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Hospitalist meta-leader: Your new mission has arrived
If you are a hospitalist and leader in your health care organization, the ongoing controversies surrounding the Affordable Care Act repeal and replace campaign are unsettling. No matter your politics, Washington’s political drama and gamesmanship pose a genuine threat to the solvency of your hospital’s budget, services, workforce, and patients.
Health care has devolved into a political football, tossed from skirmish to skirmish. Political leaders warn of the implosion of the health care system as a political tactic, not an outcome that could cost and ruin lives. Both Democrats and Republicans hope that if or when that happens, it does so in ways that allow them to blame the other side. For them, this is a game of partisan advantage that wagers the well-being of your health care system. 
For you, the situation remains predictably unpredictable. The future directives from Washington are unknowable. This makes your strategic planning – and health care leadership itself – a complex and puzzling task. Your job now is not simply leading your organization for today. Your more important mission is preparing your organization to perform in this unpredictable and perplexing future.
Forecasting is the life blood of leadership: Craft a vision and the work to achieve it; be mindful of the range of obstacles and opportunities; and know and coalesce your followers. The problem is that today’s prospects are loaded with puzzling twists and turns. The viability of both the private insurance market and public dollars are – maybe! – in future jeopardy. Patients and the workforce are understandably jittery. What is a hospitalist leader to do?
It is time to refresh your thinking, to take a big picture view of what is happening and to assess what can be done about it. There is a tendency for leaders to look at problems and then wonder how to fit solutions into their established organizational framework. In other words, solutions are cast into the mold of retaining what you have, ignoring larger options and innovative possibilities. Solutions are expected to adapt to the organization rather than the organization adapting to the solutions.
The hospitalist movement grew as early leaders – true innovators – recognized the problems of costly, inefficient and uncoordinated care. Rather than tinkering with what was, hospitalist leaders introduced a new and proactive model to provide care. It had to first prove itself and once it did, a once revolutionary idea evolved into an institutionalized solution.
No matter what emerges from the current policy debate, the national pressures on the health care system persist: rising expectations for access; decreasing patience for spending; increasing appetite for breakthrough technology; shifting workforce requirements; all combined with a population that is aging and more in need of care. These are meta-trends that will redefine how the health system operates and what it will achieve. What is a health care leader to do?
Think and act like a “meta-leader.” This framework, developed at the Harvard T.H. Chan School of Public Health, guides leaders facing complex and transformational problem solving. The prefix “meta-” encourages expansive analysis directed toward a wide range of options and opportunities. In keeping with the strategies employed by hospitalist pioneers, rather than building solutions around “what already is,” meta-leaders pursue “what could be.” In this way, solutions are designed and constructed to fit the problems they are intended to overcome.
There are three critical dimensions to the thinking and practices of meta-leadership.
The first is the Person of the meta-leader. This is who you are, your priorities and values. This is how other people regard your leadership, translated into the respect, trust, and “followership” you garner. Be a role model. This involves building your own confidence for the task at hand so that you gain and then foster the confidence of those you lead. As a meta-leader, you shape your mindset and that of others for innovation, sharpening the curiosity necessary for fostering discovery and exploration of new ideas. Be ready to take appropriate risks.
The second dimension of meta-leadership practice is the Situation. This is what is happening and what can be done about it. You did not create the complex circumstances that derive from the political showdown in Washington. However, it is your job to understand them and to develop effective strategies and operations in response. This is where the “think big” of meta-leadership comes into play. You distinguish the chasm between the adversarial policy confrontation in Washington and the collaborative solution building needed in your home institution. You want to set the stage to meaningfully coalesce the thinking, resources, and people in your organization. The invigorated shared mission is a health care system that leads into the future.
The third dimension of meta-leadership practice is about building the Connectivity needed to make that happen. This involves developing the communication, coordination, and cooperation necessary for constructing something new. Many of your answers lie within the walls of your organization, even the most innovative among them. This is where you sow adaptability and flexibility. It translates into necessary change and transformation. This is reorienting what you and others do and how you go about doing it, from shifts and adjustments to, when necessary, disruptive innovation.
A recent Harvard Business School and Harvard Medical School forum on health care innovation identified five imperatives for meeting innovation challenges in health care: 1) Creating value is the key aim for innovation and it requires a combination of care coordination along with communication; 2) Seek opportunities for process improvement that allows new ideas to be tested, accepting that failure is a step on the road to discovery; 3) Adopt a consumerism strategy for service organization that engages and involves active patients; 4) Decentralize problem solving to encourage field innovation and collaboration; and 5) Integrate new models into established institutions, introducing fresh thinking to replace outdated practices.
Meta-leadership is not a formula for an easy fix. While much remains unpredictable, an impending economic squeeze is a likely scenario. There is nothing easy about a shortage of dollars to serve more and more people in need of clinical care. This may very well be the prompt – today – that encourages the sort of innovative thinking and disruptive solution development that the future requires. Will you and your organization get ahead of this curve?
Your mission as a hospitalist meta-leader is in forging this process of discovery. Perceive what is going on through a wide lens. Orient yourself to emerging trends. Predict what is likely to emerge from this unpredictable policy environment. Take decisions and operationalize them in ways responsive to the circumstances at hand. And then communicate with your constituencies, not only to inform them of direction but also to learn from them what is working and what not. And then you start the process again, trying on ideas and practices, learning from them and through this continuous process, finding solutions that fit your situation at hand.
Health care meta-leaders today must keep both eyes firmly on their feet, to know that current operations are achieving necessary success. At the same time, they must also keep both eyes focused on the horizon, to ensure that when conditions change, their organizations are ready to adaptively innovate and transform.
Leonard J. Marcus, Ph.D. is coauthor of Renegotiating Health Care: Resolving Conflict to Build Collaboration, Second Edition (San Francisco: Jossey-Bass Publishers, 2011) and is director of the program for health care negotiation and conflict resolution, Harvard T.H. Chan School of Public Health. Dr. Marcus teaches regularly in the SHM Leadership Academy. He can be reached at [email protected]
If you are a hospitalist and leader in your health care organization, the ongoing controversies surrounding the Affordable Care Act repeal and replace campaign are unsettling. No matter your politics, Washington’s political drama and gamesmanship pose a genuine threat to the solvency of your hospital’s budget, services, workforce, and patients.
Health care has devolved into a political football, tossed from skirmish to skirmish. Political leaders warn of the implosion of the health care system as a political tactic, not an outcome that could cost and ruin lives. Both Democrats and Republicans hope that if or when that happens, it does so in ways that allow them to blame the other side. For them, this is a game of partisan advantage that wagers the well-being of your health care system.
For you, the situation remains predictably unpredictable. The future directives from Washington are unknowable. This makes your strategic planning – and health care leadership itself – a complex and puzzling task. Your job now is not simply leading your organization for today. Your more important mission is preparing your organization to perform in this unpredictable and perplexing future.
Forecasting is the life blood of leadership: Craft a vision and the work to achieve it; be mindful of the range of obstacles and opportunities; and know and coalesce your followers. The problem is that today’s prospects are loaded with puzzling twists and turns. The viability of both the private insurance market and public dollars are – maybe! – in future jeopardy. Patients and the workforce are understandably jittery. What is a hospitalist leader to do?
It is time to refresh your thinking, to take a big picture view of what is happening and to assess what can be done about it. There is a tendency for leaders to look at problems and then wonder how to fit solutions into their established organizational framework. In other words, solutions are cast into the mold of retaining what you have, ignoring larger options and innovative possibilities. Solutions are expected to adapt to the organization rather than the organization adapting to the solutions.
The hospitalist movement grew as early leaders – true innovators – recognized the problems of costly, inefficient and uncoordinated care. Rather than tinkering with what was, hospitalist leaders introduced a new and proactive model to provide care. It had to first prove itself and once it did, a once revolutionary idea evolved into an institutionalized solution.
No matter what emerges from the current policy debate, the national pressures on the health care system persist: rising expectations for access; decreasing patience for spending; increasing appetite for breakthrough technology; shifting workforce requirements; all combined with a population that is aging and more in need of care. These are meta-trends that will redefine how the health system operates and what it will achieve. What is a health care leader to do?
Think and act like a “meta-leader.” This framework, developed at the Harvard T.H. Chan School of Public Health, guides leaders facing complex and transformational problem solving. The prefix “meta-” encourages expansive analysis directed toward a wide range of options and opportunities. In keeping with the strategies employed by hospitalist pioneers, rather than building solutions around “what already is,” meta-leaders pursue “what could be.” In this way, solutions are designed and constructed to fit the problems they are intended to overcome.
There are three critical dimensions to the thinking and practices of meta-leadership.
The first is the Person of the meta-leader. This is who you are, your priorities and values. This is how other people regard your leadership, translated into the respect, trust, and “followership” you garner. Be a role model. This involves building your own confidence for the task at hand so that you gain and then foster the confidence of those you lead. As a meta-leader, you shape your mindset and that of others for innovation, sharpening the curiosity necessary for fostering discovery and exploration of new ideas. Be ready to take appropriate risks.
The second dimension of meta-leadership practice is the Situation. This is what is happening and what can be done about it. You did not create the complex circumstances that derive from the political showdown in Washington. However, it is your job to understand them and to develop effective strategies and operations in response. This is where the “think big” of meta-leadership comes into play. You distinguish the chasm between the adversarial policy confrontation in Washington and the collaborative solution building needed in your home institution. You want to set the stage to meaningfully coalesce the thinking, resources, and people in your organization. The invigorated shared mission is a health care system that leads into the future.
The third dimension of meta-leadership practice is about building the Connectivity needed to make that happen. This involves developing the communication, coordination, and cooperation necessary for constructing something new. Many of your answers lie within the walls of your organization, even the most innovative among them. This is where you sow adaptability and flexibility. It translates into necessary change and transformation. This is reorienting what you and others do and how you go about doing it, from shifts and adjustments to, when necessary, disruptive innovation.
A recent Harvard Business School and Harvard Medical School forum on health care innovation identified five imperatives for meeting innovation challenges in health care: 1) Creating value is the key aim for innovation and it requires a combination of care coordination along with communication; 2) Seek opportunities for process improvement that allows new ideas to be tested, accepting that failure is a step on the road to discovery; 3) Adopt a consumerism strategy for service organization that engages and involves active patients; 4) Decentralize problem solving to encourage field innovation and collaboration; and 5) Integrate new models into established institutions, introducing fresh thinking to replace outdated practices.
Meta-leadership is not a formula for an easy fix. While much remains unpredictable, an impending economic squeeze is a likely scenario. There is nothing easy about a shortage of dollars to serve more and more people in need of clinical care. This may very well be the prompt – today – that encourages the sort of innovative thinking and disruptive solution development that the future requires. Will you and your organization get ahead of this curve?
Your mission as a hospitalist meta-leader is in forging this process of discovery. Perceive what is going on through a wide lens. Orient yourself to emerging trends. Predict what is likely to emerge from this unpredictable policy environment. Take decisions and operationalize them in ways responsive to the circumstances at hand. And then communicate with your constituencies, not only to inform them of direction but also to learn from them what is working and what not. And then you start the process again, trying on ideas and practices, learning from them and through this continuous process, finding solutions that fit your situation at hand.
Health care meta-leaders today must keep both eyes firmly on their feet, to know that current operations are achieving necessary success. At the same time, they must also keep both eyes focused on the horizon, to ensure that when conditions change, their organizations are ready to adaptively innovate and transform.
Leonard J. Marcus, Ph.D. is coauthor of Renegotiating Health Care: Resolving Conflict to Build Collaboration, Second Edition (San Francisco: Jossey-Bass Publishers, 2011) and is director of the program for health care negotiation and conflict resolution, Harvard T.H. Chan School of Public Health. Dr. Marcus teaches regularly in the SHM Leadership Academy. He can be reached at [email protected]
If you are a hospitalist and leader in your health care organization, the ongoing controversies surrounding the Affordable Care Act repeal and replace campaign are unsettling. No matter your politics, Washington’s political drama and gamesmanship pose a genuine threat to the solvency of your hospital’s budget, services, workforce, and patients.
Health care has devolved into a political football, tossed from skirmish to skirmish. Political leaders warn of the implosion of the health care system as a political tactic, not an outcome that could cost and ruin lives. Both Democrats and Republicans hope that if or when that happens, it does so in ways that allow them to blame the other side. For them, this is a game of partisan advantage that wagers the well-being of your health care system.
For you, the situation remains predictably unpredictable. The future directives from Washington are unknowable. This makes your strategic planning – and health care leadership itself – a complex and puzzling task. Your job now is not simply leading your organization for today. Your more important mission is preparing your organization to perform in this unpredictable and perplexing future.
Forecasting is the life blood of leadership: Craft a vision and the work to achieve it; be mindful of the range of obstacles and opportunities; and know and coalesce your followers. The problem is that today’s prospects are loaded with puzzling twists and turns. The viability of both the private insurance market and public dollars are – maybe! – in future jeopardy. Patients and the workforce are understandably jittery. What is a hospitalist leader to do?
It is time to refresh your thinking, to take a big picture view of what is happening and to assess what can be done about it. There is a tendency for leaders to look at problems and then wonder how to fit solutions into their established organizational framework. In other words, solutions are cast into the mold of retaining what you have, ignoring larger options and innovative possibilities. Solutions are expected to adapt to the organization rather than the organization adapting to the solutions.
The hospitalist movement grew as early leaders – true innovators – recognized the problems of costly, inefficient and uncoordinated care. Rather than tinkering with what was, hospitalist leaders introduced a new and proactive model to provide care. It had to first prove itself and once it did, a once revolutionary idea evolved into an institutionalized solution.
No matter what emerges from the current policy debate, the national pressures on the health care system persist: rising expectations for access; decreasing patience for spending; increasing appetite for breakthrough technology; shifting workforce requirements; all combined with a population that is aging and more in need of care. These are meta-trends that will redefine how the health system operates and what it will achieve. What is a health care leader to do?
Think and act like a “meta-leader.” This framework, developed at the Harvard T.H. Chan School of Public Health, guides leaders facing complex and transformational problem solving. The prefix “meta-” encourages expansive analysis directed toward a wide range of options and opportunities. In keeping with the strategies employed by hospitalist pioneers, rather than building solutions around “what already is,” meta-leaders pursue “what could be.” In this way, solutions are designed and constructed to fit the problems they are intended to overcome.
There are three critical dimensions to the thinking and practices of meta-leadership.
The first is the Person of the meta-leader. This is who you are, your priorities and values. This is how other people regard your leadership, translated into the respect, trust, and “followership” you garner. Be a role model. This involves building your own confidence for the task at hand so that you gain and then foster the confidence of those you lead. As a meta-leader, you shape your mindset and that of others for innovation, sharpening the curiosity necessary for fostering discovery and exploration of new ideas. Be ready to take appropriate risks.
The second dimension of meta-leadership practice is the Situation. This is what is happening and what can be done about it. You did not create the complex circumstances that derive from the political showdown in Washington. However, it is your job to understand them and to develop effective strategies and operations in response. This is where the “think big” of meta-leadership comes into play. You distinguish the chasm between the adversarial policy confrontation in Washington and the collaborative solution building needed in your home institution. You want to set the stage to meaningfully coalesce the thinking, resources, and people in your organization. The invigorated shared mission is a health care system that leads into the future.
The third dimension of meta-leadership practice is about building the Connectivity needed to make that happen. This involves developing the communication, coordination, and cooperation necessary for constructing something new. Many of your answers lie within the walls of your organization, even the most innovative among them. This is where you sow adaptability and flexibility. It translates into necessary change and transformation. This is reorienting what you and others do and how you go about doing it, from shifts and adjustments to, when necessary, disruptive innovation.
A recent Harvard Business School and Harvard Medical School forum on health care innovation identified five imperatives for meeting innovation challenges in health care: 1) Creating value is the key aim for innovation and it requires a combination of care coordination along with communication; 2) Seek opportunities for process improvement that allows new ideas to be tested, accepting that failure is a step on the road to discovery; 3) Adopt a consumerism strategy for service organization that engages and involves active patients; 4) Decentralize problem solving to encourage field innovation and collaboration; and 5) Integrate new models into established institutions, introducing fresh thinking to replace outdated practices.
Meta-leadership is not a formula for an easy fix. While much remains unpredictable, an impending economic squeeze is a likely scenario. There is nothing easy about a shortage of dollars to serve more and more people in need of clinical care. This may very well be the prompt – today – that encourages the sort of innovative thinking and disruptive solution development that the future requires. Will you and your organization get ahead of this curve?
Your mission as a hospitalist meta-leader is in forging this process of discovery. Perceive what is going on through a wide lens. Orient yourself to emerging trends. Predict what is likely to emerge from this unpredictable policy environment. Take decisions and operationalize them in ways responsive to the circumstances at hand. And then communicate with your constituencies, not only to inform them of direction but also to learn from them what is working and what not. And then you start the process again, trying on ideas and practices, learning from them and through this continuous process, finding solutions that fit your situation at hand.
Health care meta-leaders today must keep both eyes firmly on their feet, to know that current operations are achieving necessary success. At the same time, they must also keep both eyes focused on the horizon, to ensure that when conditions change, their organizations are ready to adaptively innovate and transform.
Leonard J. Marcus, Ph.D. is coauthor of Renegotiating Health Care: Resolving Conflict to Build Collaboration, Second Edition (San Francisco: Jossey-Bass Publishers, 2011) and is director of the program for health care negotiation and conflict resolution, Harvard T.H. Chan School of Public Health. Dr. Marcus teaches regularly in the SHM Leadership Academy. He can be reached at [email protected]
HM17 session summary: Nurse Practitioner/Physician Assistant special interest forum
Presenters
Tracy Cardin, ACNP, SFHM ; Emilie Thornhill, PA-C
Session summary
The Nurse Practitioner and Physician Assistant (NP/PA) special interest forum at HM17 drew more than 60 providers, including NPs, PAs, and physicians.
Emilie Thornhill, a certified PA and chair of the NP/PA Committee, and Tracy Cardin, SHM board member, updated the attendees regarding the work of the NP/PA committee over the last year. The committee has created a comprehensive “NP/PA Toolkit,” which was developed over the last 2 years in response to common inquiries about deployment and integration of NPs and PAs into Hospital Medicine practice groups.
The committee has also developed several goals for the coming year, including an “Optimization and Implementation Project,” intended to positively impact the shallow supply of highly-skilled and experienced HM NPs and PAs through development of partnerships, new content, and use of existing resources to provide a platform for effective workforce training and on-boarding.
The second half of the session was utilized to hear SHM member feedback and to solicit ideas for meaningful work that the committee could accomplish in order to better serve the SHM community. Members used the time to share and describe practice pattern variations and common shared challenges. Project suggestions included:
- Benchmarking Surveys related to NP/PA burnout, including aspects of protected time, engagement, and workload; scheduling and deployment models; and NP/PA designation as faculty or staff.
- Increased utilization and engagement with HMX as a platform for sharing ideas and success stories to increase HM NP/PA visibility.
- Creation of a “Bizarre Bylaws Blog” to disseminate best practices and improve hospital bylaws through innovative storytelling of antiquated bylaws.
- Improved NP and PA participation and engagement with local chapters.
Key takeaways for HM
- An NP/PA Toolkit resource to be posted on the SHM website.
- The NP/PA committee will transition to a Special Interest Group over the next year.
- Hospital Medicine Exchange (HMX) engagement and participation are encouraged.
- An “Implementation and Optimization Project” to help improve workforce development is pending for the coming year.
Nicolas Houghton is an NP hospitalist in Cleveland and an editorial board member of The Hospitalist.
Presenters
Tracy Cardin, ACNP, SFHM ; Emilie Thornhill, PA-C
Session summary
The Nurse Practitioner and Physician Assistant (NP/PA) special interest forum at HM17 drew more than 60 providers, including NPs, PAs, and physicians.
Emilie Thornhill, a certified PA and chair of the NP/PA Committee, and Tracy Cardin, SHM board member, updated the attendees regarding the work of the NP/PA committee over the last year. The committee has created a comprehensive “NP/PA Toolkit,” which was developed over the last 2 years in response to common inquiries about deployment and integration of NPs and PAs into Hospital Medicine practice groups.
The committee has also developed several goals for the coming year, including an “Optimization and Implementation Project,” intended to positively impact the shallow supply of highly-skilled and experienced HM NPs and PAs through development of partnerships, new content, and use of existing resources to provide a platform for effective workforce training and on-boarding.
The second half of the session was utilized to hear SHM member feedback and to solicit ideas for meaningful work that the committee could accomplish in order to better serve the SHM community. Members used the time to share and describe practice pattern variations and common shared challenges. Project suggestions included:
- Benchmarking Surveys related to NP/PA burnout, including aspects of protected time, engagement, and workload; scheduling and deployment models; and NP/PA designation as faculty or staff.
- Increased utilization and engagement with HMX as a platform for sharing ideas and success stories to increase HM NP/PA visibility.
- Creation of a “Bizarre Bylaws Blog” to disseminate best practices and improve hospital bylaws through innovative storytelling of antiquated bylaws.
- Improved NP and PA participation and engagement with local chapters.
Key takeaways for HM
- An NP/PA Toolkit resource to be posted on the SHM website.
- The NP/PA committee will transition to a Special Interest Group over the next year.
- Hospital Medicine Exchange (HMX) engagement and participation are encouraged.
- An “Implementation and Optimization Project” to help improve workforce development is pending for the coming year.
Nicolas Houghton is an NP hospitalist in Cleveland and an editorial board member of The Hospitalist.
Presenters
Tracy Cardin, ACNP, SFHM ; Emilie Thornhill, PA-C
Session summary
The Nurse Practitioner and Physician Assistant (NP/PA) special interest forum at HM17 drew more than 60 providers, including NPs, PAs, and physicians.
Emilie Thornhill, a certified PA and chair of the NP/PA Committee, and Tracy Cardin, SHM board member, updated the attendees regarding the work of the NP/PA committee over the last year. The committee has created a comprehensive “NP/PA Toolkit,” which was developed over the last 2 years in response to common inquiries about deployment and integration of NPs and PAs into Hospital Medicine practice groups.
The committee has also developed several goals for the coming year, including an “Optimization and Implementation Project,” intended to positively impact the shallow supply of highly-skilled and experienced HM NPs and PAs through development of partnerships, new content, and use of existing resources to provide a platform for effective workforce training and on-boarding.
The second half of the session was utilized to hear SHM member feedback and to solicit ideas for meaningful work that the committee could accomplish in order to better serve the SHM community. Members used the time to share and describe practice pattern variations and common shared challenges. Project suggestions included:
- Benchmarking Surveys related to NP/PA burnout, including aspects of protected time, engagement, and workload; scheduling and deployment models; and NP/PA designation as faculty or staff.
- Increased utilization and engagement with HMX as a platform for sharing ideas and success stories to increase HM NP/PA visibility.
- Creation of a “Bizarre Bylaws Blog” to disseminate best practices and improve hospital bylaws through innovative storytelling of antiquated bylaws.
- Improved NP and PA participation and engagement with local chapters.
Key takeaways for HM
- An NP/PA Toolkit resource to be posted on the SHM website.
- The NP/PA committee will transition to a Special Interest Group over the next year.
- Hospital Medicine Exchange (HMX) engagement and participation are encouraged.
- An “Implementation and Optimization Project” to help improve workforce development is pending for the coming year.
Nicolas Houghton is an NP hospitalist in Cleveland and an editorial board member of The Hospitalist.
HM17 session summary: The art of story in delivering memorable lectures
Presenter
Ethan Cumbler, MD, FACP, FHM
Session summary
This session was designed to give learners a different paradigm in thinking about the structure and organization of presentations, for a more dynamic and engaging lecture.
Memorable teaching points are tied to a narrative with emotional impact. One study of surgery residents immediately after finishing grand rounds found that learners only remember approximately 10% of the material embedded in a lecture. Therefore, the focus of the lecture should not necessarily be to include a comprehensive amount of information, but to make the major points as “sticky” as possible.
This will help anchor your presentation and will hopefully assist in creating an organizational framework. Most people are familiar with lectures that have a “standard” format: “I’m going to talk about disease/problem X. This is the scope of the problem, epidemiology, pathology, etiology, diagnosis, treatment, complications, and prognosis.” While this is an organizational structure, it doesn’t draw the audience in. Instead, what was suggested was to think about a real patient case to keep the audience engaged. Since everything may not be known in real time, you can add drama and suspense as the audience and the speaker work through the case together.
One should have a “hook” as an analogy to engage with the audience while reinforcing the central “take-home” message. One can think of it as a kind of leitmotif. Another example would be the “call-back” in stand-up comedy where a concept or joke is introduced early in the routine, is not addressed for a period of time, and then reintroduced and becomes more funny the second time around.
Many people are used to seeing PowerPoint presentations with 5-7 lines per slide, 5-7 words per line, with greater than 24 point font. Dr. Cumbler recommends thinking of one’s slide from a design perspective. For example, in TED talks, one will often see large images that act as a reference but there is often very little text on the slide. In order to provide more content while not burdening slides with more text, one should reconsider handouts. Instead of sheets of paper with 6 slides which are repeats of the PowerPoint, use the handout to provide information that one cannot show during the presentation.
It is incredibly difficult to stay engaged in a lecture delivered at the same pace and in a monotone. Timing is important in music, comedy, and presentations. One should vary the volume and tempo during the talk and allow for pauses when appropriate. An example to illustrate the point was dubstep music; it is set at a tempo of 140 beats per minute, but the song is not 140 beats per minute the entire time. It will sometimes slow down, and there is always a point where the “beat drops.”
Again, a good talk is not only the information itself, but a presenter’s presence, so one should think of body language and positioning. One should use hand gestures to emphasize points in the lecture and draw the learners in. Dr. Cumbler recommended making eye contact with individuals periodically instead of a distant, vacant stare into the great expanse. One should feel free to move across the stage or walk through the audience, so ask for a wireless microphone to liberate oneself from the podium.
Key takeaways for HM
- Consider the stand-up comedy concept of the “call-back.” Start with a concept, and then return to this concept in different forms through the presentation. One can return to another variation of this for a surprise at the end. One can make a key point memorable by using a theme with multiple variations.
- Think about structure in order to draw listeners into a talk and keep them invested (organizational framework centered around a patient); create a “hook”; think about slides visually, not from a content perspective (that’s what handouts are for); keep the tempo, timing, and volume dynamic; use body language and presence to engage the room.
- If one would like to learn more, consider reading the book Presentation Zen; watch TED talks; practice multiple times to hone various aspects of the talk; give the talk multiple times for iterative improvement; always ask for feedback and try to change at least one thing from one talk to another to continuously improve.
Dr. Kim is a hospitalist who works at Emory University Hospital in Atlanta, and is an editorial board member of The Hospitalist.
Presenter
Ethan Cumbler, MD, FACP, FHM
Session summary
This session was designed to give learners a different paradigm in thinking about the structure and organization of presentations, for a more dynamic and engaging lecture.
Memorable teaching points are tied to a narrative with emotional impact. One study of surgery residents immediately after finishing grand rounds found that learners only remember approximately 10% of the material embedded in a lecture. Therefore, the focus of the lecture should not necessarily be to include a comprehensive amount of information, but to make the major points as “sticky” as possible.
This will help anchor your presentation and will hopefully assist in creating an organizational framework. Most people are familiar with lectures that have a “standard” format: “I’m going to talk about disease/problem X. This is the scope of the problem, epidemiology, pathology, etiology, diagnosis, treatment, complications, and prognosis.” While this is an organizational structure, it doesn’t draw the audience in. Instead, what was suggested was to think about a real patient case to keep the audience engaged. Since everything may not be known in real time, you can add drama and suspense as the audience and the speaker work through the case together.
One should have a “hook” as an analogy to engage with the audience while reinforcing the central “take-home” message. One can think of it as a kind of leitmotif. Another example would be the “call-back” in stand-up comedy where a concept or joke is introduced early in the routine, is not addressed for a period of time, and then reintroduced and becomes more funny the second time around.
Many people are used to seeing PowerPoint presentations with 5-7 lines per slide, 5-7 words per line, with greater than 24 point font. Dr. Cumbler recommends thinking of one’s slide from a design perspective. For example, in TED talks, one will often see large images that act as a reference but there is often very little text on the slide. In order to provide more content while not burdening slides with more text, one should reconsider handouts. Instead of sheets of paper with 6 slides which are repeats of the PowerPoint, use the handout to provide information that one cannot show during the presentation.
It is incredibly difficult to stay engaged in a lecture delivered at the same pace and in a monotone. Timing is important in music, comedy, and presentations. One should vary the volume and tempo during the talk and allow for pauses when appropriate. An example to illustrate the point was dubstep music; it is set at a tempo of 140 beats per minute, but the song is not 140 beats per minute the entire time. It will sometimes slow down, and there is always a point where the “beat drops.”
Again, a good talk is not only the information itself, but a presenter’s presence, so one should think of body language and positioning. One should use hand gestures to emphasize points in the lecture and draw the learners in. Dr. Cumbler recommended making eye contact with individuals periodically instead of a distant, vacant stare into the great expanse. One should feel free to move across the stage or walk through the audience, so ask for a wireless microphone to liberate oneself from the podium.
Key takeaways for HM
- Consider the stand-up comedy concept of the “call-back.” Start with a concept, and then return to this concept in different forms through the presentation. One can return to another variation of this for a surprise at the end. One can make a key point memorable by using a theme with multiple variations.
- Think about structure in order to draw listeners into a talk and keep them invested (organizational framework centered around a patient); create a “hook”; think about slides visually, not from a content perspective (that’s what handouts are for); keep the tempo, timing, and volume dynamic; use body language and presence to engage the room.
- If one would like to learn more, consider reading the book Presentation Zen; watch TED talks; practice multiple times to hone various aspects of the talk; give the talk multiple times for iterative improvement; always ask for feedback and try to change at least one thing from one talk to another to continuously improve.
Dr. Kim is a hospitalist who works at Emory University Hospital in Atlanta, and is an editorial board member of The Hospitalist.
Presenter
Ethan Cumbler, MD, FACP, FHM
Session summary
This session was designed to give learners a different paradigm in thinking about the structure and organization of presentations, for a more dynamic and engaging lecture.
Memorable teaching points are tied to a narrative with emotional impact. One study of surgery residents immediately after finishing grand rounds found that learners only remember approximately 10% of the material embedded in a lecture. Therefore, the focus of the lecture should not necessarily be to include a comprehensive amount of information, but to make the major points as “sticky” as possible.
This will help anchor your presentation and will hopefully assist in creating an organizational framework. Most people are familiar with lectures that have a “standard” format: “I’m going to talk about disease/problem X. This is the scope of the problem, epidemiology, pathology, etiology, diagnosis, treatment, complications, and prognosis.” While this is an organizational structure, it doesn’t draw the audience in. Instead, what was suggested was to think about a real patient case to keep the audience engaged. Since everything may not be known in real time, you can add drama and suspense as the audience and the speaker work through the case together.
One should have a “hook” as an analogy to engage with the audience while reinforcing the central “take-home” message. One can think of it as a kind of leitmotif. Another example would be the “call-back” in stand-up comedy where a concept or joke is introduced early in the routine, is not addressed for a period of time, and then reintroduced and becomes more funny the second time around.
Many people are used to seeing PowerPoint presentations with 5-7 lines per slide, 5-7 words per line, with greater than 24 point font. Dr. Cumbler recommends thinking of one’s slide from a design perspective. For example, in TED talks, one will often see large images that act as a reference but there is often very little text on the slide. In order to provide more content while not burdening slides with more text, one should reconsider handouts. Instead of sheets of paper with 6 slides which are repeats of the PowerPoint, use the handout to provide information that one cannot show during the presentation.
It is incredibly difficult to stay engaged in a lecture delivered at the same pace and in a monotone. Timing is important in music, comedy, and presentations. One should vary the volume and tempo during the talk and allow for pauses when appropriate. An example to illustrate the point was dubstep music; it is set at a tempo of 140 beats per minute, but the song is not 140 beats per minute the entire time. It will sometimes slow down, and there is always a point where the “beat drops.”
Again, a good talk is not only the information itself, but a presenter’s presence, so one should think of body language and positioning. One should use hand gestures to emphasize points in the lecture and draw the learners in. Dr. Cumbler recommended making eye contact with individuals periodically instead of a distant, vacant stare into the great expanse. One should feel free to move across the stage or walk through the audience, so ask for a wireless microphone to liberate oneself from the podium.
Key takeaways for HM
- Consider the stand-up comedy concept of the “call-back.” Start with a concept, and then return to this concept in different forms through the presentation. One can return to another variation of this for a surprise at the end. One can make a key point memorable by using a theme with multiple variations.
- Think about structure in order to draw listeners into a talk and keep them invested (organizational framework centered around a patient); create a “hook”; think about slides visually, not from a content perspective (that’s what handouts are for); keep the tempo, timing, and volume dynamic; use body language and presence to engage the room.
- If one would like to learn more, consider reading the book Presentation Zen; watch TED talks; practice multiple times to hone various aspects of the talk; give the talk multiple times for iterative improvement; always ask for feedback and try to change at least one thing from one talk to another to continuously improve.
Dr. Kim is a hospitalist who works at Emory University Hospital in Atlanta, and is an editorial board member of The Hospitalist.
Hospitalists need critical care training pathway
Dear Editor,
It is with great interest that we read the article “Hospitalists trained in family medicine seek critical care training pathway” by Claudia Stahl.1 We would like to thank the authors for the article and at the same time emphasize the relevance and necessity of critical care knowledge for hospitalists taking care of critically ill patients.
It is a well-known fact that hospitalists provide an ICU level of services, especially in community hospitals. There are step-down or intermediate-care units across large hospitals, which also are staffed mostly by hospitalists. So we strongly support the family medicine track having a critical care training pathway, and at the same time encourage internal medicine graduates to pursue a critical care certification program. It not only is helpful, but at times also proven to be beneficial for hospitalists who care for critically ill patients to have critical care knowledge.
There was lot of excitement in 2012 when SHM and the Society of Critical Care Medicine (SCCM) issued a joint position paper proposing an expedited, 1-year, critical care fellowship for hospitalists with at least 3 years of clinical job experience, instead of the 2-year fellowship.2 However, there was a quick backlash from the American College of Chest Physicians (ACCP) and the American Association of Critical-Care Nurses (AACN), who criticized the “inadequacy” of 1 year of fellowship training for HM physicians3, and so the excitement abated.
It may not be possible for hospitalists to take 2- to 3-year breaks from their career to pursue a critical care fellowship. There are certain courses, like Fundamental Critical Care Support (FCCS) and critical care updates for hospitalists; however, the duration of these courses is not enough to give the exhaustive training that we need. Many hospitalists work week-on/week-off schedules, and we are willing to invest some of our off time to pursue a year-long course. We believe a year-long course, if structurally sound, might be able to teach the skill sets to provide quality care to our critically ill patients.
Considering the paucity of available critical care training, we believe there is a strong necessity to develop long-term critical care training targeted at hospitalists caring for critically ill patients. Whether you are a family medicine graduate, an internal medicine graduate, or an advanced practitioner, once you are a hospitalist you are a hospitalist for life – irrespective of your future practice – as you continuously strive for quality of patient care and patient safety and satisfaction.
Primary author
Venkatrao Medarametla, MBBS
Assistant Professor of Medicine, University of Massachusetts Medical School
Medical Director, Intermediate Care Unit, Baystate Medical Center
Hospital Medicine, Baystate Medical Center
[email protected]
Secondary authors
Prasanth Prabhakaran, MD
Sureshkumar Chirumamilla, MD
Hospital Medicine, Baystate Medical Center
References
1. http://www.the-hospitalist.org/hospitalist/article/133078/hospitalists-trained-family-medicine-seek-critical-care-training-pathway
2. Siegal EM, Dressler DD, Dichter JR, Gorman MJ, Lipsett PA. Training a hospitalist workforce to address the intensivist shortage in American hospitals: a position paper from the Society of Hospital Medicine and the Society of Critical Care Medicine. J Hosp Med. 2012;7:359-364.
3. Baumann MH, Simpson SQ, Stahl M, et al. First, do no harm: less training ≠ quality care. Chest. 2012;142:5-7.
Dear Editor,
It is with great interest that we read the article “Hospitalists trained in family medicine seek critical care training pathway” by Claudia Stahl.1 We would like to thank the authors for the article and at the same time emphasize the relevance and necessity of critical care knowledge for hospitalists taking care of critically ill patients.
It is a well-known fact that hospitalists provide an ICU level of services, especially in community hospitals. There are step-down or intermediate-care units across large hospitals, which also are staffed mostly by hospitalists. So we strongly support the family medicine track having a critical care training pathway, and at the same time encourage internal medicine graduates to pursue a critical care certification program. It not only is helpful, but at times also proven to be beneficial for hospitalists who care for critically ill patients to have critical care knowledge.
There was lot of excitement in 2012 when SHM and the Society of Critical Care Medicine (SCCM) issued a joint position paper proposing an expedited, 1-year, critical care fellowship for hospitalists with at least 3 years of clinical job experience, instead of the 2-year fellowship.2 However, there was a quick backlash from the American College of Chest Physicians (ACCP) and the American Association of Critical-Care Nurses (AACN), who criticized the “inadequacy” of 1 year of fellowship training for HM physicians3, and so the excitement abated.
It may not be possible for hospitalists to take 2- to 3-year breaks from their career to pursue a critical care fellowship. There are certain courses, like Fundamental Critical Care Support (FCCS) and critical care updates for hospitalists; however, the duration of these courses is not enough to give the exhaustive training that we need. Many hospitalists work week-on/week-off schedules, and we are willing to invest some of our off time to pursue a year-long course. We believe a year-long course, if structurally sound, might be able to teach the skill sets to provide quality care to our critically ill patients.
Considering the paucity of available critical care training, we believe there is a strong necessity to develop long-term critical care training targeted at hospitalists caring for critically ill patients. Whether you are a family medicine graduate, an internal medicine graduate, or an advanced practitioner, once you are a hospitalist you are a hospitalist for life – irrespective of your future practice – as you continuously strive for quality of patient care and patient safety and satisfaction.
Primary author
Venkatrao Medarametla, MBBS
Assistant Professor of Medicine, University of Massachusetts Medical School
Medical Director, Intermediate Care Unit, Baystate Medical Center
Hospital Medicine, Baystate Medical Center
[email protected]
Secondary authors
Prasanth Prabhakaran, MD
Sureshkumar Chirumamilla, MD
Hospital Medicine, Baystate Medical Center
References
1. http://www.the-hospitalist.org/hospitalist/article/133078/hospitalists-trained-family-medicine-seek-critical-care-training-pathway
2. Siegal EM, Dressler DD, Dichter JR, Gorman MJ, Lipsett PA. Training a hospitalist workforce to address the intensivist shortage in American hospitals: a position paper from the Society of Hospital Medicine and the Society of Critical Care Medicine. J Hosp Med. 2012;7:359-364.
3. Baumann MH, Simpson SQ, Stahl M, et al. First, do no harm: less training ≠ quality care. Chest. 2012;142:5-7.
Dear Editor,
It is with great interest that we read the article “Hospitalists trained in family medicine seek critical care training pathway” by Claudia Stahl.1 We would like to thank the authors for the article and at the same time emphasize the relevance and necessity of critical care knowledge for hospitalists taking care of critically ill patients.
It is a well-known fact that hospitalists provide an ICU level of services, especially in community hospitals. There are step-down or intermediate-care units across large hospitals, which also are staffed mostly by hospitalists. So we strongly support the family medicine track having a critical care training pathway, and at the same time encourage internal medicine graduates to pursue a critical care certification program. It not only is helpful, but at times also proven to be beneficial for hospitalists who care for critically ill patients to have critical care knowledge.
There was lot of excitement in 2012 when SHM and the Society of Critical Care Medicine (SCCM) issued a joint position paper proposing an expedited, 1-year, critical care fellowship for hospitalists with at least 3 years of clinical job experience, instead of the 2-year fellowship.2 However, there was a quick backlash from the American College of Chest Physicians (ACCP) and the American Association of Critical-Care Nurses (AACN), who criticized the “inadequacy” of 1 year of fellowship training for HM physicians3, and so the excitement abated.
It may not be possible for hospitalists to take 2- to 3-year breaks from their career to pursue a critical care fellowship. There are certain courses, like Fundamental Critical Care Support (FCCS) and critical care updates for hospitalists; however, the duration of these courses is not enough to give the exhaustive training that we need. Many hospitalists work week-on/week-off schedules, and we are willing to invest some of our off time to pursue a year-long course. We believe a year-long course, if structurally sound, might be able to teach the skill sets to provide quality care to our critically ill patients.
Considering the paucity of available critical care training, we believe there is a strong necessity to develop long-term critical care training targeted at hospitalists caring for critically ill patients. Whether you are a family medicine graduate, an internal medicine graduate, or an advanced practitioner, once you are a hospitalist you are a hospitalist for life – irrespective of your future practice – as you continuously strive for quality of patient care and patient safety and satisfaction.
Primary author
Venkatrao Medarametla, MBBS
Assistant Professor of Medicine, University of Massachusetts Medical School
Medical Director, Intermediate Care Unit, Baystate Medical Center
Hospital Medicine, Baystate Medical Center
[email protected]
Secondary authors
Prasanth Prabhakaran, MD
Sureshkumar Chirumamilla, MD
Hospital Medicine, Baystate Medical Center
References
1. http://www.the-hospitalist.org/hospitalist/article/133078/hospitalists-trained-family-medicine-seek-critical-care-training-pathway
2. Siegal EM, Dressler DD, Dichter JR, Gorman MJ, Lipsett PA. Training a hospitalist workforce to address the intensivist shortage in American hospitals: a position paper from the Society of Hospital Medicine and the Society of Critical Care Medicine. J Hosp Med. 2012;7:359-364.
3. Baumann MH, Simpson SQ, Stahl M, et al. First, do no harm: less training ≠ quality care. Chest. 2012;142:5-7.
Sneak Peek: The Hospital Leader Blog
We go to the altar together.
Last month, I wrote about onboarding and the important responsibility that everyone associated with a hospitalist program has to ensure that each new provider quickly comes to believe he or she made a terrific choice to join the group.
Upon reflection, it seems important to address the other side of this equation. I’m talking about the responsibilities that each candidate has when deciding whether to apply for a job, to interview, and to accept or reject a group’s offer.
The relationship between a hospitalist and the group he or she is part of is a lot like a marriage. Both parties go to the altar together, and the relationship is most likely to be successful when both enter it with their eyes open, having done their due diligence, and with an intention to align their interests and support each other. Here are some things every hospitalist should be thinking about as they assess potential job opportunities:
1. Be clear about your own needs, goals, and priorities. Before you embark on the job-hunting process, take time to do some careful introspection. My partner John Nelson is fond of saying that one of the key reasons many doctors choose to become hospitalists is that they prefer to “date” their practice rather than “marry” it. Which do you want? Are you willing to accept both the benefits and the costs of your preference? What are your short- and long-term career goals? In what part of the country do you want to live, and are you looking for an urban, suburban, or small-town environment? Is it important to be in a teaching setting? Are there specific pieces of work, such as ICU care or procedures, that you want to either pursue or avoid? What personal considerations, such as the needs of your spouse or kids, might limit your options? What structural aspects of the job are most important to you? Schedule? Daily workload? Compensation? I encourage you to think through these and other similar questions so that you are clear in your own mind about your personal job selection criteria. This will enable you to honestly articulate these things to others and to assess potential job opportunities in light of them.
Read the full text of this blog post at hospitalleader.org.
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs.
Also on The Hospital Leader …
Don’t Compare HM Group Part B Costs Hospital to Hospital by Brad Flansbaum, DO, MPH, MHM
Overcoming a Continued Physician Shortage by Danielle Scheurer, MD, MSCR, SFHM
Is Patient-Centered Care Bad for Resident Education? by Vineet Arora, MD, MPP, MHM
We go to the altar together.
Last month, I wrote about onboarding and the important responsibility that everyone associated with a hospitalist program has to ensure that each new provider quickly comes to believe he or she made a terrific choice to join the group.
Upon reflection, it seems important to address the other side of this equation. I’m talking about the responsibilities that each candidate has when deciding whether to apply for a job, to interview, and to accept or reject a group’s offer.
The relationship between a hospitalist and the group he or she is part of is a lot like a marriage. Both parties go to the altar together, and the relationship is most likely to be successful when both enter it with their eyes open, having done their due diligence, and with an intention to align their interests and support each other. Here are some things every hospitalist should be thinking about as they assess potential job opportunities:
1. Be clear about your own needs, goals, and priorities. Before you embark on the job-hunting process, take time to do some careful introspection. My partner John Nelson is fond of saying that one of the key reasons many doctors choose to become hospitalists is that they prefer to “date” their practice rather than “marry” it. Which do you want? Are you willing to accept both the benefits and the costs of your preference? What are your short- and long-term career goals? In what part of the country do you want to live, and are you looking for an urban, suburban, or small-town environment? Is it important to be in a teaching setting? Are there specific pieces of work, such as ICU care or procedures, that you want to either pursue or avoid? What personal considerations, such as the needs of your spouse or kids, might limit your options? What structural aspects of the job are most important to you? Schedule? Daily workload? Compensation? I encourage you to think through these and other similar questions so that you are clear in your own mind about your personal job selection criteria. This will enable you to honestly articulate these things to others and to assess potential job opportunities in light of them.
Read the full text of this blog post at hospitalleader.org.
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs.
Also on The Hospital Leader …
Don’t Compare HM Group Part B Costs Hospital to Hospital by Brad Flansbaum, DO, MPH, MHM
Overcoming a Continued Physician Shortage by Danielle Scheurer, MD, MSCR, SFHM
Is Patient-Centered Care Bad for Resident Education? by Vineet Arora, MD, MPP, MHM
We go to the altar together.
Last month, I wrote about onboarding and the important responsibility that everyone associated with a hospitalist program has to ensure that each new provider quickly comes to believe he or she made a terrific choice to join the group.
Upon reflection, it seems important to address the other side of this equation. I’m talking about the responsibilities that each candidate has when deciding whether to apply for a job, to interview, and to accept or reject a group’s offer.
The relationship between a hospitalist and the group he or she is part of is a lot like a marriage. Both parties go to the altar together, and the relationship is most likely to be successful when both enter it with their eyes open, having done their due diligence, and with an intention to align their interests and support each other. Here are some things every hospitalist should be thinking about as they assess potential job opportunities:
1. Be clear about your own needs, goals, and priorities. Before you embark on the job-hunting process, take time to do some careful introspection. My partner John Nelson is fond of saying that one of the key reasons many doctors choose to become hospitalists is that they prefer to “date” their practice rather than “marry” it. Which do you want? Are you willing to accept both the benefits and the costs of your preference? What are your short- and long-term career goals? In what part of the country do you want to live, and are you looking for an urban, suburban, or small-town environment? Is it important to be in a teaching setting? Are there specific pieces of work, such as ICU care or procedures, that you want to either pursue or avoid? What personal considerations, such as the needs of your spouse or kids, might limit your options? What structural aspects of the job are most important to you? Schedule? Daily workload? Compensation? I encourage you to think through these and other similar questions so that you are clear in your own mind about your personal job selection criteria. This will enable you to honestly articulate these things to others and to assess potential job opportunities in light of them.
Read the full text of this blog post at hospitalleader.org.
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs.
Also on The Hospital Leader …
Don’t Compare HM Group Part B Costs Hospital to Hospital by Brad Flansbaum, DO, MPH, MHM
Overcoming a Continued Physician Shortage by Danielle Scheurer, MD, MSCR, SFHM
Is Patient-Centered Care Bad for Resident Education? by Vineet Arora, MD, MPP, MHM
On 15 years: Celebrating a nocturnist’s career longevity
“Nocturnist years are like dog years. So really we’re celebrating you for 105 years of service!”
Shawn Lee, MD, a day shift hospitalist at Overlake Medical Center in Bellevue, Wash. (where I work), said this about our colleague, Arash Nadershahi, MD, on the occasion of his 15th anniversary as a nocturnist with our group. Every hospitalist group should be so lucky to have someone like Arash among them, whether working nights or days.
When Arash joined our group the job simply entailed turning on the pager at 9 p.m. and coming in to the hospital only when the need arose. Some nights meant only answering some “cross-cover” calls from home, while other nights started with one or more patients needing admission right at the start of the shift.
As the months went by, patient volume climbed rapidly and Arash, as well as the nocturnists who joined us subsequently, began arriving at the hospital no later than the 9:00 p.m. shift start and staying in-house until 7 a.m. We never had a meeting or contentious conversation to make it official that the night shift changed to in-house all night instead of call-from-home. It just evolved that way to meet the need.
We all value Arash’s steady demeanor, excellent clinical skills, and good relationships with ED staff and nurses as well as patients. And for many years he and our other two nocturnists have covered all night shifts, including filling in when one of them is unexpectedly out for the birth of a child, illness, or other reason. The day doctors have never been called upon to work night shifts to cover an unexpected nocturnist absence.
Configuring the nocturnist position
A full-time nocturnist in our group works ten 10-hour night shifts and two 6-hour evening shifts (5-11 p.m.) per month. I like to think this has contributed to longevity for our nocturnists. One left last year after working nights for 10 years, and another just started his 9th year in the group.
The three nocturnists can work any schedule they like as long as one of them is on duty each night. For more than 10 years they’ve worked 7 consecutive night shifts followed by 14 off (that is sometimes interrupted by an evening shift). To my way of thinking, though, they’re essentially devoting 9 days to the practice for every seven consecutive shifts. The days before they start their rotation and after they complete it are spent preparing/recovering by adjusting their sleep, so aren’t really days of R&R.
For this work their compensation is very similar to that of full-time day shift doctors. The idea is that their compensation premium for working nights comes in the form of less work rather than more money; they work fewer and shorter shifts than their daytime counterparts. And we discourage moonlighting during all those days off. We want to provide the conditions for a healthy lifestyle to offset night work.
The longest-tenured nocturnist?
At 15 years of full-time work as a nocturnist, Arash may be one of the longest-tenured doctors in this role nationally. (I would love to hear about others who’ve been at it longer.) I like to think that our “pay ’em the same and work ’em less” approach may be a meaningful contributor to his longevity in the role, but I’m convinced his personal attributes are also a big factor.
His interests and creativity find their way into our workplace. For a while the day shift doctors would arrive to find our office full of motorcycle parts in various stages of assembly. Many of his doodles and drawings and witty writings are taped to the walls and cabinets. A few years ago he started writing haikus and before long everyone in the group joined in. This even led to one of our docs hosting a really fun party at which every guest wrote haikus and all had to guess the author of each one.
Other groups can’t count on finding someone as valuable as Arash, but they’ll have the best chance of it if they think carefully about how the nocturnist role is configured.
Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses.
“Nocturnist years are like dog years. So really we’re celebrating you for 105 years of service!”
Shawn Lee, MD, a day shift hospitalist at Overlake Medical Center in Bellevue, Wash. (where I work), said this about our colleague, Arash Nadershahi, MD, on the occasion of his 15th anniversary as a nocturnist with our group. Every hospitalist group should be so lucky to have someone like Arash among them, whether working nights or days.
When Arash joined our group the job simply entailed turning on the pager at 9 p.m. and coming in to the hospital only when the need arose. Some nights meant only answering some “cross-cover” calls from home, while other nights started with one or more patients needing admission right at the start of the shift.
As the months went by, patient volume climbed rapidly and Arash, as well as the nocturnists who joined us subsequently, began arriving at the hospital no later than the 9:00 p.m. shift start and staying in-house until 7 a.m. We never had a meeting or contentious conversation to make it official that the night shift changed to in-house all night instead of call-from-home. It just evolved that way to meet the need.
We all value Arash’s steady demeanor, excellent clinical skills, and good relationships with ED staff and nurses as well as patients. And for many years he and our other two nocturnists have covered all night shifts, including filling in when one of them is unexpectedly out for the birth of a child, illness, or other reason. The day doctors have never been called upon to work night shifts to cover an unexpected nocturnist absence.
Configuring the nocturnist position
A full-time nocturnist in our group works ten 10-hour night shifts and two 6-hour evening shifts (5-11 p.m.) per month. I like to think this has contributed to longevity for our nocturnists. One left last year after working nights for 10 years, and another just started his 9th year in the group.
The three nocturnists can work any schedule they like as long as one of them is on duty each night. For more than 10 years they’ve worked 7 consecutive night shifts followed by 14 off (that is sometimes interrupted by an evening shift). To my way of thinking, though, they’re essentially devoting 9 days to the practice for every seven consecutive shifts. The days before they start their rotation and after they complete it are spent preparing/recovering by adjusting their sleep, so aren’t really days of R&R.
For this work their compensation is very similar to that of full-time day shift doctors. The idea is that their compensation premium for working nights comes in the form of less work rather than more money; they work fewer and shorter shifts than their daytime counterparts. And we discourage moonlighting during all those days off. We want to provide the conditions for a healthy lifestyle to offset night work.
The longest-tenured nocturnist?
At 15 years of full-time work as a nocturnist, Arash may be one of the longest-tenured doctors in this role nationally. (I would love to hear about others who’ve been at it longer.) I like to think that our “pay ’em the same and work ’em less” approach may be a meaningful contributor to his longevity in the role, but I’m convinced his personal attributes are also a big factor.
His interests and creativity find their way into our workplace. For a while the day shift doctors would arrive to find our office full of motorcycle parts in various stages of assembly. Many of his doodles and drawings and witty writings are taped to the walls and cabinets. A few years ago he started writing haikus and before long everyone in the group joined in. This even led to one of our docs hosting a really fun party at which every guest wrote haikus and all had to guess the author of each one.
Other groups can’t count on finding someone as valuable as Arash, but they’ll have the best chance of it if they think carefully about how the nocturnist role is configured.
Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses.
“Nocturnist years are like dog years. So really we’re celebrating you for 105 years of service!”
Shawn Lee, MD, a day shift hospitalist at Overlake Medical Center in Bellevue, Wash. (where I work), said this about our colleague, Arash Nadershahi, MD, on the occasion of his 15th anniversary as a nocturnist with our group. Every hospitalist group should be so lucky to have someone like Arash among them, whether working nights or days.
When Arash joined our group the job simply entailed turning on the pager at 9 p.m. and coming in to the hospital only when the need arose. Some nights meant only answering some “cross-cover” calls from home, while other nights started with one or more patients needing admission right at the start of the shift.
As the months went by, patient volume climbed rapidly and Arash, as well as the nocturnists who joined us subsequently, began arriving at the hospital no later than the 9:00 p.m. shift start and staying in-house until 7 a.m. We never had a meeting or contentious conversation to make it official that the night shift changed to in-house all night instead of call-from-home. It just evolved that way to meet the need.
We all value Arash’s steady demeanor, excellent clinical skills, and good relationships with ED staff and nurses as well as patients. And for many years he and our other two nocturnists have covered all night shifts, including filling in when one of them is unexpectedly out for the birth of a child, illness, or other reason. The day doctors have never been called upon to work night shifts to cover an unexpected nocturnist absence.
Configuring the nocturnist position
A full-time nocturnist in our group works ten 10-hour night shifts and two 6-hour evening shifts (5-11 p.m.) per month. I like to think this has contributed to longevity for our nocturnists. One left last year after working nights for 10 years, and another just started his 9th year in the group.
The three nocturnists can work any schedule they like as long as one of them is on duty each night. For more than 10 years they’ve worked 7 consecutive night shifts followed by 14 off (that is sometimes interrupted by an evening shift). To my way of thinking, though, they’re essentially devoting 9 days to the practice for every seven consecutive shifts. The days before they start their rotation and after they complete it are spent preparing/recovering by adjusting their sleep, so aren’t really days of R&R.
For this work their compensation is very similar to that of full-time day shift doctors. The idea is that their compensation premium for working nights comes in the form of less work rather than more money; they work fewer and shorter shifts than their daytime counterparts. And we discourage moonlighting during all those days off. We want to provide the conditions for a healthy lifestyle to offset night work.
The longest-tenured nocturnist?
At 15 years of full-time work as a nocturnist, Arash may be one of the longest-tenured doctors in this role nationally. (I would love to hear about others who’ve been at it longer.) I like to think that our “pay ’em the same and work ’em less” approach may be a meaningful contributor to his longevity in the role, but I’m convinced his personal attributes are also a big factor.
His interests and creativity find their way into our workplace. For a while the day shift doctors would arrive to find our office full of motorcycle parts in various stages of assembly. Many of his doodles and drawings and witty writings are taped to the walls and cabinets. A few years ago he started writing haikus and before long everyone in the group joined in. This even led to one of our docs hosting a really fun party at which every guest wrote haikus and all had to guess the author of each one.
Other groups can’t count on finding someone as valuable as Arash, but they’ll have the best chance of it if they think carefully about how the nocturnist role is configured.
Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses.
Hospitalists share strategies to secure, excel at jobs
LAS VEGAS – In the view of academic hospitalist Alfred Burger, MD, SFHM, portability was long a dirty word in HM circles. But not anymore.
“My good friends in law and business do this all the time,” said Dr. Burger, associate program director of the internal medicine residency program at Mount Sinai Beth Israel in New York. “You’re not going to make partner in city X, but they’ve got an opening to be partner in city Y if you go there and perform for a year. People up and leave coasts, people up and leave states, people have up and left the country. ... Doctors are starting to view it the same way.”
The lessons of career development were a focal point of HM17, particularly for younger physicians who could take advantage of the Early-Career Hospitalists mini-track. But Dr. Burger said that those strategies of upward mobility can apply whether someone is chasing their first job or their fifth.
First, identify one’s strengths and play to those. Then identify the skills you don’t have or don’t excel at, and address those deficiencies.
“How can you acquire the skills to put yourself in the best position to move up, if you wish to develop your career as a leader?” Dr. Burger said. “If you wish to be the best clinician, you still need to stay on top of the game. Things like coming to SHM, staying on top of the content. That’s important.”
Another skill set is self-advocacy.
“Be your own champion,” said Brian Markoff, MD, SFHM, chief of hospital medicine at Mount Sinai St. Luke’s in New York. “Many of us are very good at this and many of us are terrible at this. You may fall somewhere in between, but you do have to be your own champion.”
Dr. Burger said that he understands that there is a fine line between too much self-promotion and too little. But he urged hospitalists at all career points to take responsibility for marketing themselves.
“Nobody is going to invest in your career unless you yourself invest in it,” he added. “You have to put it as a priority, and not in a selfish way, but in a way [that,] if you wish to move forward and move up, you’ve got to put the time in. It’s not a natural assumption anymore that, if you are the best and brightest of a group of doctors, you will just be chosen to lead.”
In a similar vein, networking is a major boon to career development that can be a double-edged scalpel.
“Having a great ‘social game’ is important, but if all you bring to the table is a social game, you’ll find yourself out of a job just as quickly as you found that job,” Dr. Burger said. “Meaning, you might be able to get it based on that, but you’re not going to be able to sustain it. At the same time, being highly accomplished and having no social graces is also a killer. So, you need to be sort of strong in both areas.”
Many of the meeting’s opportunities for tips on professional development are personal, but HM group leaders have to consider developing the careers of their employees. One of the main planks of that is physician engagement, said Flora Kisuule, MD, MPH, SFHM, of Johns Hopkins University, Baltimore.
“I don’t believe your institution or your organization can go anywhere if your employees are not engaged or if the people you work with are not engaged,” she said, adding that disengaged employees “are actively working against you. You don’t want that. You can’t go in any direction when there are people rowing in the opposite direction. At best, you stay in one place. At worst, you can end up losing ground.”
Hospitalist Christie Masters, MD, MBA, MHA, who practices at UCLA, disclosed during a session that she also runs a wellness coaching firm. She added that a focus on personal wellness and well-being is its own form of career development. It works in tandem with engagement, morale, and professional growth.
“If you’re only focusing on wellness and you don’t have hospitalists or a group that’s engaged or with high morale, they’re going to burnout or they’re going to leave,” Dr. Masters said. “And nobody wants that for their group. So, if we surround ourselves with people who feel well and feel whole, that’s going to have intangible benefits ... that affect the bottom line.”
LAS VEGAS – In the view of academic hospitalist Alfred Burger, MD, SFHM, portability was long a dirty word in HM circles. But not anymore.
“My good friends in law and business do this all the time,” said Dr. Burger, associate program director of the internal medicine residency program at Mount Sinai Beth Israel in New York. “You’re not going to make partner in city X, but they’ve got an opening to be partner in city Y if you go there and perform for a year. People up and leave coasts, people up and leave states, people have up and left the country. ... Doctors are starting to view it the same way.”
The lessons of career development were a focal point of HM17, particularly for younger physicians who could take advantage of the Early-Career Hospitalists mini-track. But Dr. Burger said that those strategies of upward mobility can apply whether someone is chasing their first job or their fifth.
First, identify one’s strengths and play to those. Then identify the skills you don’t have or don’t excel at, and address those deficiencies.
“How can you acquire the skills to put yourself in the best position to move up, if you wish to develop your career as a leader?” Dr. Burger said. “If you wish to be the best clinician, you still need to stay on top of the game. Things like coming to SHM, staying on top of the content. That’s important.”
Another skill set is self-advocacy.
“Be your own champion,” said Brian Markoff, MD, SFHM, chief of hospital medicine at Mount Sinai St. Luke’s in New York. “Many of us are very good at this and many of us are terrible at this. You may fall somewhere in between, but you do have to be your own champion.”
Dr. Burger said that he understands that there is a fine line between too much self-promotion and too little. But he urged hospitalists at all career points to take responsibility for marketing themselves.
“Nobody is going to invest in your career unless you yourself invest in it,” he added. “You have to put it as a priority, and not in a selfish way, but in a way [that,] if you wish to move forward and move up, you’ve got to put the time in. It’s not a natural assumption anymore that, if you are the best and brightest of a group of doctors, you will just be chosen to lead.”
In a similar vein, networking is a major boon to career development that can be a double-edged scalpel.
“Having a great ‘social game’ is important, but if all you bring to the table is a social game, you’ll find yourself out of a job just as quickly as you found that job,” Dr. Burger said. “Meaning, you might be able to get it based on that, but you’re not going to be able to sustain it. At the same time, being highly accomplished and having no social graces is also a killer. So, you need to be sort of strong in both areas.”
Many of the meeting’s opportunities for tips on professional development are personal, but HM group leaders have to consider developing the careers of their employees. One of the main planks of that is physician engagement, said Flora Kisuule, MD, MPH, SFHM, of Johns Hopkins University, Baltimore.
“I don’t believe your institution or your organization can go anywhere if your employees are not engaged or if the people you work with are not engaged,” she said, adding that disengaged employees “are actively working against you. You don’t want that. You can’t go in any direction when there are people rowing in the opposite direction. At best, you stay in one place. At worst, you can end up losing ground.”
Hospitalist Christie Masters, MD, MBA, MHA, who practices at UCLA, disclosed during a session that she also runs a wellness coaching firm. She added that a focus on personal wellness and well-being is its own form of career development. It works in tandem with engagement, morale, and professional growth.
“If you’re only focusing on wellness and you don’t have hospitalists or a group that’s engaged or with high morale, they’re going to burnout or they’re going to leave,” Dr. Masters said. “And nobody wants that for their group. So, if we surround ourselves with people who feel well and feel whole, that’s going to have intangible benefits ... that affect the bottom line.”
LAS VEGAS – In the view of academic hospitalist Alfred Burger, MD, SFHM, portability was long a dirty word in HM circles. But not anymore.
“My good friends in law and business do this all the time,” said Dr. Burger, associate program director of the internal medicine residency program at Mount Sinai Beth Israel in New York. “You’re not going to make partner in city X, but they’ve got an opening to be partner in city Y if you go there and perform for a year. People up and leave coasts, people up and leave states, people have up and left the country. ... Doctors are starting to view it the same way.”
The lessons of career development were a focal point of HM17, particularly for younger physicians who could take advantage of the Early-Career Hospitalists mini-track. But Dr. Burger said that those strategies of upward mobility can apply whether someone is chasing their first job or their fifth.
First, identify one’s strengths and play to those. Then identify the skills you don’t have or don’t excel at, and address those deficiencies.
“How can you acquire the skills to put yourself in the best position to move up, if you wish to develop your career as a leader?” Dr. Burger said. “If you wish to be the best clinician, you still need to stay on top of the game. Things like coming to SHM, staying on top of the content. That’s important.”
Another skill set is self-advocacy.
“Be your own champion,” said Brian Markoff, MD, SFHM, chief of hospital medicine at Mount Sinai St. Luke’s in New York. “Many of us are very good at this and many of us are terrible at this. You may fall somewhere in between, but you do have to be your own champion.”
Dr. Burger said that he understands that there is a fine line between too much self-promotion and too little. But he urged hospitalists at all career points to take responsibility for marketing themselves.
“Nobody is going to invest in your career unless you yourself invest in it,” he added. “You have to put it as a priority, and not in a selfish way, but in a way [that,] if you wish to move forward and move up, you’ve got to put the time in. It’s not a natural assumption anymore that, if you are the best and brightest of a group of doctors, you will just be chosen to lead.”
In a similar vein, networking is a major boon to career development that can be a double-edged scalpel.
“Having a great ‘social game’ is important, but if all you bring to the table is a social game, you’ll find yourself out of a job just as quickly as you found that job,” Dr. Burger said. “Meaning, you might be able to get it based on that, but you’re not going to be able to sustain it. At the same time, being highly accomplished and having no social graces is also a killer. So, you need to be sort of strong in both areas.”
Many of the meeting’s opportunities for tips on professional development are personal, but HM group leaders have to consider developing the careers of their employees. One of the main planks of that is physician engagement, said Flora Kisuule, MD, MPH, SFHM, of Johns Hopkins University, Baltimore.
“I don’t believe your institution or your organization can go anywhere if your employees are not engaged or if the people you work with are not engaged,” she said, adding that disengaged employees “are actively working against you. You don’t want that. You can’t go in any direction when there are people rowing in the opposite direction. At best, you stay in one place. At worst, you can end up losing ground.”
Hospitalist Christie Masters, MD, MBA, MHA, who practices at UCLA, disclosed during a session that she also runs a wellness coaching firm. She added that a focus on personal wellness and well-being is its own form of career development. It works in tandem with engagement, morale, and professional growth.
“If you’re only focusing on wellness and you don’t have hospitalists or a group that’s engaged or with high morale, they’re going to burnout or they’re going to leave,” Dr. Masters said. “And nobody wants that for their group. So, if we surround ourselves with people who feel well and feel whole, that’s going to have intangible benefits ... that affect the bottom line.”
VIDEO: NPs, PAs weigh common issues in hospitalist practice
Practicing at the top of your license, billing and reimbursement, recruiting and orientation – Those were some of the hot topics discussed by more than 50 attendees of HM17’s Special Interest Forum for nurse practitioners (NPs) and physician assistants (PAs).
“Every year, we are seeing more and more HM groups integrating NPs and PAs into their practice,” said forum moderator Emilie Thornhill, PA-C, a certified PA, who works for Oschner Health in New Orleans, La.
Ms. Thornhill emphasized that a common issue among attendees is restrictive HM policies in dictating the scope of practice for NP/PAs in hospitalist groups.
“That seems to be the thing that is holding us back the most,” she said. “SHM is really going to be the home for these individuals to find the resources they need to address these issues.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Practicing at the top of your license, billing and reimbursement, recruiting and orientation – Those were some of the hot topics discussed by more than 50 attendees of HM17’s Special Interest Forum for nurse practitioners (NPs) and physician assistants (PAs).
“Every year, we are seeing more and more HM groups integrating NPs and PAs into their practice,” said forum moderator Emilie Thornhill, PA-C, a certified PA, who works for Oschner Health in New Orleans, La.
Ms. Thornhill emphasized that a common issue among attendees is restrictive HM policies in dictating the scope of practice for NP/PAs in hospitalist groups.
“That seems to be the thing that is holding us back the most,” she said. “SHM is really going to be the home for these individuals to find the resources they need to address these issues.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Practicing at the top of your license, billing and reimbursement, recruiting and orientation – Those were some of the hot topics discussed by more than 50 attendees of HM17’s Special Interest Forum for nurse practitioners (NPs) and physician assistants (PAs).
“Every year, we are seeing more and more HM groups integrating NPs and PAs into their practice,” said forum moderator Emilie Thornhill, PA-C, a certified PA, who works for Oschner Health in New Orleans, La.
Ms. Thornhill emphasized that a common issue among attendees is restrictive HM policies in dictating the scope of practice for NP/PAs in hospitalist groups.
“That seems to be the thing that is holding us back the most,” she said. “SHM is really going to be the home for these individuals to find the resources they need to address these issues.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Work-life balance is not a ‘thing’ but alignment is
We are destined to fail at achieving work-life balance because it does not exist, nor has it ever existed, according to an expert on how people experience time.
The field of chronemics studies the space between people, namely how they communicate with others and with themselves as they experience life in a matrix, not just linearly.
“When we talk about time, we need to remember that context and communication really matter,” Dawna Ballard, PhD, a chronemics expert and associate professor of communication at the University of Texas at Austin, said during a session Tuesday. “We think of our concept of time as ‘truth,’ but when we experience other cultures, often we see they don’t function according to our idea of time.”
The modern concept of time as told by a clock was invented during the Industrial Age to control people and events by forcing a direct line between their lives outside the factory and the farm, according to Dr. Ballard. That is not to say that industrial time is bad. It is efficient and perhaps even necessary for organizing large groups of people, she said.
Time management as a concept evolved out of the ethos of “punching the clock” at the factory, but has carried over to the office where in fact, according to Dr. Ballard, people do not tend to be as effective if they are expected to work in a linear way, since that is not the experience in today’s digital world where interruptions are common. In a survey of 1,000 people, after researchers subtracted the time people spend on email, social media, and other digital interruptions, only 3½ hours of the typical 8-hour work day were left for actual work, and these remaining hours were not consecutive, Dr. Ballard noted.
“In reality, we operate in relationship to time more like we did in preindustrial times than we did during industrial times,” said Dr. Ballard. “Medicine has always had that approach, but the management of it is by people who are still being trained according to industrial [notions] of time.”
The resulting cognitive dissonance contributes to people experiencing guilt for not “balancing” their day properly, according to Dr. Ballard. Because to balance something means separating the pieces and quantifying them separately, people whose lives interrupt them throughout the work day find themselves thinking they have “failed” at achieving a work/life balance, when what they really have done is experience their life as it actually is. “No one likes to feel like a failure, particularly people who are high achievers and who expect to have agency over their lives.”
Dr. Ballard said that an alternative to seeing work and life as components that must be balanced is to instead view these things as being in an alignment that can shift over time. She also suggested challenging the accepted notions of what being productive really means in the context of how one’s life actually is, and to occasionally put down the smartphone and consciously practice experiencing time in an unstructured way.
We are destined to fail at achieving work-life balance because it does not exist, nor has it ever existed, according to an expert on how people experience time.
The field of chronemics studies the space between people, namely how they communicate with others and with themselves as they experience life in a matrix, not just linearly.
“When we talk about time, we need to remember that context and communication really matter,” Dawna Ballard, PhD, a chronemics expert and associate professor of communication at the University of Texas at Austin, said during a session Tuesday. “We think of our concept of time as ‘truth,’ but when we experience other cultures, often we see they don’t function according to our idea of time.”
The modern concept of time as told by a clock was invented during the Industrial Age to control people and events by forcing a direct line between their lives outside the factory and the farm, according to Dr. Ballard. That is not to say that industrial time is bad. It is efficient and perhaps even necessary for organizing large groups of people, she said.
Time management as a concept evolved out of the ethos of “punching the clock” at the factory, but has carried over to the office where in fact, according to Dr. Ballard, people do not tend to be as effective if they are expected to work in a linear way, since that is not the experience in today’s digital world where interruptions are common. In a survey of 1,000 people, after researchers subtracted the time people spend on email, social media, and other digital interruptions, only 3½ hours of the typical 8-hour work day were left for actual work, and these remaining hours were not consecutive, Dr. Ballard noted.
“In reality, we operate in relationship to time more like we did in preindustrial times than we did during industrial times,” said Dr. Ballard. “Medicine has always had that approach, but the management of it is by people who are still being trained according to industrial [notions] of time.”
The resulting cognitive dissonance contributes to people experiencing guilt for not “balancing” their day properly, according to Dr. Ballard. Because to balance something means separating the pieces and quantifying them separately, people whose lives interrupt them throughout the work day find themselves thinking they have “failed” at achieving a work/life balance, when what they really have done is experience their life as it actually is. “No one likes to feel like a failure, particularly people who are high achievers and who expect to have agency over their lives.”
Dr. Ballard said that an alternative to seeing work and life as components that must be balanced is to instead view these things as being in an alignment that can shift over time. She also suggested challenging the accepted notions of what being productive really means in the context of how one’s life actually is, and to occasionally put down the smartphone and consciously practice experiencing time in an unstructured way.
We are destined to fail at achieving work-life balance because it does not exist, nor has it ever existed, according to an expert on how people experience time.
The field of chronemics studies the space between people, namely how they communicate with others and with themselves as they experience life in a matrix, not just linearly.
“When we talk about time, we need to remember that context and communication really matter,” Dawna Ballard, PhD, a chronemics expert and associate professor of communication at the University of Texas at Austin, said during a session Tuesday. “We think of our concept of time as ‘truth,’ but when we experience other cultures, often we see they don’t function according to our idea of time.”
The modern concept of time as told by a clock was invented during the Industrial Age to control people and events by forcing a direct line between their lives outside the factory and the farm, according to Dr. Ballard. That is not to say that industrial time is bad. It is efficient and perhaps even necessary for organizing large groups of people, she said.
Time management as a concept evolved out of the ethos of “punching the clock” at the factory, but has carried over to the office where in fact, according to Dr. Ballard, people do not tend to be as effective if they are expected to work in a linear way, since that is not the experience in today’s digital world where interruptions are common. In a survey of 1,000 people, after researchers subtracted the time people spend on email, social media, and other digital interruptions, only 3½ hours of the typical 8-hour work day were left for actual work, and these remaining hours were not consecutive, Dr. Ballard noted.
“In reality, we operate in relationship to time more like we did in preindustrial times than we did during industrial times,” said Dr. Ballard. “Medicine has always had that approach, but the management of it is by people who are still being trained according to industrial [notions] of time.”
The resulting cognitive dissonance contributes to people experiencing guilt for not “balancing” their day properly, according to Dr. Ballard. Because to balance something means separating the pieces and quantifying them separately, people whose lives interrupt them throughout the work day find themselves thinking they have “failed” at achieving a work/life balance, when what they really have done is experience their life as it actually is. “No one likes to feel like a failure, particularly people who are high achievers and who expect to have agency over their lives.”
Dr. Ballard said that an alternative to seeing work and life as components that must be balanced is to instead view these things as being in an alignment that can shift over time. She also suggested challenging the accepted notions of what being productive really means in the context of how one’s life actually is, and to occasionally put down the smartphone and consciously practice experiencing time in an unstructured way.
Trends in value-based care favor hospitalists, expert says
Value-based care’s ascendancy equals increased opportunities for hospitalists who know how to wield informatics, speak the language of systems improvement, and have an ability to function as a commodity within a health system, according to the dean of hospital medicine.
“If I were a betting man, I’d say there is no way value-based care can happen without hospitalists,” Robert Wachter, MD, MHM, said during a leadership summit at this year’s annual meeting of the Society of Hospital Medicine. Dr. Wachter is the New York Times bestselling author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.” He also is a professor and chair of the department of medicine at the University of California, San Francisco.
“There will be talk about closing hospitals and building competencies in ambulatory care. That’s the first 5 minutes, but then there is the realization people are still going to get sick, representing a massive amount of cost, and as far as I can tell, there is no alternative to having hospitals for this,” Dr. Wachter said. “Hospitalists will come out just fine.”
This will be true particularly for hospitalists who understand that electronic health records companies have helped health systems collect massive amounts of data but do not offer help for how those data can be applied to drive better outcomes and improve performance ratings, according to Dr. Wachter.
“These companies have no competencies in data analytics or data visualization,” Dr. Wachter said. “I am hopeful because Silicon Valley has woken up to the possibilities of this and are looking for ways to partner with health care. … The world of improving value, safety, and patient experience is going to be a world enabled by thoughtful use of informatics. So, if you don’t have those competencies, I think it’s important to grow them over time.”
Speaking the language of “lean” or that of other systematic strategies for improvement will also increase the value a hospitalist can bring to an organization, according to Dr. Wachter, who said that as hospital senior leadership and frontline personnel work together to implement system improvement, new leadership roles for hospitalists, ranging from chief patient experience officer to chief quality officers, and everything in between, are being created.
Another “hopeful trend” for hospitalists is the growing focus on the provider experience, said Dr. Wachter, since improving systems is not possible if staff are not engaged. “It’s impossible to believe you’re going to accomplish your goals of improving care and improving patient experience, and efficiencies, with a cadre of burned-out doctors,” he said.
Dr. Wachter said that to be indispensable, hospitalists need to understand they often are commoditized, offered by their senior leadership as bargaining chips when deals are made with surrounding health systems seeking to outsource some of their hospitalist functions.
“Managing a large community-affiliated network was not a core competency in the past,” Dr Wachter said. “But it will become increasingly important.”
Value-based care’s ascendancy equals increased opportunities for hospitalists who know how to wield informatics, speak the language of systems improvement, and have an ability to function as a commodity within a health system, according to the dean of hospital medicine.
“If I were a betting man, I’d say there is no way value-based care can happen without hospitalists,” Robert Wachter, MD, MHM, said during a leadership summit at this year’s annual meeting of the Society of Hospital Medicine. Dr. Wachter is the New York Times bestselling author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.” He also is a professor and chair of the department of medicine at the University of California, San Francisco.
“There will be talk about closing hospitals and building competencies in ambulatory care. That’s the first 5 minutes, but then there is the realization people are still going to get sick, representing a massive amount of cost, and as far as I can tell, there is no alternative to having hospitals for this,” Dr. Wachter said. “Hospitalists will come out just fine.”
This will be true particularly for hospitalists who understand that electronic health records companies have helped health systems collect massive amounts of data but do not offer help for how those data can be applied to drive better outcomes and improve performance ratings, according to Dr. Wachter.
“These companies have no competencies in data analytics or data visualization,” Dr. Wachter said. “I am hopeful because Silicon Valley has woken up to the possibilities of this and are looking for ways to partner with health care. … The world of improving value, safety, and patient experience is going to be a world enabled by thoughtful use of informatics. So, if you don’t have those competencies, I think it’s important to grow them over time.”
Speaking the language of “lean” or that of other systematic strategies for improvement will also increase the value a hospitalist can bring to an organization, according to Dr. Wachter, who said that as hospital senior leadership and frontline personnel work together to implement system improvement, new leadership roles for hospitalists, ranging from chief patient experience officer to chief quality officers, and everything in between, are being created.
Another “hopeful trend” for hospitalists is the growing focus on the provider experience, said Dr. Wachter, since improving systems is not possible if staff are not engaged. “It’s impossible to believe you’re going to accomplish your goals of improving care and improving patient experience, and efficiencies, with a cadre of burned-out doctors,” he said.
Dr. Wachter said that to be indispensable, hospitalists need to understand they often are commoditized, offered by their senior leadership as bargaining chips when deals are made with surrounding health systems seeking to outsource some of their hospitalist functions.
“Managing a large community-affiliated network was not a core competency in the past,” Dr Wachter said. “But it will become increasingly important.”
Value-based care’s ascendancy equals increased opportunities for hospitalists who know how to wield informatics, speak the language of systems improvement, and have an ability to function as a commodity within a health system, according to the dean of hospital medicine.
“If I were a betting man, I’d say there is no way value-based care can happen without hospitalists,” Robert Wachter, MD, MHM, said during a leadership summit at this year’s annual meeting of the Society of Hospital Medicine. Dr. Wachter is the New York Times bestselling author of “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.” He also is a professor and chair of the department of medicine at the University of California, San Francisco.
“There will be talk about closing hospitals and building competencies in ambulatory care. That’s the first 5 minutes, but then there is the realization people are still going to get sick, representing a massive amount of cost, and as far as I can tell, there is no alternative to having hospitals for this,” Dr. Wachter said. “Hospitalists will come out just fine.”
This will be true particularly for hospitalists who understand that electronic health records companies have helped health systems collect massive amounts of data but do not offer help for how those data can be applied to drive better outcomes and improve performance ratings, according to Dr. Wachter.
“These companies have no competencies in data analytics or data visualization,” Dr. Wachter said. “I am hopeful because Silicon Valley has woken up to the possibilities of this and are looking for ways to partner with health care. … The world of improving value, safety, and patient experience is going to be a world enabled by thoughtful use of informatics. So, if you don’t have those competencies, I think it’s important to grow them over time.”
Speaking the language of “lean” or that of other systematic strategies for improvement will also increase the value a hospitalist can bring to an organization, according to Dr. Wachter, who said that as hospital senior leadership and frontline personnel work together to implement system improvement, new leadership roles for hospitalists, ranging from chief patient experience officer to chief quality officers, and everything in between, are being created.
Another “hopeful trend” for hospitalists is the growing focus on the provider experience, said Dr. Wachter, since improving systems is not possible if staff are not engaged. “It’s impossible to believe you’re going to accomplish your goals of improving care and improving patient experience, and efficiencies, with a cadre of burned-out doctors,” he said.
Dr. Wachter said that to be indispensable, hospitalists need to understand they often are commoditized, offered by their senior leadership as bargaining chips when deals are made with surrounding health systems seeking to outsource some of their hospitalist functions.
“Managing a large community-affiliated network was not a core competency in the past,” Dr Wachter said. “But it will become increasingly important.”