication dosing guidelines;
• Handheld devices (for quick lookup of medication doses, side effects, predictive scoring systems, medical calculators, etc.); and
• Gowns and gloves.

Additional “gear” for the patients can include:

• Arm bands for identification and medication scanning;
• Telemetry;
• Bed alarms;
• IV pumps with guard rails around dosing;
• Antibiotic impregnated central lines; and
• Early mobilization protocols.

The Next Level

To take the medical industry to the next level of safe reliability, we need all providers to accept and embrace the concept of “safety gear” for themselves and for their patients. We need to make it perfectly obvious when that gear is missing. It should invoke a reaction of ghastly fear when we witness anyone (provider, patient, or family) skimping on their gear: removing an armband for convenience, bypassing a smart pump, or skipping decision support in CPOE. And for the current gear that is imperfect, slows us down, beeps too often, or reduces our agility, the solution should include improving the gear, not ignoring it or discounting its importance.

So before you go to work today (every day?), think about what you need to keep yourself and your patients safe. And get your gear on.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

It’s great to be a Tennessee Volunteer. I said, It’s great to be a Tennessee Volunteer!

The crowd, a sea of orange, packs into Neyland Stadium in Knoxville, Tenn., brimming with pride, dedicated to the team they call the Vols. Neyland Stadium, built in 1921, comfortably seats more than 100,000 brash fans on most fall weekends during the college football season. These die-hard fans pack the stadium regularly, hoping to catch a glimpse of victory.

Throughout the decades of Tennessee Volunteers football, numerous coaches have spent countless hours thinking about how to realize those victories. And they have also spent a lot time thinking about how to keep their players safe. Each coach has had different styles and tactics, but all had one thing in common: They were clearly invested in keeping their players safe. A safe player is a good player, one who can make the full season without injury. As such, before each practice and each game, the players don the gear required to play the safest game possible.

This gear is expensive, difficult to put on, difficult to keep on, makes them run slower, and makes them sweat heavier. When you think about it, it is a wonder that they wear it at all—unless you consider the fact that each precisely placed article takes them one step closer to surviving the game intact, and making it to the next victory. Just like any other type of protective equipment, football equipment has evolved over the course of time. The helmet, for example, is now custom-fit for each player with calipers, and then subsequent additions are applied to ensure durability, shock resistance, and comfort. Relatively new additions include eye shields (to protect the eyes and reduce glare) and even radio devices (to allow the coach to relay last-minute critical information to the quarterback). These helmets are all customized to the players’ position, to allow for the best balance between protection and visibility.

And the helmet is just the beginning. The remaining bare minimum amount of gear needed for standard player safety includes a mouthpiece, jaw pads, neck roll, shoulder pads, shock pads, rib pads, hip pads, knee pads, and cleats. All told, the weight of all this equipment is between 10 and 25 pounds and takes up to an hour to fully gear up. But nonetheless, it has become such a mainstay, of centralized importance to the game, that each team has a dedicated equipment manager. They are charged with providing, maintaining, and transporting the best gear for every member of the team. The equipment manager is a vital resource for the team and the sport.

Despite the extra weight and inconvenience that their gear can burden them with, you don’t see a single football player “skimp” on it. And it would certainly be obvious to all those around them if they ran onto the field without their helmet. Over the years, the football industry has not abandoned gear that they thought was less than perfect, too heavy, too bulky, or made the player perform with less agility. They just made the gear better, lighter, more comfortable, and more protective.

You Can Do This

In a similar fashion, hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be? I would argue there are a number of coaches and equipment managers in the hospital setting whose mission is to keep their “players” safe. The players are both patients and providers, as generally a “safe provider” is one who makes and implements solid decisions, and who is housed within a safe, predictable, and highly-reliable system, is also one who can and will keep their patients safe.

We may not think of ourselves as such, but hospitalists can be extremely effective coaches and equipment managers. They can help create and maintain safe and effective gear for themselves and those patients and providers around them. They can be a mentor for displaying how vitally import this gear is and can work to improve it when it proves to be imperfect.

Although we don’t tend to think of these things as “safety gear,” these things do, in fact, keep us and our patients safe. Some of these include:

• Computerized physician order entry (CPOE) with decision support (or order sets without CPOE);
• Checklists;
• Procedural time-outs;
• Protocols;
• Medication dosing guidelines;
• Handheld devices (for quick lookup of medication doses, side effects, predictive scoring systems, medical calculators, etc.); and
• Gowns and gloves.

Additional “gear” for the patients can include:

• Arm bands for identification and medication scanning;
• Telemetry;
• Bed alarms;
• IV pumps with guard rails around dosing;
• Antibiotic impregnated central lines; and
• Early mobilization protocols.

The Next Level

To take the medical industry to the next level of safe reliability, we need all providers to accept and embrace the concept of “safety gear” for themselves and for their patients. We need to make it perfectly obvious when that gear is missing. It should invoke a reaction of ghastly fear when we witness anyone (provider, patient, or family) skimping on their gear: removing an armband for convenience, bypassing a smart pump, or skipping decision support in CPOE. And for the current gear that is imperfect, slows us down, beeps too often, or reduces our agility, the solution should include improving the gear, not ignoring it or discounting its importance.

So before you go to work today (every day?), think about what you need to keep yourself and your patients safe. And get your gear on.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

It’s great to be a Tennessee Volunteer. I said, It’s great to be a Tennessee Volunteer!

The crowd, a sea of orange, packs into Neyland Stadium in Knoxville, Tenn., brimming with pride, dedicated to the team they call the Vols. Neyland Stadium, built in 1921, comfortably seats more than 100,000 brash fans on most fall weekends during the college football season. These die-hard fans pack the stadium regularly, hoping to catch a glimpse of victory.

Throughout the decades of Tennessee Volunteers football, numerous coaches have spent countless hours thinking about how to realize those victories. And they have also spent a lot time thinking about how to keep their players safe. Each coach has had different styles and tactics, but all had one thing in common: They were clearly invested in keeping their players safe. A safe player is a good player, one who can make the full season without injury. As such, before each practice and each game, the players don the gear required to play the safest game possible.

This gear is expensive, difficult to put on, difficult to keep on, makes them run slower, and makes them sweat heavier. When you think about it, it is a wonder that they wear it at all—unless you consider the fact that each precisely placed article takes them one step closer to surviving the game intact, and making it to the next victory. Just like any other type of protective equipment, football equipment has evolved over the course of time. The helmet, for example, is now custom-fit for each player with calipers, and then subsequent additions are applied to ensure durability, shock resistance, and comfort. Relatively new additions include eye shields (to protect the eyes and reduce glare) and even radio devices (to allow the coach to relay last-minute critical information to the quarterback). These helmets are all customized to the players’ position, to allow for the best balance between protection and visibility.

And the helmet is just the beginning. The remaining bare minimum amount of gear needed for standard player safety includes a mouthpiece, jaw pads, neck roll, shoulder pads, shock pads, rib pads, hip pads, knee pads, and cleats. All told, the weight of all this equipment is between 10 and 25 pounds and takes up to an hour to fully gear up. But nonetheless, it has become such a mainstay, of centralized importance to the game, that each team has a dedicated equipment manager. They are charged with providing, maintaining, and transporting the best gear for every member of the team. The equipment manager is a vital resource for the team and the sport.

Despite the extra weight and inconvenience that their gear can burden them with, you don’t see a single football player “skimp” on it. And it would certainly be obvious to all those around them if they ran onto the field without their helmet. Over the years, the football industry has not abandoned gear that they thought was less than perfect, too heavy, too bulky, or made the player perform with less agility. They just made the gear better, lighter, more comfortable, and more protective.

You Can Do This

In a similar fashion, hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be? I would argue there are a number of coaches and equipment managers in the hospital setting whose mission is to keep their “players” safe. The players are both patients and providers, as generally a “safe provider” is one who makes and implements solid decisions, and who is housed within a safe, predictable, and highly-reliable system, is also one who can and will keep their patients safe.

We may not think of ourselves as such, but hospitalists can be extremely effective coaches and equipment managers. They can help create and maintain safe and effective gear for themselves and those patients and providers around them. They can be a mentor for displaying how vitally import this gear is and can work to improve it when it proves to be imperfect.

Although we don’t tend to think of these things as “safety gear,” these things do, in fact, keep us and our patients safe. Some of these include:

• Computerized physician order entry (CPOE) with decision support (or order sets without CPOE);
• Checklists;
• Procedural time-outs;
• Protocols;
• Medication dosing guidelines;
• Handheld devices (for quick lookup of medication doses, side effects, predictive scoring systems, medical calculators, etc.); and
• Gowns and gloves.

Additional “gear” for the patients can include:

• Arm bands for identification and medication scanning;
• Telemetry;
• Bed alarms;
• IV pumps with guard rails around dosing;
• Antibiotic impregnated central lines; and
• Early mobilization protocols.

The Next Level

To take the medical industry to the next level of safe reliability, we need all providers to accept and embrace the concept of “safety gear” for themselves and for their patients. We need to make it perfectly obvious when that gear is missing. It should invoke a reaction of ghastly fear when we witness anyone (provider, patient, or family) skimping on their gear: removing an armband for convenience, bypassing a smart pump, or skipping decision support in CPOE. And for the current gear that is imperfect, slows us down, beeps too often, or reduces our agility, the solution should include improving the gear, not ignoring it or discounting its importance.

So before you go to work today (every day?), think about what you need to keep yourself and your patients safe. And get your gear on.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Danielle Scheurer, MD, MSCR, SFHM

We hospitalists are scientifically minded. We understand basic statistics, including percentages, percentiles, numerators, denominators (see Figure 1, right). In healthcare, we see a lot of patients we call denominators; these denominators are generally the types of patients to whom not much happens. They come in “pre-” and they leave “post-.” They generally pass through our walls, and our lives, according to plan, without leaving an impenetrable memory of who they were or what they experienced.

The numerators, on the other hand, do have something happen to them—something unexpected, untoward, unanticipated, unlikely. Sometimes we describe numerators as “noncompliant” or “medically complicated” or “refractory to treatment.” We often find ways to rationalize and explain how the patient turned from a denominator into a numerator—something they did, or didn’t do, to nudge them above the line. They smoked, they ate too much, they didn’t take their medications “as prescribed.” Often there is a less robust discussion about what we could have done to reduce the nudge: understand their background, their literacy, their finances, their physical/cognitive limitations, their understanding of risks and benefits.

I read a powerful piece about “numerators” written by Kerry O’Connell. In this piece, she describes what it was like to cross over the line into being a numerator after acquiring a hospital-acquired infection:

Five years ago this summer while under deep anesthesia for arm surgery number 3, I drifted above the line and joined the group called Numerators. … Numerators have lost a lot to join this group; many have lost organs, and some have lost all their limbs, all have many kinds of scars from their journey. It was not our choice to leave the world of Denominators … and many will struggle the rest of their lives to understand why...

There are lots of silly rules for not counting some infected souls, as if by not counting us we might not exist. Numerators that are identified are then divided by the Denominators to create a nameless, faceless, mysteriously small number called infection rates. “Rates,” like their cousin “odds,” claim to portray hope while predicting doom for some of us. Denominators are in love with rates, for no matter how many Numerators they have sired, someone else has sired more. Rates soothe the Denominator conscious and allow them to sleep peacefully at night ...

Numerators don’t ask for much from the world. We ask that Denominators look behind the numbers to see the people, to love us, count us, respect our suffering, and help keep us out of bankruptcy, for once we were Denominators just like you. Our greatest dream is that you find the daily strength to truly care. To care enough to follow the checklists, to care enough to wash your hands, to care enough to only use virgin needles, for the saddest day for all Numerators is when another unsuspecting Denominator rises above the line to join our group.¹

CB’s Story

Now think of all the numerators you have met. I am going to repeat that phrase. Think of all the numerators you have met. I have met quite a few. Now I am going to tell you about my most memorable numerator.

CB was a 36-year-old white female admitted to the hospital with a recent diagnosis of ulcerative colitis. She had a protracted hospital course on various immunosuppressant drugs, none of which relieved her symptoms. During her hospital stay, her family, including her 2-year-old twins, visited every single day. After several weeks with no improvement, the decision was made to proceed to a colectomy. The surgical procedure itself was uncomplicated, a true denominator.

Then, on post-op Day 5, the day of her anticipated discharge, a pulmonary embolus thrust her into the numerator position. A preventable, eventually fatal numerator—a numerator who “just would not keep her compression devices on” and whom the staff tried to get out of bed, “but she just wouldn’t do it.” A numerator who just so happened to be my sister.

Every year on April 2, when I call my niece and nephew to wish them a happy birthday, I think about numerators. And I think about how incredibly different life would be for those 10-year-old twins, had their mom just stayed a denominator. And every day, when I sit in conference rooms and hear from countless people about how difficult it is to prevent this and reduce that, and how zero is not feasible, I think about numerators. I don’t look at their bar chart, or their run chart, or their red line, or their blue line, or whether their line is within the control limits, or what their P-value is. I think about who represents that black dot, and about how we are going to actually convince ourselves to “First, do no harm.”

When I find myself amongst a crowd quibbling about finances, lunch breaks, workflows, accountability, and about who is going to check the box or fill out the form, I think about the numerators, and how we are truly wasting their time, their livelihood, and their ability to stay below the line.

And someday, when my niece and nephew are old enough to understand, I will try to help them tolerate and accept the fact that “preventable” and “prevented” are not interchangeable. At least not in the medical industry. At least not yet.

In memory of Colleen Conlin Bowen, May 14, 2004

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Reference

1. Safe Patient Project. Numerators. Consumers Union website. Available at: http://www.safepatientproject.org/2010/06/numerators.html. Accessed Sept. 29, 2012.

Danielle Scheurer, MD, MSCR, SFHM

We hospitalists are scientifically minded. We understand basic statistics, including percentages, percentiles, numerators, denominators (see Figure 1, right). In healthcare, we see a lot of patients we call denominators; these denominators are generally the types of patients to whom not much happens. They come in “pre-” and they leave “post-.” They generally pass through our walls, and our lives, according to plan, without leaving an impenetrable memory of who they were or what they experienced.

The numerators, on the other hand, do have something happen to them—something unexpected, untoward, unanticipated, unlikely. Sometimes we describe numerators as “noncompliant” or “medically complicated” or “refractory to treatment.” We often find ways to rationalize and explain how the patient turned from a denominator into a numerator—something they did, or didn’t do, to nudge them above the line. They smoked, they ate too much, they didn’t take their medications “as prescribed.” Often there is a less robust discussion about what we could have done to reduce the nudge: understand their background, their literacy, their finances, their physical/cognitive limitations, their understanding of risks and benefits.

I read a powerful piece about “numerators” written by Kerry O’Connell. In this piece, she describes what it was like to cross over the line into being a numerator after acquiring a hospital-acquired infection:

Five years ago this summer while under deep anesthesia for arm surgery number 3, I drifted above the line and joined the group called Numerators. … Numerators have lost a lot to join this group; many have lost organs, and some have lost all their limbs, all have many kinds of scars from their journey. It was not our choice to leave the world of Denominators … and many will struggle the rest of their lives to understand why...

There are lots of silly rules for not counting some infected souls, as if by not counting us we might not exist. Numerators that are identified are then divided by the Denominators to create a nameless, faceless, mysteriously small number called infection rates. “Rates,” like their cousin “odds,” claim to portray hope while predicting doom for some of us. Denominators are in love with rates, for no matter how many Numerators they have sired, someone else has sired more. Rates soothe the Denominator conscious and allow them to sleep peacefully at night ...

Numerators don’t ask for much from the world. We ask that Denominators look behind the numbers to see the people, to love us, count us, respect our suffering, and help keep us out of bankruptcy, for once we were Denominators just like you. Our greatest dream is that you find the daily strength to truly care. To care enough to follow the checklists, to care enough to wash your hands, to care enough to only use virgin needles, for the saddest day for all Numerators is when another unsuspecting Denominator rises above the line to join our group.¹

CB’s Story

Now think of all the numerators you have met. I am going to repeat that phrase. Think of all the numerators you have met. I have met quite a few. Now I am going to tell you about my most memorable numerator.

CB was a 36-year-old white female admitted to the hospital with a recent diagnosis of ulcerative colitis. She had a protracted hospital course on various immunosuppressant drugs, none of which relieved her symptoms. During her hospital stay, her family, including her 2-year-old twins, visited every single day. After several weeks with no improvement, the decision was made to proceed to a colectomy. The surgical procedure itself was uncomplicated, a true denominator.

Then, on post-op Day 5, the day of her anticipated discharge, a pulmonary embolus thrust her into the numerator position. A preventable, eventually fatal numerator—a numerator who “just would not keep her compression devices on” and whom the staff tried to get out of bed, “but she just wouldn’t do it.” A numerator who just so happened to be my sister.

Every year on April 2, when I call my niece and nephew to wish them a happy birthday, I think about numerators. And I think about how incredibly different life would be for those 10-year-old twins, had their mom just stayed a denominator. And every day, when I sit in conference rooms and hear from countless people about how difficult it is to prevent this and reduce that, and how zero is not feasible, I think about numerators. I don’t look at their bar chart, or their run chart, or their red line, or their blue line, or whether their line is within the control limits, or what their P-value is. I think about who represents that black dot, and about how we are going to actually convince ourselves to “First, do no harm.”

When I find myself amongst a crowd quibbling about finances, lunch breaks, workflows, accountability, and about who is going to check the box or fill out the form, I think about the numerators, and how we are truly wasting their time, their livelihood, and their ability to stay below the line.

And someday, when my niece and nephew are old enough to understand, I will try to help them tolerate and accept the fact that “preventable” and “prevented” are not interchangeable. At least not in the medical industry. At least not yet.

In memory of Colleen Conlin Bowen, May 14, 2004

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Reference

1. Safe Patient Project. Numerators. Consumers Union website. Available at: http://www.safepatientproject.org/2010/06/numerators.html. Accessed Sept. 29, 2012.

Danielle Scheurer, MD, MSCR, SFHM

We hospitalists are scientifically minded. We understand basic statistics, including percentages, percentiles, numerators, denominators (see Figure 1, right). In healthcare, we see a lot of patients we call denominators; these denominators are generally the types of patients to whom not much happens. They come in “pre-” and they leave “post-.” They generally pass through our walls, and our lives, according to plan, without leaving an impenetrable memory of who they were or what they experienced.

The numerators, on the other hand, do have something happen to them—something unexpected, untoward, unanticipated, unlikely. Sometimes we describe numerators as “noncompliant” or “medically complicated” or “refractory to treatment.” We often find ways to rationalize and explain how the patient turned from a denominator into a numerator—something they did, or didn’t do, to nudge them above the line. They smoked, they ate too much, they didn’t take their medications “as prescribed.” Often there is a less robust discussion about what we could have done to reduce the nudge: understand their background, their literacy, their finances, their physical/cognitive limitations, their understanding of risks and benefits.

I read a powerful piece about “numerators” written by Kerry O’Connell. In this piece, she describes what it was like to cross over the line into being a numerator after acquiring a hospital-acquired infection:

Five years ago this summer while under deep anesthesia for arm surgery number 3, I drifted above the line and joined the group called Numerators. … Numerators have lost a lot to join this group; many have lost organs, and some have lost all their limbs, all have many kinds of scars from their journey. It was not our choice to leave the world of Denominators … and many will struggle the rest of their lives to understand why...

There are lots of silly rules for not counting some infected souls, as if by not counting us we might not exist. Numerators that are identified are then divided by the Denominators to create a nameless, faceless, mysteriously small number called infection rates. “Rates,” like their cousin “odds,” claim to portray hope while predicting doom for some of us. Denominators are in love with rates, for no matter how many Numerators they have sired, someone else has sired more. Rates soothe the Denominator conscious and allow them to sleep peacefully at night ...

Numerators don’t ask for much from the world. We ask that Denominators look behind the numbers to see the people, to love us, count us, respect our suffering, and help keep us out of bankruptcy, for once we were Denominators just like you. Our greatest dream is that you find the daily strength to truly care. To care enough to follow the checklists, to care enough to wash your hands, to care enough to only use virgin needles, for the saddest day for all Numerators is when another unsuspecting Denominator rises above the line to join our group.¹

CB’s Story

Now think of all the numerators you have met. I am going to repeat that phrase. Think of all the numerators you have met. I have met quite a few. Now I am going to tell you about my most memorable numerator.

CB was a 36-year-old white female admitted to the hospital with a recent diagnosis of ulcerative colitis. She had a protracted hospital course on various immunosuppressant drugs, none of which relieved her symptoms. During her hospital stay, her family, including her 2-year-old twins, visited every single day. After several weeks with no improvement, the decision was made to proceed to a colectomy. The surgical procedure itself was uncomplicated, a true denominator.

Then, on post-op Day 5, the day of her anticipated discharge, a pulmonary embolus thrust her into the numerator position. A preventable, eventually fatal numerator—a numerator who “just would not keep her compression devices on” and whom the staff tried to get out of bed, “but she just wouldn’t do it.” A numerator who just so happened to be my sister.

Every year on April 2, when I call my niece and nephew to wish them a happy birthday, I think about numerators. And I think about how incredibly different life would be for those 10-year-old twins, had their mom just stayed a denominator. And every day, when I sit in conference rooms and hear from countless people about how difficult it is to prevent this and reduce that, and how zero is not feasible, I think about numerators. I don’t look at their bar chart, or their run chart, or their red line, or their blue line, or whether their line is within the control limits, or what their P-value is. I think about who represents that black dot, and about how we are going to actually convince ourselves to “First, do no harm.”

When I find myself amongst a crowd quibbling about finances, lunch breaks, workflows, accountability, and about who is going to check the box or fill out the form, I think about the numerators, and how we are truly wasting their time, their livelihood, and their ability to stay below the line.

And someday, when my niece and nephew are old enough to understand, I will try to help them tolerate and accept the fact that “preventable” and “prevented” are not interchangeable. At least not in the medical industry. At least not yet.

In memory of Colleen Conlin Bowen, May 14, 2004

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Reference

1. Safe Patient Project. Numerators. Consumers Union website. Available at: http://www.safepatientproject.org/2010/06/numerators.html. Accessed Sept. 29, 2012.

Danielle Scheurer, MD, MSCR, SFHM

It’s 1982, and in middle-school gyms across the country, among punch bowls and parental scrutiny, young girls and boys are slow-dancing with outstretched arms to a breathtaking song by the band Chicago. The song tells of the agonizing difficulty of apology, how despite the want and need to apologize, it is just too arduous.

Fast-forward 30 years, and it is hard to believe that cheesy No. 1 Billboard hit espoused the feelings that continue to haunt healthcare providers across the country: It’s hard for me to say I’m sorry.

Others Say It

If you look at the world around us, you see apology everywhere. Customer service representatives and customer-minded industries routinely let those words flow off their tongues with ease and grace.

While I was driving down the interstate last week, the number of traffic lanes shrunk from three to two to one. Anticipating widespread aggravation from weary travelers, the state transportation department deployed several large road signs every few miles; they read “WE APOLOGIZE FOR THE INCONVENIENCE … BEAR WITH US WHILE WE MAKE YOUR ROADS SMOOTHER AND SAFER.” Those simple messages made me feel like the congestion was not a senseless waste of time, that the state’s Department of Transportation was actually being strategic and thoughtful in their rationing of lanes during rush hour in the middle of the week.

Phone-based, customer-service departments figured out the simple apology a long time ago. While holding the line for a Lands’ End customer-service representative a few weeks ago, I heard, “We apologize for the delay. Your business is important to us. Please hold the line while we address callers ahead of you.” It validated for me that those phone representatives are not just sitting around eating lunch, completely ignoring my call, and that maybe there are others who procrastinated buying back-to-school backpacks until September—and just happened to call right before me.

I even got an apology at the dry cleaner. Amidst my last batch of clothes, my astute dry cleaner apparently found a very stubborn stain, which resisted all of their usual concoctions. It was on the back of a shirt and I probably would not have even noticed it was there. But nonetheless, they sent an apology tag, with a picture of a distraught butler who seemed to have struggled with that stain for hours.

Why Not Us?

So why is “sorry” so hard in healthcare? When things happen to patients, things that are inconvenient or downright dangerous, we have great difficulty in simply saying: “Hey, I am really sorry this happened to you,” or “I am so sorry you are still here. You must be really frustrated by our inefficiencies.”

I have the distinct pleasure of overseeing my hospital’s risk-management department for a few months. This means I get to see and hear what does and doesn’t happen to patients, which, at times, is misaligned with what should or shouldn’t happen to patients. When unanticipated events occur, the group launches into an investigation of what happened, why it happened, and the risk that it could happen again. After the initial dust settles and the facts are relayed from the care team to the risk-management team, the risk team always asks of those involved: “So what does the patient and their family know?” And we get a range of answers—some polished, some fumbled, some baffled.

The next question is: “Well, what should they know?” And that is always an easy question to answer. They should know the truth. Not just some of the truth, or half the truth, or a partial truth. Not what the care team thinks the patient “can handle.” They should just get the truth. To the best of the team’s ability, they should tell the patient:

• What (they think) happened;
• Why (they think) it happened;
• What it means for the patient; and
• What they are going to do to make it not happen again.

And then the patient (and family members) deserve an apology—sincere, compassionate, genuine. The apology should be the easy part, as most providers do not always know what happened, why it happened, or what they are going to do to prevent it from happening, but they usually truly do feel sorry that it happened at all.

“Sorry”=Positive Results

Patients are unanimous in their desire to be informed if a medical error has occurred; focus groups have found that patients believe such information would enhance their trust in their physicians and would reassure them that they were receiving complete information. And they want an apology.¹

But interestingly, many physicians believe that full disclosure with apology is not warranted or appropriate, and that the apology could erode patient trust, might scare the patient, and might increase the risk of legal liability.¹

There is little evidence that disclosure is harmful or detrimental, and there is some evidence that it is beneficial to the medical industry (i.e. reduces claims and litigation costs). A study published in 2010 from the University of Michigan Health System found a disclosure-with-compensation program was associated with a 36% reduction in new claims, a 65% reduction in lawsuits, and a 59% reduction in total liability cost.²

I have witnessed this phenomenon from both sides. My mother, who has Alzheimer’s and lives in an assisted-living facility, recently was given twice the dose of her medications one morning. She was “given” her night medications by being placed in her room, which she has no recollection of (the staff are supposed to watch her take her medications). The next morning, she saw the medications and took them, then took another dose when the nurse came by to give her morning medications. It was not realized until she’d already taken the medications and the staff noticed the medicine cup from the night before. My mom said she felt a little weak and dizzy for a few hours, but nothing significant, and she fully recovered. Interestingly, my mom mentioned it in passing, but no one called to let us know a medication error had occurred. Although she was not harmed, it made us, her family, lose a little trust in the facility because we found out about it indirectly, without any acknowledgement or apology.

On the other side of the equation, I have witnessed countless numbers of patient events in which providers feel worried and uncomfortable about the effects of disclosure with apology on themselves and their patients.

The bottom line is, disclosure with apology is needed and appreciated by patients, and it is absolutely the right thing to do. So download that cheesy Chicago song to your iPod and practice saying (or singing) “I’m sorry.” If the butler with chemicals can do it, so can we.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA. 2003;289(8):1001-1007.
2. Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010;153(4):213-221.

Danielle Scheurer, MD, MSCR, SFHM

It’s 1982, and in middle-school gyms across the country, among punch bowls and parental scrutiny, young girls and boys are slow-dancing with outstretched arms to a breathtaking song by the band Chicago. The song tells of the agonizing difficulty of apology, how despite the want and need to apologize, it is just too arduous.

Fast-forward 30 years, and it is hard to believe that cheesy No. 1 Billboard hit espoused the feelings that continue to haunt healthcare providers across the country: It’s hard for me to say I’m sorry.

Others Say It

If you look at the world around us, you see apology everywhere. Customer service representatives and customer-minded industries routinely let those words flow off their tongues with ease and grace.

While I was driving down the interstate last week, the number of traffic lanes shrunk from three to two to one. Anticipating widespread aggravation from weary travelers, the state transportation department deployed several large road signs every few miles; they read “WE APOLOGIZE FOR THE INCONVENIENCE … BEAR WITH US WHILE WE MAKE YOUR ROADS SMOOTHER AND SAFER.” Those simple messages made me feel like the congestion was not a senseless waste of time, that the state’s Department of Transportation was actually being strategic and thoughtful in their rationing of lanes during rush hour in the middle of the week.

Phone-based, customer-service departments figured out the simple apology a long time ago. While holding the line for a Lands’ End customer-service representative a few weeks ago, I heard, “We apologize for the delay. Your business is important to us. Please hold the line while we address callers ahead of you.” It validated for me that those phone representatives are not just sitting around eating lunch, completely ignoring my call, and that maybe there are others who procrastinated buying back-to-school backpacks until September—and just happened to call right before me.

I even got an apology at the dry cleaner. Amidst my last batch of clothes, my astute dry cleaner apparently found a very stubborn stain, which resisted all of their usual concoctions. It was on the back of a shirt and I probably would not have even noticed it was there. But nonetheless, they sent an apology tag, with a picture of a distraught butler who seemed to have struggled with that stain for hours.

Why Not Us?

So why is “sorry” so hard in healthcare? When things happen to patients, things that are inconvenient or downright dangerous, we have great difficulty in simply saying: “Hey, I am really sorry this happened to you,” or “I am so sorry you are still here. You must be really frustrated by our inefficiencies.”

I have the distinct pleasure of overseeing my hospital’s risk-management department for a few months. This means I get to see and hear what does and doesn’t happen to patients, which, at times, is misaligned with what should or shouldn’t happen to patients. When unanticipated events occur, the group launches into an investigation of what happened, why it happened, and the risk that it could happen again. After the initial dust settles and the facts are relayed from the care team to the risk-management team, the risk team always asks of those involved: “So what does the patient and their family know?” And we get a range of answers—some polished, some fumbled, some baffled.

The next question is: “Well, what should they know?” And that is always an easy question to answer. They should know the truth. Not just some of the truth, or half the truth, or a partial truth. Not what the care team thinks the patient “can handle.” They should just get the truth. To the best of the team’s ability, they should tell the patient:

• What (they think) happened;
• Why (they think) it happened;
• What it means for the patient; and
• What they are going to do to make it not happen again.

And then the patient (and family members) deserve an apology—sincere, compassionate, genuine. The apology should be the easy part, as most providers do not always know what happened, why it happened, or what they are going to do to prevent it from happening, but they usually truly do feel sorry that it happened at all.

“Sorry”=Positive Results

Patients are unanimous in their desire to be informed if a medical error has occurred; focus groups have found that patients believe such information would enhance their trust in their physicians and would reassure them that they were receiving complete information. And they want an apology.¹

But interestingly, many physicians believe that full disclosure with apology is not warranted or appropriate, and that the apology could erode patient trust, might scare the patient, and might increase the risk of legal liability.¹

There is little evidence that disclosure is harmful or detrimental, and there is some evidence that it is beneficial to the medical industry (i.e. reduces claims and litigation costs). A study published in 2010 from the University of Michigan Health System found a disclosure-with-compensation program was associated with a 36% reduction in new claims, a 65% reduction in lawsuits, and a 59% reduction in total liability cost.²

I have witnessed this phenomenon from both sides. My mother, who has Alzheimer’s and lives in an assisted-living facility, recently was given twice the dose of her medications one morning. She was “given” her night medications by being placed in her room, which she has no recollection of (the staff are supposed to watch her take her medications). The next morning, she saw the medications and took them, then took another dose when the nurse came by to give her morning medications. It was not realized until she’d already taken the medications and the staff noticed the medicine cup from the night before. My mom said she felt a little weak and dizzy for a few hours, but nothing significant, and she fully recovered. Interestingly, my mom mentioned it in passing, but no one called to let us know a medication error had occurred. Although she was not harmed, it made us, her family, lose a little trust in the facility because we found out about it indirectly, without any acknowledgement or apology.

On the other side of the equation, I have witnessed countless numbers of patient events in which providers feel worried and uncomfortable about the effects of disclosure with apology on themselves and their patients.

The bottom line is, disclosure with apology is needed and appreciated by patients, and it is absolutely the right thing to do. So download that cheesy Chicago song to your iPod and practice saying (or singing) “I’m sorry.” If the butler with chemicals can do it, so can we.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA. 2003;289(8):1001-1007.
2. Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010;153(4):213-221.

Danielle Scheurer, MD, MSCR, SFHM

It’s 1982, and in middle-school gyms across the country, among punch bowls and parental scrutiny, young girls and boys are slow-dancing with outstretched arms to a breathtaking song by the band Chicago. The song tells of the agonizing difficulty of apology, how despite the want and need to apologize, it is just too arduous.

Fast-forward 30 years, and it is hard to believe that cheesy No. 1 Billboard hit espoused the feelings that continue to haunt healthcare providers across the country: It’s hard for me to say I’m sorry.

Others Say It

If you look at the world around us, you see apology everywhere. Customer service representatives and customer-minded industries routinely let those words flow off their tongues with ease and grace.

While I was driving down the interstate last week, the number of traffic lanes shrunk from three to two to one. Anticipating widespread aggravation from weary travelers, the state transportation department deployed several large road signs every few miles; they read “WE APOLOGIZE FOR THE INCONVENIENCE … BEAR WITH US WHILE WE MAKE YOUR ROADS SMOOTHER AND SAFER.” Those simple messages made me feel like the congestion was not a senseless waste of time, that the state’s Department of Transportation was actually being strategic and thoughtful in their rationing of lanes during rush hour in the middle of the week.

Phone-based, customer-service departments figured out the simple apology a long time ago. While holding the line for a Lands’ End customer-service representative a few weeks ago, I heard, “We apologize for the delay. Your business is important to us. Please hold the line while we address callers ahead of you.” It validated for me that those phone representatives are not just sitting around eating lunch, completely ignoring my call, and that maybe there are others who procrastinated buying back-to-school backpacks until September—and just happened to call right before me.

I even got an apology at the dry cleaner. Amidst my last batch of clothes, my astute dry cleaner apparently found a very stubborn stain, which resisted all of their usual concoctions. It was on the back of a shirt and I probably would not have even noticed it was there. But nonetheless, they sent an apology tag, with a picture of a distraught butler who seemed to have struggled with that stain for hours.

Why Not Us?

So why is “sorry” so hard in healthcare? When things happen to patients, things that are inconvenient or downright dangerous, we have great difficulty in simply saying: “Hey, I am really sorry this happened to you,” or “I am so sorry you are still here. You must be really frustrated by our inefficiencies.”

I have the distinct pleasure of overseeing my hospital’s risk-management department for a few months. This means I get to see and hear what does and doesn’t happen to patients, which, at times, is misaligned with what should or shouldn’t happen to patients. When unanticipated events occur, the group launches into an investigation of what happened, why it happened, and the risk that it could happen again. After the initial dust settles and the facts are relayed from the care team to the risk-management team, the risk team always asks of those involved: “So what does the patient and their family know?” And we get a range of answers—some polished, some fumbled, some baffled.

The next question is: “Well, what should they know?” And that is always an easy question to answer. They should know the truth. Not just some of the truth, or half the truth, or a partial truth. Not what the care team thinks the patient “can handle.” They should just get the truth. To the best of the team’s ability, they should tell the patient:

• What (they think) happened;
• Why (they think) it happened;
• What it means for the patient; and
• What they are going to do to make it not happen again.

And then the patient (and family members) deserve an apology—sincere, compassionate, genuine. The apology should be the easy part, as most providers do not always know what happened, why it happened, or what they are going to do to prevent it from happening, but they usually truly do feel sorry that it happened at all.

“Sorry”=Positive Results

Patients are unanimous in their desire to be informed if a medical error has occurred; focus groups have found that patients believe such information would enhance their trust in their physicians and would reassure them that they were receiving complete information. And they want an apology.¹

But interestingly, many physicians believe that full disclosure with apology is not warranted or appropriate, and that the apology could erode patient trust, might scare the patient, and might increase the risk of legal liability.¹

There is little evidence that disclosure is harmful or detrimental, and there is some evidence that it is beneficial to the medical industry (i.e. reduces claims and litigation costs). A study published in 2010 from the University of Michigan Health System found a disclosure-with-compensation program was associated with a 36% reduction in new claims, a 65% reduction in lawsuits, and a 59% reduction in total liability cost.²

I have witnessed this phenomenon from both sides. My mother, who has Alzheimer’s and lives in an assisted-living facility, recently was given twice the dose of her medications one morning. She was “given” her night medications by being placed in her room, which she has no recollection of (the staff are supposed to watch her take her medications). The next morning, she saw the medications and took them, then took another dose when the nurse came by to give her morning medications. It was not realized until she’d already taken the medications and the staff noticed the medicine cup from the night before. My mom said she felt a little weak and dizzy for a few hours, but nothing significant, and she fully recovered. Interestingly, my mom mentioned it in passing, but no one called to let us know a medication error had occurred. Although she was not harmed, it made us, her family, lose a little trust in the facility because we found out about it indirectly, without any acknowledgement or apology.

On the other side of the equation, I have witnessed countless numbers of patient events in which providers feel worried and uncomfortable about the effects of disclosure with apology on themselves and their patients.

The bottom line is, disclosure with apology is needed and appreciated by patients, and it is absolutely the right thing to do. So download that cheesy Chicago song to your iPod and practice saying (or singing) “I’m sorry.” If the butler with chemicals can do it, so can we.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA. 2003;289(8):1001-1007.
2. Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010;153(4):213-221.

Danielle Scheurer, MD, MSCR, SFHM

This is a tumultuous time in healthcare: regulatory burdens, payment reductions, public scrutiny. And the rapidity of change is mind-boggling. All of this would probably be fine, except that people generally resist change, especially rapid change. Here today, gone tomorrow. That usually does not go over very well.

But given that this is the state of affairs for the foreseeable future, the question is, why is change so hard, and what can we do make it easier?

I thought about this at church the other day. My family and I attend church weekly (except when we don’t) at a small, old, quaint Catholic church built in 1789. My husband and I were raised Catholic, but as you may know, not every Catholic is really a Catholic. Based on my childhood churchgoing routine, my family would best be described as “Creasters,” which are “Catholics” (in quotations on purpose) who dedicate most of their religious energy to showing up only on Christmas and Easter. We are also known as “diet Catholics” or “lite Catholics.” Although I can plow through the “Our Father” with ease and grace, the Lord’s Prayer usually results in some mumbling, hushed tones and ceiling-staring.

My husband, on the other hand, was raised a real Catholic. He went to Catholic grade school, received communion six days a week, routinely served as an altar boy, and only missed Sunday Mass for a fever of more than 101 degrees (and even that was a stretch). For years, I have looked to him for cues on when to sit, stand, kneel, talk, sing, and be silent. When Sunday school questions come to the dinner table by way of our 8-year-old, I generally feign a choking episode and defer to my husband.

So this has been our routine for more than a decade: he the leader and I the limper. But then something shocking happened several months ago. In the middle of Mass, I realized my husband had no idea what was going on. He fumbled awkwardly through the service, lowered his speech volume with each passing misstep, and was almost completely silent by the end of the service.

As it ends up, every couple of hundred years, the Catholic Church decides to shake things up and change the Mass around. During key repeatings, the words are now different. What used to be “and also with you” is now “and with your spirit.” These changes were not monumental and went relatively unnoticed by current or former Creasters, but they were mind-boggling for the real Catholics.

The Church must have anticipated that these changes would be difficult to assimilate, as they placed countless numbers of laminated cue cards all over the church, in every pew, the confessional stand, and at all entry and exit points. Undoubtedly, they were hoping (assuming) we would take them home and learn the changes on our own, outside of Mass. So some months passed by, and after a few weeks with a cue card, I was in pretty good shape. My brain rewired the sayings, and I was able to shed my cue-card crutch.

My husband, on the other hand, is still reaching for the cue cards, with a long-standing dependence that now resembles that of an addict. Occasionally feeling confident, he will lay the card down, and will start spewing out the old sayings from a short circuit in the amygdala, programmed in fifth grade and hard-wired for accuracy. Then he will regain consciousness and realize everyone is staring at him.

As hospitalists, we know how hard it is to change, but we also know we have to routinely change to keep pace with the industry. So how do we reconcile the differences?

I recently read the book “Switch,” which describes some techniques on how to change when change is hard.¹ The authors write about a rider, an elephant, and a path. If all three are aligned toward a change, it will most likely succeed; without all three, change will be very difficult or unsuccessful altogether.

The rider is the intellectual portion, which will find the rational, statistical, logical solution to get from point A to point B. But the rider is steering an elephant, which is bulky, unruly, and emotional. The rider has to figure out how to motivate and direct the elephant; the two of them then have to get down a common path, which could be winding, confusing, and full of roadblocks. So to overcome all of these, the book gives innumerable, tangible examples of how to maneuver all three of these to facilitate change. In the case of my husband’s Mass issue, a few things could have facilitated the change for many:

Direct the rider:

• Find the bright spots. Find a success story of how others quickly relearned Mass within weeks and see how they accomplished it.
• Script the critical moves. Be very precise about what needs to be done differently; don’t just tell people to “learn the Mass,” but instead tell them to “repeat three new lines every day in the shower” until they have an error-free Mass.
• Point to the destination. Be very specific about the future goal, such as “You will be cue-card-free by October.”

Motivate the elephant:

• Find the feeling. Find a “heavy” emotion that will motivate the change. Shame, embarrassment, or anger from being stared at by a 10-year-old after missing so many lines should be pretty effective.
• Shrink the change. Make it seem like all the lines are easy to learn, if learned only one at a time.
• Grow the person. Motivate the Catholic to learn it as quickly and seamlessly as they did in fifth grade; if you already did it once, you just have do it again!

Shape the path:

• Tweak the environment. Have cue cards all over the place, laminate them, make them easy to fit in a pocket or purse.
• Build habits. Have the Catholic go to church every week until they have an “error-free” Mass.
• Rally the herd. Have them watch others for cues on behavior; this has worked for me for decades!

You can see that many of these techniques should be easier in healthcare than in other industries, especially motivating the elephant and shaping the path. To facilitate change, hospitalists should find ways to direct the rider, motivate the elephant, and shape the path, and we may find that change is not as daunting and overwhelming as it might at first seem.

And when you finally do make a positive change happen, give yourself a high-five—and send a “Hail Mary” to the Creasters.

Dr. Scheurer is physician editor of The Hospitalist.

Reference

1. Heath C, Heath D. Switch: How to Change Things when Change is Hard. New York: Random House; 2010.

Danielle Scheurer, MD, MSCR, SFHM

This is a tumultuous time in healthcare: regulatory burdens, payment reductions, public scrutiny. And the rapidity of change is mind-boggling. All of this would probably be fine, except that people generally resist change, especially rapid change. Here today, gone tomorrow. That usually does not go over very well.

But given that this is the state of affairs for the foreseeable future, the question is, why is change so hard, and what can we do make it easier?

I thought about this at church the other day. My family and I attend church weekly (except when we don’t) at a small, old, quaint Catholic church built in 1789. My husband and I were raised Catholic, but as you may know, not every Catholic is really a Catholic. Based on my childhood churchgoing routine, my family would best be described as “Creasters,” which are “Catholics” (in quotations on purpose) who dedicate most of their religious energy to showing up only on Christmas and Easter. We are also known as “diet Catholics” or “lite Catholics.” Although I can plow through the “Our Father” with ease and grace, the Lord’s Prayer usually results in some mumbling, hushed tones and ceiling-staring.

My husband, on the other hand, was raised a real Catholic. He went to Catholic grade school, received communion six days a week, routinely served as an altar boy, and only missed Sunday Mass for a fever of more than 101 degrees (and even that was a stretch). For years, I have looked to him for cues on when to sit, stand, kneel, talk, sing, and be silent. When Sunday school questions come to the dinner table by way of our 8-year-old, I generally feign a choking episode and defer to my husband.

So this has been our routine for more than a decade: he the leader and I the limper. But then something shocking happened several months ago. In the middle of Mass, I realized my husband had no idea what was going on. He fumbled awkwardly through the service, lowered his speech volume with each passing misstep, and was almost completely silent by the end of the service.

As it ends up, every couple of hundred years, the Catholic Church decides to shake things up and change the Mass around. During key repeatings, the words are now different. What used to be “and also with you” is now “and with your spirit.” These changes were not monumental and went relatively unnoticed by current or former Creasters, but they were mind-boggling for the real Catholics.

The Church must have anticipated that these changes would be difficult to assimilate, as they placed countless numbers of laminated cue cards all over the church, in every pew, the confessional stand, and at all entry and exit points. Undoubtedly, they were hoping (assuming) we would take them home and learn the changes on our own, outside of Mass. So some months passed by, and after a few weeks with a cue card, I was in pretty good shape. My brain rewired the sayings, and I was able to shed my cue-card crutch.

My husband, on the other hand, is still reaching for the cue cards, with a long-standing dependence that now resembles that of an addict. Occasionally feeling confident, he will lay the card down, and will start spewing out the old sayings from a short circuit in the amygdala, programmed in fifth grade and hard-wired for accuracy. Then he will regain consciousness and realize everyone is staring at him.

As hospitalists, we know how hard it is to change, but we also know we have to routinely change to keep pace with the industry. So how do we reconcile the differences?

I recently read the book “Switch,” which describes some techniques on how to change when change is hard.¹ The authors write about a rider, an elephant, and a path. If all three are aligned toward a change, it will most likely succeed; without all three, change will be very difficult or unsuccessful altogether.

The rider is the intellectual portion, which will find the rational, statistical, logical solution to get from point A to point B. But the rider is steering an elephant, which is bulky, unruly, and emotional. The rider has to figure out how to motivate and direct the elephant; the two of them then have to get down a common path, which could be winding, confusing, and full of roadblocks. So to overcome all of these, the book gives innumerable, tangible examples of how to maneuver all three of these to facilitate change. In the case of my husband’s Mass issue, a few things could have facilitated the change for many:

Direct the rider:

• Find the bright spots. Find a success story of how others quickly relearned Mass within weeks and see how they accomplished it.
• Script the critical moves. Be very precise about what needs to be done differently; don’t just tell people to “learn the Mass,” but instead tell them to “repeat three new lines every day in the shower” until they have an error-free Mass.
• Point to the destination. Be very specific about the future goal, such as “You will be cue-card-free by October.”

Motivate the elephant:

• Find the feeling. Find a “heavy” emotion that will motivate the change. Shame, embarrassment, or anger from being stared at by a 10-year-old after missing so many lines should be pretty effective.
• Shrink the change. Make it seem like all the lines are easy to learn, if learned only one at a time.
• Grow the person. Motivate the Catholic to learn it as quickly and seamlessly as they did in fifth grade; if you already did it once, you just have do it again!

Shape the path:

• Tweak the environment. Have cue cards all over the place, laminate them, make them easy to fit in a pocket or purse.
• Build habits. Have the Catholic go to church every week until they have an “error-free” Mass.
• Rally the herd. Have them watch others for cues on behavior; this has worked for me for decades!

You can see that many of these techniques should be easier in healthcare than in other industries, especially motivating the elephant and shaping the path. To facilitate change, hospitalists should find ways to direct the rider, motivate the elephant, and shape the path, and we may find that change is not as daunting and overwhelming as it might at first seem.

And when you finally do make a positive change happen, give yourself a high-five—and send a “Hail Mary” to the Creasters.

Dr. Scheurer is physician editor of The Hospitalist.

Reference

1. Heath C, Heath D. Switch: How to Change Things when Change is Hard. New York: Random House; 2010.

Danielle Scheurer, MD, MSCR, SFHM

This is a tumultuous time in healthcare: regulatory burdens, payment reductions, public scrutiny. And the rapidity of change is mind-boggling. All of this would probably be fine, except that people generally resist change, especially rapid change. Here today, gone tomorrow. That usually does not go over very well.

But given that this is the state of affairs for the foreseeable future, the question is, why is change so hard, and what can we do make it easier?

I thought about this at church the other day. My family and I attend church weekly (except when we don’t) at a small, old, quaint Catholic church built in 1789. My husband and I were raised Catholic, but as you may know, not every Catholic is really a Catholic. Based on my childhood churchgoing routine, my family would best be described as “Creasters,” which are “Catholics” (in quotations on purpose) who dedicate most of their religious energy to showing up only on Christmas and Easter. We are also known as “diet Catholics” or “lite Catholics.” Although I can plow through the “Our Father” with ease and grace, the Lord’s Prayer usually results in some mumbling, hushed tones and ceiling-staring.

My husband, on the other hand, was raised a real Catholic. He went to Catholic grade school, received communion six days a week, routinely served as an altar boy, and only missed Sunday Mass for a fever of more than 101 degrees (and even that was a stretch). For years, I have looked to him for cues on when to sit, stand, kneel, talk, sing, and be silent. When Sunday school questions come to the dinner table by way of our 8-year-old, I generally feign a choking episode and defer to my husband.

So this has been our routine for more than a decade: he the leader and I the limper. But then something shocking happened several months ago. In the middle of Mass, I realized my husband had no idea what was going on. He fumbled awkwardly through the service, lowered his speech volume with each passing misstep, and was almost completely silent by the end of the service.

As it ends up, every couple of hundred years, the Catholic Church decides to shake things up and change the Mass around. During key repeatings, the words are now different. What used to be “and also with you” is now “and with your spirit.” These changes were not monumental and went relatively unnoticed by current or former Creasters, but they were mind-boggling for the real Catholics.

The Church must have anticipated that these changes would be difficult to assimilate, as they placed countless numbers of laminated cue cards all over the church, in every pew, the confessional stand, and at all entry and exit points. Undoubtedly, they were hoping (assuming) we would take them home and learn the changes on our own, outside of Mass. So some months passed by, and after a few weeks with a cue card, I was in pretty good shape. My brain rewired the sayings, and I was able to shed my cue-card crutch.

My husband, on the other hand, is still reaching for the cue cards, with a long-standing dependence that now resembles that of an addict. Occasionally feeling confident, he will lay the card down, and will start spewing out the old sayings from a short circuit in the amygdala, programmed in fifth grade and hard-wired for accuracy. Then he will regain consciousness and realize everyone is staring at him.

As hospitalists, we know how hard it is to change, but we also know we have to routinely change to keep pace with the industry. So how do we reconcile the differences?

I recently read the book “Switch,” which describes some techniques on how to change when change is hard.¹ The authors write about a rider, an elephant, and a path. If all three are aligned toward a change, it will most likely succeed; without all three, change will be very difficult or unsuccessful altogether.

The rider is the intellectual portion, which will find the rational, statistical, logical solution to get from point A to point B. But the rider is steering an elephant, which is bulky, unruly, and emotional. The rider has to figure out how to motivate and direct the elephant; the two of them then have to get down a common path, which could be winding, confusing, and full of roadblocks. So to overcome all of these, the book gives innumerable, tangible examples of how to maneuver all three of these to facilitate change. In the case of my husband’s Mass issue, a few things could have facilitated the change for many:

Direct the rider:

• Find the bright spots. Find a success story of how others quickly relearned Mass within weeks and see how they accomplished it.
• Script the critical moves. Be very precise about what needs to be done differently; don’t just tell people to “learn the Mass,” but instead tell them to “repeat three new lines every day in the shower” until they have an error-free Mass.
• Point to the destination. Be very specific about the future goal, such as “You will be cue-card-free by October.”

Motivate the elephant:

• Find the feeling. Find a “heavy” emotion that will motivate the change. Shame, embarrassment, or anger from being stared at by a 10-year-old after missing so many lines should be pretty effective.
• Shrink the change. Make it seem like all the lines are easy to learn, if learned only one at a time.
• Grow the person. Motivate the Catholic to learn it as quickly and seamlessly as they did in fifth grade; if you already did it once, you just have do it again!

Shape the path:

• Tweak the environment. Have cue cards all over the place, laminate them, make them easy to fit in a pocket or purse.
• Build habits. Have the Catholic go to church every week until they have an “error-free” Mass.
• Rally the herd. Have them watch others for cues on behavior; this has worked for me for decades!

You can see that many of these techniques should be easier in healthcare than in other industries, especially motivating the elephant and shaping the path. To facilitate change, hospitalists should find ways to direct the rider, motivate the elephant, and shape the path, and we may find that change is not as daunting and overwhelming as it might at first seem.

And when you finally do make a positive change happen, give yourself a high-five—and send a “Hail Mary” to the Creasters.

Dr. Scheurer is physician editor of The Hospitalist.

Reference

1. Heath C, Heath D. Switch: How to Change Things when Change is Hard. New York: Random House; 2010.

Danielle Scheurer, MD, MSCR, SFHM

As we all know, the HM revolution has evolved at a breakneck pace. While our specialty’s growth has outpaced that of any other in the history of modern medicine, hospitalists have a narrow bell curve of age, with a relatively rare “old” hospitalist. Having been a specialty for less than 20 years, HM’s working hospitalists primarily encompass a single generation. However, we are on the brink of brining a new generations of hospitalists into the workforce: Generation Y.

Social scientists and peer-reviewed publications have spent countless hours and pages speculating and defining generational spans. The typicality of each generation is both completely fascinating and grotesquely overgeneralized.

Baby boomers (born 1946-1961) are characterized by expansive individual freedoms; they are associated with civil rights, gay rights, and the feminist movement. They are notoriously hard-working, disciplined, independent, and relied little on their parents.

Generation X (born 1962-1981) is characterized as being media-savvy and highly educated, but more materialistic and less hard-working than baby boomers. Most hospitalists fall into Generation X, currently ages 31 to 50.

And now enter Generation Y, born beginning in 1982. This generation has more nicknames than Snoop Dogg. They also are known as Millennials, Generation Next, the Net Generation (referring to a reliance and comfort with the Internet), the Trophy Generation (referring to their need for rewards based solely on participation), the Boomerang/Peter Pan Generation (referring to their delay of typical adult transitions and a longer reliance on their parents), and “echo boomers” (as children of the baby boomers).

David McCullough brilliantly summarized Generation Y in a recent commencement speech. If his name does not sound familiar, it is likely because you have never lived in Wellesley, Mass. Known as “Swellesley” to local residents, it is a charming town about 15 miles west of Boston. Wellesley has a “Lake Wobegon” mentality, where “all the children are above average.” McCullough, a Wellesley High School English teacher, delivered the high school’s commencement speech this year to a packed room of high achievers. His message?

“Contrary to what your under-9 soccer trophy suggests, your glowing seventh-grade report card, despite every assurance of a certain corpulent purple dinosaur, that nice Mister Rogers, and your batty Aunt Sylvia, no matter how often your maternal caped crusader has swooped in to save you … you’re nothing special.

“Yes, you’ve been pampered, cosseted, doted upon, helmeted, bubble-wrapped. Yes, capable adults with other things to do have held you, kissed you, fed you, wiped your mouth, wiped your bottom, trained you, taught you, tutored you, coached you, listened to you, counseled you, encouraged you, consoled you, and encouraged you again. You’ve been nudged, cajoled, wheedled, and implored. You’ve been feted and fawned over, and called sweetie pie. Yes, you have. And, certainly, we’ve been to your games, your plays, your recitals, your science fairs. Absolutely, smiles ignite when you walk into a room, and hundreds gasp with delight at your every tweet. Why, maybe you’ve even had your picture in the [local newspaper]. And now you’ve conquered high school … and, indisputably, here we all have gathered for you, the pride and joy of this fine community, the first to emerge from that magnificent new building …

“But do not get the idea you’re anything special. Because you’re not.”¹

I imagine this blasphemy caused something on the order of an existential crisis in Wellesley, but it does capture the essence of what it has been like to grow up as a Generation Y’er.

Two longitudinal surveys also give a glimpse into the generational psyche separating baby boomers, Generation X, and Generation Y: the “Monitoring the Future” survey and the “American Freshman” survey, both conducted annually by the University of Michigan and UCLA, respectively. A few notable trends from these surveys comparing the last three generations include:²

• The proportion who responded that being wealthy is very important ranged from 45% of baby boomers to 70% of Generation X and 75% of Generation Y;
• Fifty percent of baby boomers, 39% of Generation X, and 35% of Generation Y said it is important to keep up to date with political affairs; and
• Seventy-three percent of baby boomers and 45% of Generation Y responded that it was important to develop a meaningful philosophy of life.

While these characteristics might not sound particularly appealing, social scientists have found highly laudable adjectives that accurately describe the psyche of Generation Y, which include confidence, tolerance, and affability. One writer describes them as “polite, pleasant, moderate, earnest, friendly … no anger, no edge, no ego.”³

So, as with every generation, Generation Y comes with its share of traits that are irresistible and those that are maddening. Eighty million strong, accounting for about one-quarter of all Americans, how can future HM groups adapt to the flood coming down the pipeline?

We can learn from other industries, as Generation Y has been in the workforce elsewhere for years. Companies like Goldman Sachs and IBM figured out how to keep them engaged in their workplaces in a meaningful way, knowing they have high expectations for workplace mentorship/coaching, salary, and advancement, and seek more feedback and decision-making involvement.

Recommendations

I offer a few tangible recommendations; many of these will be beneficial for any hospitalist group:

• Ensure a robust and ongoing mentoring program. Generation Y’ers are more likely to need and thrive from a functional mentor program, where they can seek and receive advice and guidance in regular intervals.
• Ensure that financial compensation, incentive programs, and pathways for advancement are clearly defined. As mentioned above, many Generation Y’ers consider wealth important, so avenues for advancement should be well defined for those willing to pursue it.
• Create non-financial reward systems, such as “Hospitalist of the Month” recognitions based on clinical or other criteria (teamwork, attitude, fortitude). This generation, more than most, has an expectation for recognition and rewards. These non-financial rewards can be easily, appropriately, and fairly built in.
• Utilize information technology to its fullest capacity, and engage them in creating ways of using technology to its advantage, including blogs, Twitter, etc. More than past generations, they are comfortable with and have an aptitude for information technology, and that should be harnessed at the point of care.
• Ensure hospitalists have a firm understanding of the appropriate use of social media at work, and outside it. They are as comfortable with social media as past generations have been with email, and helping define clear boundaries will be of benefit to everyone in the group.

And when you spend a few years getting all your Generation Y’ers settled in, along will come Generation Z.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Brown B. Wellesley High grads told: “You’re not special.” The Swellesley Report website. Available at: http://www.theswellesleyreport.com/2012/06/wellesley-high-grads-told-youre-not-special/. Accessed July 8, 2012.
2. Healy M. Millennials might not be so special after all, study finds. USA Today website. Available at: http://www.usatoday.com/news/health/wellness/story/2012-03-15/Millennials-might-not-be-so-special-after-all-study-finds/53552744/1. Accessed July 9, 2012.
3. Deresiewicz W. Generation Sell. The New York Times website. Available at: http://www.nytimes.com/2011/11/13/opinion/sunday/the-entrepreneurial-generation.html?pagewanted=1&_r=1. Accessed July 8, 2012.

Danielle Scheurer, MD, MSCR, SFHM

As we all know, the HM revolution has evolved at a breakneck pace. While our specialty’s growth has outpaced that of any other in the history of modern medicine, hospitalists have a narrow bell curve of age, with a relatively rare “old” hospitalist. Having been a specialty for less than 20 years, HM’s working hospitalists primarily encompass a single generation. However, we are on the brink of brining a new generations of hospitalists into the workforce: Generation Y.

Social scientists and peer-reviewed publications have spent countless hours and pages speculating and defining generational spans. The typicality of each generation is both completely fascinating and grotesquely overgeneralized.

Baby boomers (born 1946-1961) are characterized by expansive individual freedoms; they are associated with civil rights, gay rights, and the feminist movement. They are notoriously hard-working, disciplined, independent, and relied little on their parents.

Generation X (born 1962-1981) is characterized as being media-savvy and highly educated, but more materialistic and less hard-working than baby boomers. Most hospitalists fall into Generation X, currently ages 31 to 50.

And now enter Generation Y, born beginning in 1982. This generation has more nicknames than Snoop Dogg. They also are known as Millennials, Generation Next, the Net Generation (referring to a reliance and comfort with the Internet), the Trophy Generation (referring to their need for rewards based solely on participation), the Boomerang/Peter Pan Generation (referring to their delay of typical adult transitions and a longer reliance on their parents), and “echo boomers” (as children of the baby boomers).

David McCullough brilliantly summarized Generation Y in a recent commencement speech. If his name does not sound familiar, it is likely because you have never lived in Wellesley, Mass. Known as “Swellesley” to local residents, it is a charming town about 15 miles west of Boston. Wellesley has a “Lake Wobegon” mentality, where “all the children are above average.” McCullough, a Wellesley High School English teacher, delivered the high school’s commencement speech this year to a packed room of high achievers. His message?

“Contrary to what your under-9 soccer trophy suggests, your glowing seventh-grade report card, despite every assurance of a certain corpulent purple dinosaur, that nice Mister Rogers, and your batty Aunt Sylvia, no matter how often your maternal caped crusader has swooped in to save you … you’re nothing special.

“Yes, you’ve been pampered, cosseted, doted upon, helmeted, bubble-wrapped. Yes, capable adults with other things to do have held you, kissed you, fed you, wiped your mouth, wiped your bottom, trained you, taught you, tutored you, coached you, listened to you, counseled you, encouraged you, consoled you, and encouraged you again. You’ve been nudged, cajoled, wheedled, and implored. You’ve been feted and fawned over, and called sweetie pie. Yes, you have. And, certainly, we’ve been to your games, your plays, your recitals, your science fairs. Absolutely, smiles ignite when you walk into a room, and hundreds gasp with delight at your every tweet. Why, maybe you’ve even had your picture in the [local newspaper]. And now you’ve conquered high school … and, indisputably, here we all have gathered for you, the pride and joy of this fine community, the first to emerge from that magnificent new building …

“But do not get the idea you’re anything special. Because you’re not.”¹

I imagine this blasphemy caused something on the order of an existential crisis in Wellesley, but it does capture the essence of what it has been like to grow up as a Generation Y’er.

Two longitudinal surveys also give a glimpse into the generational psyche separating baby boomers, Generation X, and Generation Y: the “Monitoring the Future” survey and the “American Freshman” survey, both conducted annually by the University of Michigan and UCLA, respectively. A few notable trends from these surveys comparing the last three generations include:²

• The proportion who responded that being wealthy is very important ranged from 45% of baby boomers to 70% of Generation X and 75% of Generation Y;
• Fifty percent of baby boomers, 39% of Generation X, and 35% of Generation Y said it is important to keep up to date with political affairs; and
• Seventy-three percent of baby boomers and 45% of Generation Y responded that it was important to develop a meaningful philosophy of life.

While these characteristics might not sound particularly appealing, social scientists have found highly laudable adjectives that accurately describe the psyche of Generation Y, which include confidence, tolerance, and affability. One writer describes them as “polite, pleasant, moderate, earnest, friendly … no anger, no edge, no ego.”³

So, as with every generation, Generation Y comes with its share of traits that are irresistible and those that are maddening. Eighty million strong, accounting for about one-quarter of all Americans, how can future HM groups adapt to the flood coming down the pipeline?

We can learn from other industries, as Generation Y has been in the workforce elsewhere for years. Companies like Goldman Sachs and IBM figured out how to keep them engaged in their workplaces in a meaningful way, knowing they have high expectations for workplace mentorship/coaching, salary, and advancement, and seek more feedback and decision-making involvement.

Recommendations

I offer a few tangible recommendations; many of these will be beneficial for any hospitalist group:

• Ensure a robust and ongoing mentoring program. Generation Y’ers are more likely to need and thrive from a functional mentor program, where they can seek and receive advice and guidance in regular intervals.
• Ensure that financial compensation, incentive programs, and pathways for advancement are clearly defined. As mentioned above, many Generation Y’ers consider wealth important, so avenues for advancement should be well defined for those willing to pursue it.
• Create non-financial reward systems, such as “Hospitalist of the Month” recognitions based on clinical or other criteria (teamwork, attitude, fortitude). This generation, more than most, has an expectation for recognition and rewards. These non-financial rewards can be easily, appropriately, and fairly built in.
• Utilize information technology to its fullest capacity, and engage them in creating ways of using technology to its advantage, including blogs, Twitter, etc. More than past generations, they are comfortable with and have an aptitude for information technology, and that should be harnessed at the point of care.
• Ensure hospitalists have a firm understanding of the appropriate use of social media at work, and outside it. They are as comfortable with social media as past generations have been with email, and helping define clear boundaries will be of benefit to everyone in the group.

And when you spend a few years getting all your Generation Y’ers settled in, along will come Generation Z.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Brown B. Wellesley High grads told: “You’re not special.” The Swellesley Report website. Available at: http://www.theswellesleyreport.com/2012/06/wellesley-high-grads-told-youre-not-special/. Accessed July 8, 2012.
2. Healy M. Millennials might not be so special after all, study finds. USA Today website. Available at: http://www.usatoday.com/news/health/wellness/story/2012-03-15/Millennials-might-not-be-so-special-after-all-study-finds/53552744/1. Accessed July 9, 2012.
3. Deresiewicz W. Generation Sell. The New York Times website. Available at: http://www.nytimes.com/2011/11/13/opinion/sunday/the-entrepreneurial-generation.html?pagewanted=1&_r=1. Accessed July 8, 2012.

Danielle Scheurer, MD, MSCR, SFHM

As we all know, the HM revolution has evolved at a breakneck pace. While our specialty’s growth has outpaced that of any other in the history of modern medicine, hospitalists have a narrow bell curve of age, with a relatively rare “old” hospitalist. Having been a specialty for less than 20 years, HM’s working hospitalists primarily encompass a single generation. However, we are on the brink of brining a new generations of hospitalists into the workforce: Generation Y.

Social scientists and peer-reviewed publications have spent countless hours and pages speculating and defining generational spans. The typicality of each generation is both completely fascinating and grotesquely overgeneralized.

Baby boomers (born 1946-1961) are characterized by expansive individual freedoms; they are associated with civil rights, gay rights, and the feminist movement. They are notoriously hard-working, disciplined, independent, and relied little on their parents.

Generation X (born 1962-1981) is characterized as being media-savvy and highly educated, but more materialistic and less hard-working than baby boomers. Most hospitalists fall into Generation X, currently ages 31 to 50.

And now enter Generation Y, born beginning in 1982. This generation has more nicknames than Snoop Dogg. They also are known as Millennials, Generation Next, the Net Generation (referring to a reliance and comfort with the Internet), the Trophy Generation (referring to their need for rewards based solely on participation), the Boomerang/Peter Pan Generation (referring to their delay of typical adult transitions and a longer reliance on their parents), and “echo boomers” (as children of the baby boomers).

David McCullough brilliantly summarized Generation Y in a recent commencement speech. If his name does not sound familiar, it is likely because you have never lived in Wellesley, Mass. Known as “Swellesley” to local residents, it is a charming town about 15 miles west of Boston. Wellesley has a “Lake Wobegon” mentality, where “all the children are above average.” McCullough, a Wellesley High School English teacher, delivered the high school’s commencement speech this year to a packed room of high achievers. His message?

“Contrary to what your under-9 soccer trophy suggests, your glowing seventh-grade report card, despite every assurance of a certain corpulent purple dinosaur, that nice Mister Rogers, and your batty Aunt Sylvia, no matter how often your maternal caped crusader has swooped in to save you … you’re nothing special.

“Yes, you’ve been pampered, cosseted, doted upon, helmeted, bubble-wrapped. Yes, capable adults with other things to do have held you, kissed you, fed you, wiped your mouth, wiped your bottom, trained you, taught you, tutored you, coached you, listened to you, counseled you, encouraged you, consoled you, and encouraged you again. You’ve been nudged, cajoled, wheedled, and implored. You’ve been feted and fawned over, and called sweetie pie. Yes, you have. And, certainly, we’ve been to your games, your plays, your recitals, your science fairs. Absolutely, smiles ignite when you walk into a room, and hundreds gasp with delight at your every tweet. Why, maybe you’ve even had your picture in the [local newspaper]. And now you’ve conquered high school … and, indisputably, here we all have gathered for you, the pride and joy of this fine community, the first to emerge from that magnificent new building …

“But do not get the idea you’re anything special. Because you’re not.”¹

I imagine this blasphemy caused something on the order of an existential crisis in Wellesley, but it does capture the essence of what it has been like to grow up as a Generation Y’er.

Two longitudinal surveys also give a glimpse into the generational psyche separating baby boomers, Generation X, and Generation Y: the “Monitoring the Future” survey and the “American Freshman” survey, both conducted annually by the University of Michigan and UCLA, respectively. A few notable trends from these surveys comparing the last three generations include:²

• The proportion who responded that being wealthy is very important ranged from 45% of baby boomers to 70% of Generation X and 75% of Generation Y;
• Fifty percent of baby boomers, 39% of Generation X, and 35% of Generation Y said it is important to keep up to date with political affairs; and
• Seventy-three percent of baby boomers and 45% of Generation Y responded that it was important to develop a meaningful philosophy of life.

While these characteristics might not sound particularly appealing, social scientists have found highly laudable adjectives that accurately describe the psyche of Generation Y, which include confidence, tolerance, and affability. One writer describes them as “polite, pleasant, moderate, earnest, friendly … no anger, no edge, no ego.”³

So, as with every generation, Generation Y comes with its share of traits that are irresistible and those that are maddening. Eighty million strong, accounting for about one-quarter of all Americans, how can future HM groups adapt to the flood coming down the pipeline?

We can learn from other industries, as Generation Y has been in the workforce elsewhere for years. Companies like Goldman Sachs and IBM figured out how to keep them engaged in their workplaces in a meaningful way, knowing they have high expectations for workplace mentorship/coaching, salary, and advancement, and seek more feedback and decision-making involvement.

Recommendations

I offer a few tangible recommendations; many of these will be beneficial for any hospitalist group:

• Ensure a robust and ongoing mentoring program. Generation Y’ers are more likely to need and thrive from a functional mentor program, where they can seek and receive advice and guidance in regular intervals.
• Ensure that financial compensation, incentive programs, and pathways for advancement are clearly defined. As mentioned above, many Generation Y’ers consider wealth important, so avenues for advancement should be well defined for those willing to pursue it.
• Create non-financial reward systems, such as “Hospitalist of the Month” recognitions based on clinical or other criteria (teamwork, attitude, fortitude). This generation, more than most, has an expectation for recognition and rewards. These non-financial rewards can be easily, appropriately, and fairly built in.
• Utilize information technology to its fullest capacity, and engage them in creating ways of using technology to its advantage, including blogs, Twitter, etc. More than past generations, they are comfortable with and have an aptitude for information technology, and that should be harnessed at the point of care.
• Ensure hospitalists have a firm understanding of the appropriate use of social media at work, and outside it. They are as comfortable with social media as past generations have been with email, and helping define clear boundaries will be of benefit to everyone in the group.

And when you spend a few years getting all your Generation Y’ers settled in, along will come Generation Z.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Brown B. Wellesley High grads told: “You’re not special.” The Swellesley Report website. Available at: http://www.theswellesleyreport.com/2012/06/wellesley-high-grads-told-youre-not-special/. Accessed July 8, 2012.
2. Healy M. Millennials might not be so special after all, study finds. USA Today website. Available at: http://www.usatoday.com/news/health/wellness/story/2012-03-15/Millennials-might-not-be-so-special-after-all-study-finds/53552744/1. Accessed July 9, 2012.
3. Deresiewicz W. Generation Sell. The New York Times website. Available at: http://www.nytimes.com/2011/11/13/opinion/sunday/the-entrepreneurial-generation.html?pagewanted=1&_r=1. Accessed July 8, 2012.

Danielle Scheurer, MD, MSCR, SFHM

Let’s be honest. How many times in the past (insert any timeline here; month, week, day, minute) have you heard a disparaging comment about a hospital regulatory agency? They usually sound something like, “Well, I’ll be darned if I am going to let CMS tell me how to practice medicine” or “So is this another Joint Commission thing?”

I understand the frustration. The healthcare industry is incredibly regulated. So much so that I, and countless others in hospital administration offices around the country, relinquish an inordinate amount of time figuring out what it is we are supposed to be complying with, then figuring how we are actually going to do it. It often has been equated to Whac-a-Mole, a game that requires more eyeballs and arm strength than an extraterrestrial possesses. There are many reasons that underlie the frustration and lead to the disparaging comments:

• Some requirements are not perfectly evidence-based. Not all process measures actually correlate with any outcomes; just because someone checks an oxygen saturation on every pneumonia patient doesn’t mean anything else improves for the patient.
• Some requirements are poorly implemented. I think we can all agree that counseling patients to stop smoking is a laudable goal. However, “smoking cessation counseling” is often relegated to uttering a short phrase (“you know you should really quit smoking”) while holding the exit-door handle, then checking the box for documentation. This “counseling session” is probably as effective as declaring every day a Great American Smokeout.
• Some regulations result in unintended consequences when implemented into large, complicated organizations. An obvious example is the time to first antibiotic in pneumonia patients, which resulted in frequent and unnecessary antibiotic utilization in patients who did not have pneumonia.
• Some are just extremely difficult to accomplish with high reliability. An example here is time to PCI for heart attacks. It’s clearly the right thing to do, and clearly very difficult to get it completed, on time, on every single patient. And 99% compliance is just not good enough, because the 1% matters.

And as a result of these imperfections, “noncompliance” leads to lots of emails, rework, restructuring, and at times downright bickering—hence, the disparaging comments.

Regulatory Origins and Missions

But let’s back up for a minute and think about why healthcare regulations exist: Many local, state, and federal agencies have enhanced the scrutiny of healthcare over time because, quite frankly, the healthcare industry did not regulate itself very well. We insisted for decades that patients were each too unique to be “cook-booked,” that medicine was an art as much as it was a science, and that “it’s just complicated.”

It took a few (too many) high-profile deaths and a few common-sense publications to incense the public, our payors, and our regulators. Who is not familiar with the 98,000-preventable-deaths-a-year statistic? Not only is that figure sobering, but it also is quite difficult to untether from our reputation. Henceforth, over the course of decades, a multitude of moles have emerged, littering the landscape and sparing no area of the healthcare industry.

So let’s back up another minute and think about what these agencies are trying to do: Could it be that most regulatory agencies really do want to leverage large-scale improvements in patient outcomes, at the best value?

Take this vision statement, as an example: “All people always experience the safest, highest-quality, best-value healthcare across all settings.”

Sounds like the kind of healthcare I want for my kids and my mom. That is the vision statement of the Joint Commission.

How about this vision statement: “CMS is a major force and a trustworthy partner for the continual improvement of health and healthcare for all Americans.”

Not too shabby.

So why do we view regulators like moles? Why do we arm ourselves with big, black mallets ready to strike when we see them emerge from the corner of our eye?

HM-Mole Alliance

Whac-a-Mole is an unwinnable game. No player has ever whacked all the moles. If you have not been to your local arcade lately, the game starts out slow, such that most players can keep pace; it then accelerates, such that several moles are outside the holes simultaneously, and their time above ground becomes consecutively shorter. You can add mallets, even add players, but generally they end up getting in each other’s way, communication breaks down, and one mole gets whacked twice, while another exits unscathed, only to break the soil elsewhere.

Danielle Scheurer, MD, MSCR, SFHM

Maybe a better strategy is to have a strategy—to work with our “trustworthy partners” to align our vision statements, anticipate the vermin’s approach, and fill the holes (or chasms) before anything has a chance to squeeze through. Maybe we should tell them where the moles are, because we actually already know what they look like and where they dwell. Why don’t we tell them which moles are the most dangerous, the most annoying, or are the most likely to tear up the topsoil into an irreparable state?

What about all the issues that no one is telling us we have to comply with—for example, a universal allergy list across the spectrum of care, or a perfectly reliable system to ensure that a patient with an epidural catheter cannot be anticoagulated? Such a list is endless, and no one is telling us we have to address the majority of the items on the list.

It comes down to this: What kind of healthcare do you want for yourself, your family, and the patients who trust you? I’d rather not have a reactive, frantic race to obliterate the next torrid creature that has arisen. I suggest a proactive, strategic pathway of tilling the soil.

In anticipation of a universal vote for the latter, join me in congratulating the healthcare industry in holding ourselves accountable, embracing a new era of transparency and collaboration, and routinely going beyond the expectations of our regulators. And leaving the mallet in the arcade.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Danielle Scheurer, MD, MSCR, SFHM

Let’s be honest. How many times in the past (insert any timeline here; month, week, day, minute) have you heard a disparaging comment about a hospital regulatory agency? They usually sound something like, “Well, I’ll be darned if I am going to let CMS tell me how to practice medicine” or “So is this another Joint Commission thing?”

I understand the frustration. The healthcare industry is incredibly regulated. So much so that I, and countless others in hospital administration offices around the country, relinquish an inordinate amount of time figuring out what it is we are supposed to be complying with, then figuring how we are actually going to do it. It often has been equated to Whac-a-Mole, a game that requires more eyeballs and arm strength than an extraterrestrial possesses. There are many reasons that underlie the frustration and lead to the disparaging comments:

• Some requirements are not perfectly evidence-based. Not all process measures actually correlate with any outcomes; just because someone checks an oxygen saturation on every pneumonia patient doesn’t mean anything else improves for the patient.
• Some requirements are poorly implemented. I think we can all agree that counseling patients to stop smoking is a laudable goal. However, “smoking cessation counseling” is often relegated to uttering a short phrase (“you know you should really quit smoking”) while holding the exit-door handle, then checking the box for documentation. This “counseling session” is probably as effective as declaring every day a Great American Smokeout.
• Some regulations result in unintended consequences when implemented into large, complicated organizations. An obvious example is the time to first antibiotic in pneumonia patients, which resulted in frequent and unnecessary antibiotic utilization in patients who did not have pneumonia.
• Some are just extremely difficult to accomplish with high reliability. An example here is time to PCI for heart attacks. It’s clearly the right thing to do, and clearly very difficult to get it completed, on time, on every single patient. And 99% compliance is just not good enough, because the 1% matters.

And as a result of these imperfections, “noncompliance” leads to lots of emails, rework, restructuring, and at times downright bickering—hence, the disparaging comments.

Regulatory Origins and Missions

But let’s back up for a minute and think about why healthcare regulations exist: Many local, state, and federal agencies have enhanced the scrutiny of healthcare over time because, quite frankly, the healthcare industry did not regulate itself very well. We insisted for decades that patients were each too unique to be “cook-booked,” that medicine was an art as much as it was a science, and that “it’s just complicated.”

It took a few (too many) high-profile deaths and a few common-sense publications to incense the public, our payors, and our regulators. Who is not familiar with the 98,000-preventable-deaths-a-year statistic? Not only is that figure sobering, but it also is quite difficult to untether from our reputation. Henceforth, over the course of decades, a multitude of moles have emerged, littering the landscape and sparing no area of the healthcare industry.

So let’s back up another minute and think about what these agencies are trying to do: Could it be that most regulatory agencies really do want to leverage large-scale improvements in patient outcomes, at the best value?

Take this vision statement, as an example: “All people always experience the safest, highest-quality, best-value healthcare across all settings.”

Sounds like the kind of healthcare I want for my kids and my mom. That is the vision statement of the Joint Commission.

How about this vision statement: “CMS is a major force and a trustworthy partner for the continual improvement of health and healthcare for all Americans.”

Not too shabby.

So why do we view regulators like moles? Why do we arm ourselves with big, black mallets ready to strike when we see them emerge from the corner of our eye?

HM-Mole Alliance

Whac-a-Mole is an unwinnable game. No player has ever whacked all the moles. If you have not been to your local arcade lately, the game starts out slow, such that most players can keep pace; it then accelerates, such that several moles are outside the holes simultaneously, and their time above ground becomes consecutively shorter. You can add mallets, even add players, but generally they end up getting in each other’s way, communication breaks down, and one mole gets whacked twice, while another exits unscathed, only to break the soil elsewhere.

Danielle Scheurer, MD, MSCR, SFHM

Maybe a better strategy is to have a strategy—to work with our “trustworthy partners” to align our vision statements, anticipate the vermin’s approach, and fill the holes (or chasms) before anything has a chance to squeeze through. Maybe we should tell them where the moles are, because we actually already know what they look like and where they dwell. Why don’t we tell them which moles are the most dangerous, the most annoying, or are the most likely to tear up the topsoil into an irreparable state?

What about all the issues that no one is telling us we have to comply with—for example, a universal allergy list across the spectrum of care, or a perfectly reliable system to ensure that a patient with an epidural catheter cannot be anticoagulated? Such a list is endless, and no one is telling us we have to address the majority of the items on the list.

It comes down to this: What kind of healthcare do you want for yourself, your family, and the patients who trust you? I’d rather not have a reactive, frantic race to obliterate the next torrid creature that has arisen. I suggest a proactive, strategic pathway of tilling the soil.

In anticipation of a universal vote for the latter, join me in congratulating the healthcare industry in holding ourselves accountable, embracing a new era of transparency and collaboration, and routinely going beyond the expectations of our regulators. And leaving the mallet in the arcade.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Danielle Scheurer, MD, MSCR, SFHM

Let’s be honest. How many times in the past (insert any timeline here; month, week, day, minute) have you heard a disparaging comment about a hospital regulatory agency? They usually sound something like, “Well, I’ll be darned if I am going to let CMS tell me how to practice medicine” or “So is this another Joint Commission thing?”

I understand the frustration. The healthcare industry is incredibly regulated. So much so that I, and countless others in hospital administration offices around the country, relinquish an inordinate amount of time figuring out what it is we are supposed to be complying with, then figuring how we are actually going to do it. It often has been equated to Whac-a-Mole, a game that requires more eyeballs and arm strength than an extraterrestrial possesses. There are many reasons that underlie the frustration and lead to the disparaging comments:

• Some requirements are not perfectly evidence-based. Not all process measures actually correlate with any outcomes; just because someone checks an oxygen saturation on every pneumonia patient doesn’t mean anything else improves for the patient.
• Some requirements are poorly implemented. I think we can all agree that counseling patients to stop smoking is a laudable goal. However, “smoking cessation counseling” is often relegated to uttering a short phrase (“you know you should really quit smoking”) while holding the exit-door handle, then checking the box for documentation. This “counseling session” is probably as effective as declaring every day a Great American Smokeout.
• Some regulations result in unintended consequences when implemented into large, complicated organizations. An obvious example is the time to first antibiotic in pneumonia patients, which resulted in frequent and unnecessary antibiotic utilization in patients who did not have pneumonia.
• Some are just extremely difficult to accomplish with high reliability. An example here is time to PCI for heart attacks. It’s clearly the right thing to do, and clearly very difficult to get it completed, on time, on every single patient. And 99% compliance is just not good enough, because the 1% matters.

And as a result of these imperfections, “noncompliance” leads to lots of emails, rework, restructuring, and at times downright bickering—hence, the disparaging comments.

Regulatory Origins and Missions

But let’s back up for a minute and think about why healthcare regulations exist: Many local, state, and federal agencies have enhanced the scrutiny of healthcare over time because, quite frankly, the healthcare industry did not regulate itself very well. We insisted for decades that patients were each too unique to be “cook-booked,” that medicine was an art as much as it was a science, and that “it’s just complicated.”

It took a few (too many) high-profile deaths and a few common-sense publications to incense the public, our payors, and our regulators. Who is not familiar with the 98,000-preventable-deaths-a-year statistic? Not only is that figure sobering, but it also is quite difficult to untether from our reputation. Henceforth, over the course of decades, a multitude of moles have emerged, littering the landscape and sparing no area of the healthcare industry.

So let’s back up another minute and think about what these agencies are trying to do: Could it be that most regulatory agencies really do want to leverage large-scale improvements in patient outcomes, at the best value?

Take this vision statement, as an example: “All people always experience the safest, highest-quality, best-value healthcare across all settings.”

Sounds like the kind of healthcare I want for my kids and my mom. That is the vision statement of the Joint Commission.

How about this vision statement: “CMS is a major force and a trustworthy partner for the continual improvement of health and healthcare for all Americans.”

Not too shabby.

So why do we view regulators like moles? Why do we arm ourselves with big, black mallets ready to strike when we see them emerge from the corner of our eye?

HM-Mole Alliance

Whac-a-Mole is an unwinnable game. No player has ever whacked all the moles. If you have not been to your local arcade lately, the game starts out slow, such that most players can keep pace; it then accelerates, such that several moles are outside the holes simultaneously, and their time above ground becomes consecutively shorter. You can add mallets, even add players, but generally they end up getting in each other’s way, communication breaks down, and one mole gets whacked twice, while another exits unscathed, only to break the soil elsewhere.

Danielle Scheurer, MD, MSCR, SFHM

Maybe a better strategy is to have a strategy—to work with our “trustworthy partners” to align our vision statements, anticipate the vermin’s approach, and fill the holes (or chasms) before anything has a chance to squeeze through. Maybe we should tell them where the moles are, because we actually already know what they look like and where they dwell. Why don’t we tell them which moles are the most dangerous, the most annoying, or are the most likely to tear up the topsoil into an irreparable state?

What about all the issues that no one is telling us we have to comply with—for example, a universal allergy list across the spectrum of care, or a perfectly reliable system to ensure that a patient with an epidural catheter cannot be anticoagulated? Such a list is endless, and no one is telling us we have to address the majority of the items on the list.

It comes down to this: What kind of healthcare do you want for yourself, your family, and the patients who trust you? I’d rather not have a reactive, frantic race to obliterate the next torrid creature that has arisen. I suggest a proactive, strategic pathway of tilling the soil.

In anticipation of a universal vote for the latter, join me in congratulating the healthcare industry in holding ourselves accountable, embracing a new era of transparency and collaboration, and routinely going beyond the expectations of our regulators. And leaving the mallet in the arcade.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

It might seem like a stretch, but my recent encounters with clothes dryers have taught me a few lessons about what HM groups need to function at their highest level:

• We need to know one another;
• We need to undergo routine maintenance; and
• We need to not get overworked.

I’ve had pretty bad luck with clothes dryers. Washing machines, no problem; I find them cooperative, reliable, long-lasting. But dryers and I are perfectly incompatible.

So I should have known I was in for problems when, last summer, we moved into a house with an old conveyed dryer. After closing on the house, I became the proud owner of the off-white, rust-tinted clothes dryer, along with the expired warranty and a stack of maintenance books. It motored along fine for a while, unattended by me (or anyone else in my household), until one day it just stopped. It stalled, mid-load, leaving inside a huge lump of wet clothes, and another, wetter load waiting in the washer.

So, not terribly surprised by yet another unreliable appliance but annoyed nonetheless, I Googled “dryer repair, Charleston, South Carolina.” A millisecond later, I found what seemed like a reputable, appealing name. Feeling like I was supporting local small business, I dialed the number and heard on the other end of a crackly landline the voice of “Fred,” his name changed to protect the innocent. After a few minutes on the phone with Fred, I imagined (later to be confirmed) a local Southern man with a broad-based baseball cap, low-riding jeans with a large belt buckle, and a knack for dryer-sized appliances.

His first logical question after my plea for help was: “What kinda dryer you got?” Hmmm, good question, since I never actually paid attention. Maytag? GE? “Umm,” I answered, “not sure.” Fred then uttered the next most logical question, this time sounding slightly annoyed: “Gas or electric?” Now you are getting a sense of how much time I spend around my dryer: “Umm, not sure.”

There was a pause on the other end of the line, and a pit in my stomach. I was thinking, “I can’t believe I am failing a screening test for this darn appliance.” As I considered making up an answer, he broke the silence: “Well … then I guess I’ll just have to pay you a visit.”

Lesson: It is pretty hard to take good care of your dryer, or to fix it when it breaks, if you don’t know too much about it. HM groups need to get to know each other, to have an understanding of what we are made of, and how we can help each other when in need of “repair.”

Tender, Loving Care

When Fred arrived at my house, he thoroughly disarticulated the dryer into remarkably small pieces. It didn’t take long after to find the culprit. There was enough lint built up around the innards to ignite a large factory.

Feeling a little defensive about my lack of dryer maintenance, I launched into a litany of complaints about my husband. “He doesn’t believe in lint traps, thinks cleaning them is beyond a nuisance, and only resorts to the task when gray dust bunnies are bulging out of the top.” It was about this time that Fred, with years of old-fashioned Southern wisdom, pointed out to me that I was lucky to have a husband that goes near a dryer; based on one-too-many husband-complaint sessions with friends, Fred had a pretty good point.

Fred was visibly disgusted with the lack of maintenance and care of this trusted appliance, because, as he later disclosed, he doesn’t just fix dryers, he actually loves dryers, which is respectable in a strange sort of way. I felt a surge of Catholic guilt about my lack of maintenance, so I vowed to Fred to take care of my dryer with all my ability, and thanked him for a job well done.

Lesson: If you don’t regularly maintain the lint trap, it all builds up on the inside, which can ignite a fire. HM groups need to regularly participate in “maintenance” functions, to keep the group humming along without risk of combustion. Such maintenance should include evaluation of roles, responsibilities, and reimbursement structures that result in equity and longevity.

The Smart Squeeze

After a few weeks of peace and harmony in the Scheurer household, without a single school uniform being re-worn with a ketchup stain, again, the unspeakable happened. An entire load of wet laundry sat in the dryer, stuck in park, with a wetter load in the washer. I flipped the switch; nothing happened. This time I even went so far as to “pop the hood,” just to look around (not that I knew what I was looking for). Without an obvious defect glaring at me, I closed the hood and, hesitantly, called Fred.

He promptly returned, on a Saturday morning, to my dwelling, and began the disarticulation process again. But before the third screw was off, he yelled, “Aha!”

Now, I wasn’t sure if the “aha” was going to translate into a “once again, you have proven yourself incapable of maintaining a simple appliance” when he disclosed, “the belt’s broke.”

What a relief; the belt broke. Surely I had no culpability for a broken belt. Alas, the broken belt had little to do with the uncooperative dryer; the belt broke because I had overloaded the old, pitiful thing. In an attempt at efficiency, I threw in a big, sopping load of towels, at least half a dozen too many, topped off with a bath mat.

Lesson: There is only so much efficiency you can squeeze out of a hospitalist group. If you load it up too heavy, it will break.

Take Stock of Your ‘Appliance’

So you see, hospitalist groups really are a lot like dryers: hundreds of brands and model types, differing slightly in maintenance requirements and load-bearing abilities, but all sharing some common denominators: a need to be understood, a need to be maintained, and a need to not be overloaded.

So ask yourself the following questions about your group:

• Do we know what brands we have?
• Are we cleaning out our lint?
• Are we breaking some belts?

If you don’t know the answers, you should probably find out...or else call Fred.

Dr. Scheurer is physician editor of The Hospitalist. Email her at [email protected].

It might seem like a stretch, but my recent encounters with clothes dryers have taught me a few lessons about what HM groups need to function at their highest level:

• We need to know one another;
• We need to undergo routine maintenance; and
• We need to not get overworked.

I’ve had pretty bad luck with clothes dryers. Washing machines, no problem; I find them cooperative, reliable, long-lasting. But dryers and I are perfectly incompatible.

So I should have known I was in for problems when, last summer, we moved into a house with an old conveyed dryer. After closing on the house, I became the proud owner of the off-white, rust-tinted clothes dryer, along with the expired warranty and a stack of maintenance books. It motored along fine for a while, unattended by me (or anyone else in my household), until one day it just stopped. It stalled, mid-load, leaving inside a huge lump of wet clothes, and another, wetter load waiting in the washer.

So, not terribly surprised by yet another unreliable appliance but annoyed nonetheless, I Googled “dryer repair, Charleston, South Carolina.” A millisecond later, I found what seemed like a reputable, appealing name. Feeling like I was supporting local small business, I dialed the number and heard on the other end of a crackly landline the voice of “Fred,” his name changed to protect the innocent. After a few minutes on the phone with Fred, I imagined (later to be confirmed) a local Southern man with a broad-based baseball cap, low-riding jeans with a large belt buckle, and a knack for dryer-sized appliances.

His first logical question after my plea for help was: “What kinda dryer you got?” Hmmm, good question, since I never actually paid attention. Maytag? GE? “Umm,” I answered, “not sure.” Fred then uttered the next most logical question, this time sounding slightly annoyed: “Gas or electric?” Now you are getting a sense of how much time I spend around my dryer: “Umm, not sure.”

There was a pause on the other end of the line, and a pit in my stomach. I was thinking, “I can’t believe I am failing a screening test for this darn appliance.” As I considered making up an answer, he broke the silence: “Well … then I guess I’ll just have to pay you a visit.”

Lesson: It is pretty hard to take good care of your dryer, or to fix it when it breaks, if you don’t know too much about it. HM groups need to get to know each other, to have an understanding of what we are made of, and how we can help each other when in need of “repair.”

Tender, Loving Care

When Fred arrived at my house, he thoroughly disarticulated the dryer into remarkably small pieces. It didn’t take long after to find the culprit. There was enough lint built up around the innards to ignite a large factory.

Feeling a little defensive about my lack of dryer maintenance, I launched into a litany of complaints about my husband. “He doesn’t believe in lint traps, thinks cleaning them is beyond a nuisance, and only resorts to the task when gray dust bunnies are bulging out of the top.” It was about this time that Fred, with years of old-fashioned Southern wisdom, pointed out to me that I was lucky to have a husband that goes near a dryer; based on one-too-many husband-complaint sessions with friends, Fred had a pretty good point.

Fred was visibly disgusted with the lack of maintenance and care of this trusted appliance, because, as he later disclosed, he doesn’t just fix dryers, he actually loves dryers, which is respectable in a strange sort of way. I felt a surge of Catholic guilt about my lack of maintenance, so I vowed to Fred to take care of my dryer with all my ability, and thanked him for a job well done.

Lesson: If you don’t regularly maintain the lint trap, it all builds up on the inside, which can ignite a fire. HM groups need to regularly participate in “maintenance” functions, to keep the group humming along without risk of combustion. Such maintenance should include evaluation of roles, responsibilities, and reimbursement structures that result in equity and longevity.

The Smart Squeeze

After a few weeks of peace and harmony in the Scheurer household, without a single school uniform being re-worn with a ketchup stain, again, the unspeakable happened. An entire load of wet laundry sat in the dryer, stuck in park, with a wetter load in the washer. I flipped the switch; nothing happened. This time I even went so far as to “pop the hood,” just to look around (not that I knew what I was looking for). Without an obvious defect glaring at me, I closed the hood and, hesitantly, called Fred.

He promptly returned, on a Saturday morning, to my dwelling, and began the disarticulation process again. But before the third screw was off, he yelled, “Aha!”

Now, I wasn’t sure if the “aha” was going to translate into a “once again, you have proven yourself incapable of maintaining a simple appliance” when he disclosed, “the belt’s broke.”

What a relief; the belt broke. Surely I had no culpability for a broken belt. Alas, the broken belt had little to do with the uncooperative dryer; the belt broke because I had overloaded the old, pitiful thing. In an attempt at efficiency, I threw in a big, sopping load of towels, at least half a dozen too many, topped off with a bath mat.

Lesson: There is only so much efficiency you can squeeze out of a hospitalist group. If you load it up too heavy, it will break.

Take Stock of Your ‘Appliance’

So you see, hospitalist groups really are a lot like dryers: hundreds of brands and model types, differing slightly in maintenance requirements and load-bearing abilities, but all sharing some common denominators: a need to be understood, a need to be maintained, and a need to not be overloaded.

So ask yourself the following questions about your group:

• Do we know what brands we have?
• Are we cleaning out our lint?
• Are we breaking some belts?

If you don’t know the answers, you should probably find out...or else call Fred.

Dr. Scheurer is physician editor of The Hospitalist. Email her at [email protected].

It might seem like a stretch, but my recent encounters with clothes dryers have taught me a few lessons about what HM groups need to function at their highest level:

• We need to know one another;
• We need to undergo routine maintenance; and
• We need to not get overworked.

I’ve had pretty bad luck with clothes dryers. Washing machines, no problem; I find them cooperative, reliable, long-lasting. But dryers and I are perfectly incompatible.

So I should have known I was in for problems when, last summer, we moved into a house with an old conveyed dryer. After closing on the house, I became the proud owner of the off-white, rust-tinted clothes dryer, along with the expired warranty and a stack of maintenance books. It motored along fine for a while, unattended by me (or anyone else in my household), until one day it just stopped. It stalled, mid-load, leaving inside a huge lump of wet clothes, and another, wetter load waiting in the washer.

So, not terribly surprised by yet another unreliable appliance but annoyed nonetheless, I Googled “dryer repair, Charleston, South Carolina.” A millisecond later, I found what seemed like a reputable, appealing name. Feeling like I was supporting local small business, I dialed the number and heard on the other end of a crackly landline the voice of “Fred,” his name changed to protect the innocent. After a few minutes on the phone with Fred, I imagined (later to be confirmed) a local Southern man with a broad-based baseball cap, low-riding jeans with a large belt buckle, and a knack for dryer-sized appliances.

His first logical question after my plea for help was: “What kinda dryer you got?” Hmmm, good question, since I never actually paid attention. Maytag? GE? “Umm,” I answered, “not sure.” Fred then uttered the next most logical question, this time sounding slightly annoyed: “Gas or electric?” Now you are getting a sense of how much time I spend around my dryer: “Umm, not sure.”

There was a pause on the other end of the line, and a pit in my stomach. I was thinking, “I can’t believe I am failing a screening test for this darn appliance.” As I considered making up an answer, he broke the silence: “Well … then I guess I’ll just have to pay you a visit.”

Lesson: It is pretty hard to take good care of your dryer, or to fix it when it breaks, if you don’t know too much about it. HM groups need to get to know each other, to have an understanding of what we are made of, and how we can help each other when in need of “repair.”

Tender, Loving Care

When Fred arrived at my house, he thoroughly disarticulated the dryer into remarkably small pieces. It didn’t take long after to find the culprit. There was enough lint built up around the innards to ignite a large factory.

Feeling a little defensive about my lack of dryer maintenance, I launched into a litany of complaints about my husband. “He doesn’t believe in lint traps, thinks cleaning them is beyond a nuisance, and only resorts to the task when gray dust bunnies are bulging out of the top.” It was about this time that Fred, with years of old-fashioned Southern wisdom, pointed out to me that I was lucky to have a husband that goes near a dryer; based on one-too-many husband-complaint sessions with friends, Fred had a pretty good point.

Fred was visibly disgusted with the lack of maintenance and care of this trusted appliance, because, as he later disclosed, he doesn’t just fix dryers, he actually loves dryers, which is respectable in a strange sort of way. I felt a surge of Catholic guilt about my lack of maintenance, so I vowed to Fred to take care of my dryer with all my ability, and thanked him for a job well done.

Lesson: If you don’t regularly maintain the lint trap, it all builds up on the inside, which can ignite a fire. HM groups need to regularly participate in “maintenance” functions, to keep the group humming along without risk of combustion. Such maintenance should include evaluation of roles, responsibilities, and reimbursement structures that result in equity and longevity.

The Smart Squeeze

After a few weeks of peace and harmony in the Scheurer household, without a single school uniform being re-worn with a ketchup stain, again, the unspeakable happened. An entire load of wet laundry sat in the dryer, stuck in park, with a wetter load in the washer. I flipped the switch; nothing happened. This time I even went so far as to “pop the hood,” just to look around (not that I knew what I was looking for). Without an obvious defect glaring at me, I closed the hood and, hesitantly, called Fred.

He promptly returned, on a Saturday morning, to my dwelling, and began the disarticulation process again. But before the third screw was off, he yelled, “Aha!”

Now, I wasn’t sure if the “aha” was going to translate into a “once again, you have proven yourself incapable of maintaining a simple appliance” when he disclosed, “the belt’s broke.”

What a relief; the belt broke. Surely I had no culpability for a broken belt. Alas, the broken belt had little to do with the uncooperative dryer; the belt broke because I had overloaded the old, pitiful thing. In an attempt at efficiency, I threw in a big, sopping load of towels, at least half a dozen too many, topped off with a bath mat.

Lesson: There is only so much efficiency you can squeeze out of a hospitalist group. If you load it up too heavy, it will break.

Take Stock of Your ‘Appliance’

So you see, hospitalist groups really are a lot like dryers: hundreds of brands and model types, differing slightly in maintenance requirements and load-bearing abilities, but all sharing some common denominators: a need to be understood, a need to be maintained, and a need to not be overloaded.

So ask yourself the following questions about your group:

• Do we know what brands we have?
• Are we cleaning out our lint?
• Are we breaking some belts?

If you don’t know the answers, you should probably find out...or else call Fred.

Dr. Scheurer is physician editor of The Hospitalist. Email her at [email protected].

As an introduction to my new role as physician editor, I should explain why I took this on. Simply stated: I drank the Kool-Aid. As most of you know, drinking brightly colored sugar water is a metaphor for a sincere and dedicated belief in a philosophy (though the basis of the term resides in the Jonestown massacre of 1978, let’s put that aside for now). The philosophy to which I am referring is that which defines our field. I firmly believe in the power and the future of hospital medicine, now 30,000 strong.

I am not exactly sure when I first drank the Kool-Aid. I suspect that, like for many hospitalists, it was a slow progression in the beginning, a sip or two here and there, interspersed with 7-Eleven-sized gulps at SHM annual meetings. But I do know HM, as a specialty, is firmly ingrained in me, the super-sweet beverage running deep in my veins.

Our specialty has borne monumental accomplishments in a very short sprint, and we are well on our way to dozens more in the near future. Here are a few reasons I believe in our future:

Healthcare Can’t Live without Us

Of hospitals with more than 200 beds, hospitalists practice in more than 80% of them. I would venture the same is not true of dermatologists or neurosurgeons. We have extended our tentacles into most every area of the hospital, from the ED to post-operative holding, from the blood bank to the C-suite.

We are integral to the success of almost every area under the hospital roof. The surgeons need sharp and skillful partners. The ED physicians need reliable receivers. The quality department needs informed observers. The admitting department needs sensible triagers. The utilization review department needs thorough documenters. The primary-care doctor needs discharge coordinators.

We have been all of those things and more. Hospitalists will continue to forge into new terrain, to fill the needed voids, to bridge the gap between the seamless hospital system patients deserve and the disjointed hospital system patients often traverse through. No other specialty is doing this with such remarkable flexibility and affability.

We Now Own Some Very Tough Problems

Value, efficiency, throughput, care transitions: These are not exactly issues with effortless solutions. But through ingenuity, innovation, and elbow grease, we are chiseling away at reliable solutions for each of these areas.

Few other specialties have tackled such nebulous and multifaceted problems. We have gone so far as to build them into our core competencies and maintenance of certification. This is testimony to our dedication and willingness to create a better system.

We Are Shaping the Pipeline

Hospitalists have an immense influence over trainees in many specialties; virtually all major academic medical centers employ hospitalists for the majority of their teaching services. We likely have more face time with medical students than any other specialty. We define for them what it means to be a doctor in the 21st century.

It is certainly no longer as simple as knowing facts and figures, and possessing adequate beside rapport. Those competencies constitute less than half of what we now need to seamlessly perform. With our visibility, we are defining for the pipeline what modern doctors “look” like. Much more than think tanks, we are communicators, coordinators, and patient advocates, maneuvering them through the maze of what we currently call healthcare.

We Have Incredible Leadership

I have been repeatedly awestruck with the volume and quality of leaders within SHM and the larger hospital medicine community. Hospitalist leaders have energized all aspects of the healthcare industry, including the Centers for Medicare & Medicaid Services, the American Board of Internal Medicine, and innumerable other professional societies and medical organizations.

We routinely occupy leadership seats among residency and fellowship programs, quality and safety structures, and C-suites around the country, within hospitals of all shapes, sizes, and structures. We are leading multi-million-dollar research teams at local, regional, state, and national levels.

SHM has been instrumental in providing training opportunities for hospitalists yearning for the skill set needed to take them and their organizations to the next level. There is no doubt hospitalists will continue to expand in leadership positions around the country—and beyond.

We Are a Bargain

One of the continually unsettling statistics that gets bantered around is how “expensive” we are to hospitals. That annual sum, when last surveyed, topped out at well over $100,000 per year per full-time equivalent hospitalist. That sure sounds like a lot of money—worth a few reliable vehicles, a few years of college education, or a sizable medical school loan repayment.

But I would counter that if a hospitalist is really being a hospitalist, by diligently operating within all those facets listed above, then administrators should consider us a heap of cheap dates. This would not include hospitalists with a truncated vision of their role in the hospital, which starts and ends in sharply demarcated 12-hour shifts. The latter approach, the limited perch, could certainly be perceived as a lavish investment. In the current cost-conscious healthcare environment, it’s better to be viewed as a cheap date.

My Mission

So that is a bit about why I am here: to discourse, praise, and evangelize about hospital medicine, past, present, and future; to summarize and speculate, why we are here, and where we are going next; to regularly shower each of you with the Kool-Aid; to buffer you from the daily difficulties of a very laborious yet very rewarding career. It will be an honor and a challenge to maintain this momentum, but I do believe I can execute.

Let me end with a few words about my predecessor, Jeffrey Glasheen, MD, SFHM, who successfully shepherded the previous four-plus years of The Hospitalist. Jeff is intelligent, witty, thoughtful, and an exceptional writer. He has graciously transitioned me into the publication, and I owe him my gratitude. Jeff, just don’t go too far away, in case I ever need a sprinkle of Kool-Aid myself.

Dr. Scheurer is physician editor for The Hospitalist, and is a hospitalist and chief quality officer at the Medical University of South Carolina, Charleston, S.C. Send your comments and questions to [email protected].

As an introduction to my new role as physician editor, I should explain why I took this on. Simply stated: I drank the Kool-Aid. As most of you know, drinking brightly colored sugar water is a metaphor for a sincere and dedicated belief in a philosophy (though the basis of the term resides in the Jonestown massacre of 1978, let’s put that aside for now). The philosophy to which I am referring is that which defines our field. I firmly believe in the power and the future of hospital medicine, now 30,000 strong.

I am not exactly sure when I first drank the Kool-Aid. I suspect that, like for many hospitalists, it was a slow progression in the beginning, a sip or two here and there, interspersed with 7-Eleven-sized gulps at SHM annual meetings. But I do know HM, as a specialty, is firmly ingrained in me, the super-sweet beverage running deep in my veins.

Our specialty has borne monumental accomplishments in a very short sprint, and we are well on our way to dozens more in the near future. Here are a few reasons I believe in our future:

Healthcare Can’t Live without Us

Of hospitals with more than 200 beds, hospitalists practice in more than 80% of them. I would venture the same is not true of dermatologists or neurosurgeons. We have extended our tentacles into most every area of the hospital, from the ED to post-operative holding, from the blood bank to the C-suite.

We are integral to the success of almost every area under the hospital roof. The surgeons need sharp and skillful partners. The ED physicians need reliable receivers. The quality department needs informed observers. The admitting department needs sensible triagers. The utilization review department needs thorough documenters. The primary-care doctor needs discharge coordinators.

We have been all of those things and more. Hospitalists will continue to forge into new terrain, to fill the needed voids, to bridge the gap between the seamless hospital system patients deserve and the disjointed hospital system patients often traverse through. No other specialty is doing this with such remarkable flexibility and affability.

We Now Own Some Very Tough Problems

Value, efficiency, throughput, care transitions: These are not exactly issues with effortless solutions. But through ingenuity, innovation, and elbow grease, we are chiseling away at reliable solutions for each of these areas.

Few other specialties have tackled such nebulous and multifaceted problems. We have gone so far as to build them into our core competencies and maintenance of certification. This is testimony to our dedication and willingness to create a better system.

We Are Shaping the Pipeline

Hospitalists have an immense influence over trainees in many specialties; virtually all major academic medical centers employ hospitalists for the majority of their teaching services. We likely have more face time with medical students than any other specialty. We define for them what it means to be a doctor in the 21st century.

It is certainly no longer as simple as knowing facts and figures, and possessing adequate beside rapport. Those competencies constitute less than half of what we now need to seamlessly perform. With our visibility, we are defining for the pipeline what modern doctors “look” like. Much more than think tanks, we are communicators, coordinators, and patient advocates, maneuvering them through the maze of what we currently call healthcare.

We Have Incredible Leadership

I have been repeatedly awestruck with the volume and quality of leaders within SHM and the larger hospital medicine community. Hospitalist leaders have energized all aspects of the healthcare industry, including the Centers for Medicare & Medicaid Services, the American Board of Internal Medicine, and innumerable other professional societies and medical organizations.

We routinely occupy leadership seats among residency and fellowship programs, quality and safety structures, and C-suites around the country, within hospitals of all shapes, sizes, and structures. We are leading multi-million-dollar research teams at local, regional, state, and national levels.

SHM has been instrumental in providing training opportunities for hospitalists yearning for the skill set needed to take them and their organizations to the next level. There is no doubt hospitalists will continue to expand in leadership positions around the country—and beyond.

We Are a Bargain

One of the continually unsettling statistics that gets bantered around is how “expensive” we are to hospitals. That annual sum, when last surveyed, topped out at well over $100,000 per year per full-time equivalent hospitalist. That sure sounds like a lot of money—worth a few reliable vehicles, a few years of college education, or a sizable medical school loan repayment.

But I would counter that if a hospitalist is really being a hospitalist, by diligently operating within all those facets listed above, then administrators should consider us a heap of cheap dates. This would not include hospitalists with a truncated vision of their role in the hospital, which starts and ends in sharply demarcated 12-hour shifts. The latter approach, the limited perch, could certainly be perceived as a lavish investment. In the current cost-conscious healthcare environment, it’s better to be viewed as a cheap date.

My Mission

So that is a bit about why I am here: to discourse, praise, and evangelize about hospital medicine, past, present, and future; to summarize and speculate, why we are here, and where we are going next; to regularly shower each of you with the Kool-Aid; to buffer you from the daily difficulties of a very laborious yet very rewarding career. It will be an honor and a challenge to maintain this momentum, but I do believe I can execute.

Let me end with a few words about my predecessor, Jeffrey Glasheen, MD, SFHM, who successfully shepherded the previous four-plus years of The Hospitalist. Jeff is intelligent, witty, thoughtful, and an exceptional writer. He has graciously transitioned me into the publication, and I owe him my gratitude. Jeff, just don’t go too far away, in case I ever need a sprinkle of Kool-Aid myself.

Dr. Scheurer is physician editor for The Hospitalist, and is a hospitalist and chief quality officer at the Medical University of South Carolina, Charleston, S.C. Send your comments and questions to [email protected].

As an introduction to my new role as physician editor, I should explain why I took this on. Simply stated: I drank the Kool-Aid. As most of you know, drinking brightly colored sugar water is a metaphor for a sincere and dedicated belief in a philosophy (though the basis of the term resides in the Jonestown massacre of 1978, let’s put that aside for now). The philosophy to which I am referring is that which defines our field. I firmly believe in the power and the future of hospital medicine, now 30,000 strong.

I am not exactly sure when I first drank the Kool-Aid. I suspect that, like for many hospitalists, it was a slow progression in the beginning, a sip or two here and there, interspersed with 7-Eleven-sized gulps at SHM annual meetings. But I do know HM, as a specialty, is firmly ingrained in me, the super-sweet beverage running deep in my veins.

Our specialty has borne monumental accomplishments in a very short sprint, and we are well on our way to dozens more in the near future. Here are a few reasons I believe in our future:

Healthcare Can’t Live without Us

Of hospitals with more than 200 beds, hospitalists practice in more than 80% of them. I would venture the same is not true of dermatologists or neurosurgeons. We have extended our tentacles into most every area of the hospital, from the ED to post-operative holding, from the blood bank to the C-suite.

We are integral to the success of almost every area under the hospital roof. The surgeons need sharp and skillful partners. The ED physicians need reliable receivers. The quality department needs informed observers. The admitting department needs sensible triagers. The utilization review department needs thorough documenters. The primary-care doctor needs discharge coordinators.

We have been all of those things and more. Hospitalists will continue to forge into new terrain, to fill the needed voids, to bridge the gap between the seamless hospital system patients deserve and the disjointed hospital system patients often traverse through. No other specialty is doing this with such remarkable flexibility and affability.

We Now Own Some Very Tough Problems

Value, efficiency, throughput, care transitions: These are not exactly issues with effortless solutions. But through ingenuity, innovation, and elbow grease, we are chiseling away at reliable solutions for each of these areas.

Few other specialties have tackled such nebulous and multifaceted problems. We have gone so far as to build them into our core competencies and maintenance of certification. This is testimony to our dedication and willingness to create a better system.

We Are Shaping the Pipeline

Hospitalists have an immense influence over trainees in many specialties; virtually all major academic medical centers employ hospitalists for the majority of their teaching services. We likely have more face time with medical students than any other specialty. We define for them what it means to be a doctor in the 21st century.

It is certainly no longer as simple as knowing facts and figures, and possessing adequate beside rapport. Those competencies constitute less than half of what we now need to seamlessly perform. With our visibility, we are defining for the pipeline what modern doctors “look” like. Much more than think tanks, we are communicators, coordinators, and patient advocates, maneuvering them through the maze of what we currently call healthcare.

We Have Incredible Leadership

I have been repeatedly awestruck with the volume and quality of leaders within SHM and the larger hospital medicine community. Hospitalist leaders have energized all aspects of the healthcare industry, including the Centers for Medicare & Medicaid Services, the American Board of Internal Medicine, and innumerable other professional societies and medical organizations.

We routinely occupy leadership seats among residency and fellowship programs, quality and safety structures, and C-suites around the country, within hospitals of all shapes, sizes, and structures. We are leading multi-million-dollar research teams at local, regional, state, and national levels.

SHM has been instrumental in providing training opportunities for hospitalists yearning for the skill set needed to take them and their organizations to the next level. There is no doubt hospitalists will continue to expand in leadership positions around the country—and beyond.

We Are a Bargain

One of the continually unsettling statistics that gets bantered around is how “expensive” we are to hospitals. That annual sum, when last surveyed, topped out at well over $100,000 per year per full-time equivalent hospitalist. That sure sounds like a lot of money—worth a few reliable vehicles, a few years of college education, or a sizable medical school loan repayment.

But I would counter that if a hospitalist is really being a hospitalist, by diligently operating within all those facets listed above, then administrators should consider us a heap of cheap dates. This would not include hospitalists with a truncated vision of their role in the hospital, which starts and ends in sharply demarcated 12-hour shifts. The latter approach, the limited perch, could certainly be perceived as a lavish investment. In the current cost-conscious healthcare environment, it’s better to be viewed as a cheap date.

My Mission

So that is a bit about why I am here: to discourse, praise, and evangelize about hospital medicine, past, present, and future; to summarize and speculate, why we are here, and where we are going next; to regularly shower each of you with the Kool-Aid; to buffer you from the daily difficulties of a very laborious yet very rewarding career. It will be an honor and a challenge to maintain this momentum, but I do believe I can execute.

Let me end with a few words about my predecessor, Jeffrey Glasheen, MD, SFHM, who successfully shepherded the previous four-plus years of The Hospitalist. Jeff is intelligent, witty, thoughtful, and an exceptional writer. He has graciously transitioned me into the publication, and I owe him my gratitude. Jeff, just don’t go too far away, in case I ever need a sprinkle of Kool-Aid myself.

Dr. Scheurer is physician editor for The Hospitalist, and is a hospitalist and chief quality officer at the Medical University of South Carolina, Charleston, S.C. Send your comments and questions to [email protected].

Outgoing SHM President Joe Li, MD, SFHM, summarized the Ernest Hemingway history of the “six-word story.” as a metaphor for the future of HM. Hemingway was famous for his short stories; his six-word stories are etched in literary folk lore.

Similarly, the future of hospital medicine will depend on how we are perceived by our six-word stories, Dr. Li said at HM12 in San Diego. Here are a few worrisome outcomes: 

1. “Less continuity, more readmissions, billions lost;” or

2. “Hospitalization, inadequate communications, ready for readmission.”

What we need to work toward are six-word stories that will serve our profession and our patients well, such as “high quality, low cost, high value,” or “hospitalists, high-value, patient-focused care.”

Key Takeaways:

• Our six-word stories are vital to the perception and reality of hospital medicine;
• We are all responsible for the future of the six word stories of hospital medicine.

Dr. Scheurer is physician editor of The Hospitalist.

Outgoing SHM President Joe Li, MD, SFHM, summarized the Ernest Hemingway history of the “six-word story.” as a metaphor for the future of HM. Hemingway was famous for his short stories; his six-word stories are etched in literary folk lore.

Similarly, the future of hospital medicine will depend on how we are perceived by our six-word stories, Dr. Li said at HM12 in San Diego. Here are a few worrisome outcomes: 

1. “Less continuity, more readmissions, billions lost;” or

2. “Hospitalization, inadequate communications, ready for readmission.”

What we need to work toward are six-word stories that will serve our profession and our patients well, such as “high quality, low cost, high value,” or “hospitalists, high-value, patient-focused care.”

Key Takeaways:

• Our six-word stories are vital to the perception and reality of hospital medicine;
• We are all responsible for the future of the six word stories of hospital medicine.

Dr. Scheurer is physician editor of The Hospitalist.

Outgoing SHM President Joe Li, MD, SFHM, summarized the Ernest Hemingway history of the “six-word story.” as a metaphor for the future of HM. Hemingway was famous for his short stories; his six-word stories are etched in literary folk lore.

Similarly, the future of hospital medicine will depend on how we are perceived by our six-word stories, Dr. Li said at HM12 in San Diego. Here are a few worrisome outcomes: 

1. “Less continuity, more readmissions, billions lost;” or

2. “Hospitalization, inadequate communications, ready for readmission.”

What we need to work toward are six-word stories that will serve our profession and our patients well, such as “high quality, low cost, high value,” or “hospitalists, high-value, patient-focused care.”

Key Takeaways:

• Our six-word stories are vital to the perception and reality of hospital medicine;
• We are all responsible for the future of the six word stories of hospital medicine.

Dr. Scheurer is physician editor of The Hospitalist.

We have staked our reputation on our ability to improve healthcare quality, and we need to deliver, according to incoming SHM President Shaun Frost, MD, SFHM, who addressed hospitalists this morning at HM12 in San Diego. Such care delivery will require personal accountability to embrace the work necessary to realize the potential of HM.

As Lou Holtz, the former Notre Dame head football coach, once said, “when all is said and done, a lot more is said than done.” Although always couched within a system, many current limitations with quality improvement and patient safety are rooted at the level of individual accountability. Dr. Frost pointed to hand hygiene and sign-out performance as tangible examples.

Key Takeaways:

• We are at a point in our profession where we need to define and enforce individual accountability for processes considered vital to good patient care.
• We need to all hold ourselves accountability for our ability to deliver genuine results.

Dr. Scheurer is physician editor of The Hospitalist

We have staked our reputation on our ability to improve healthcare quality, and we need to deliver, according to incoming SHM President Shaun Frost, MD, SFHM, who addressed hospitalists this morning at HM12 in San Diego. Such care delivery will require personal accountability to embrace the work necessary to realize the potential of HM.

As Lou Holtz, the former Notre Dame head football coach, once said, “when all is said and done, a lot more is said than done.” Although always couched within a system, many current limitations with quality improvement and patient safety are rooted at the level of individual accountability. Dr. Frost pointed to hand hygiene and sign-out performance as tangible examples.

Key Takeaways:

• We are at a point in our profession where we need to define and enforce individual accountability for processes considered vital to good patient care.
• We need to all hold ourselves accountability for our ability to deliver genuine results.

Dr. Scheurer is physician editor of The Hospitalist

We have staked our reputation on our ability to improve healthcare quality, and we need to deliver, according to incoming SHM President Shaun Frost, MD, SFHM, who addressed hospitalists this morning at HM12 in San Diego. Such care delivery will require personal accountability to embrace the work necessary to realize the potential of HM.

As Lou Holtz, the former Notre Dame head football coach, once said, “when all is said and done, a lot more is said than done.” Although always couched within a system, many current limitations with quality improvement and patient safety are rooted at the level of individual accountability. Dr. Frost pointed to hand hygiene and sign-out performance as tangible examples.

Key Takeaways:

• We are at a point in our profession where we need to define and enforce individual accountability for processes considered vital to good patient care.
• We need to all hold ourselves accountability for our ability to deliver genuine results.

Dr. Scheurer is physician editor of The Hospitalist