Career

The industry’s first certification for home health and hospices that provide top-caliber community-based palliative care services in the patient’s place of residence is being launched by The Joint Commission.

“As healthcare continues to evolve and the Affordable Care Act is beginning to impact the industry, one of the things that has come to light is that many patients over the years have experienced unnecessary hospitalization admissions when the management of their disease stage really required palliative care,” says Margherita Labson, RN, MSHSA, CPHQ, executive director of The Joint Commission’s Home Care Program. “For those of us in the home care environment in the community, we’ve always tried to manage this, but the current models of care didn’t really meet the needs of these patients because the Medicare benefit is an episodic payment program that’s built for rehab and restoration, not for maintenance.”

The Joint Commission’s new program, she says, provides value to patients, results in a lower rate of a necessary readmission, and contributes to patient satisfaction and improved outcomes of care.

Surveys for Community-Based Palliative Care (CBPC) Certification will begin on July 1. Certification is awarded for a three-year period, and the certification’s framework helps providers design, deliver, and validate patient-centered care and services. Key CBPC certification requirements include:

• A robust interdisciplinary care team
• Customized, comprehensive care plans
• After-hours care and services
• Use of evidence-based clinical practice guidelines
• A defined hand-off communications process

“This helps to address perhaps one of the key frustrations of hospitalists: the repeated readmissions of patients struggling with serious chronic illnesses,” Labson says. “It helps reduce the number of inappropriate hospital admissions and allows the hospitalist to focus on the admission and successful management of those patients that are appropriate for hospital intervention or acute-care intervention at that point.”

The industry’s first certification for home health and hospices that provide top-caliber community-based palliative care services in the patient’s place of residence is being launched by The Joint Commission.

“As healthcare continues to evolve and the Affordable Care Act is beginning to impact the industry, one of the things that has come to light is that many patients over the years have experienced unnecessary hospitalization admissions when the management of their disease stage really required palliative care,” says Margherita Labson, RN, MSHSA, CPHQ, executive director of The Joint Commission’s Home Care Program. “For those of us in the home care environment in the community, we’ve always tried to manage this, but the current models of care didn’t really meet the needs of these patients because the Medicare benefit is an episodic payment program that’s built for rehab and restoration, not for maintenance.”

The Joint Commission’s new program, she says, provides value to patients, results in a lower rate of a necessary readmission, and contributes to patient satisfaction and improved outcomes of care.

Surveys for Community-Based Palliative Care (CBPC) Certification will begin on July 1. Certification is awarded for a three-year period, and the certification’s framework helps providers design, deliver, and validate patient-centered care and services. Key CBPC certification requirements include:

• A robust interdisciplinary care team
• Customized, comprehensive care plans
• After-hours care and services
• Use of evidence-based clinical practice guidelines
• A defined hand-off communications process

“This helps to address perhaps one of the key frustrations of hospitalists: the repeated readmissions of patients struggling with serious chronic illnesses,” Labson says. “It helps reduce the number of inappropriate hospital admissions and allows the hospitalist to focus on the admission and successful management of those patients that are appropriate for hospital intervention or acute-care intervention at that point.”

The industry’s first certification for home health and hospices that provide top-caliber community-based palliative care services in the patient’s place of residence is being launched by The Joint Commission.

“As healthcare continues to evolve and the Affordable Care Act is beginning to impact the industry, one of the things that has come to light is that many patients over the years have experienced unnecessary hospitalization admissions when the management of their disease stage really required palliative care,” says Margherita Labson, RN, MSHSA, CPHQ, executive director of The Joint Commission’s Home Care Program. “For those of us in the home care environment in the community, we’ve always tried to manage this, but the current models of care didn’t really meet the needs of these patients because the Medicare benefit is an episodic payment program that’s built for rehab and restoration, not for maintenance.”

The Joint Commission’s new program, she says, provides value to patients, results in a lower rate of a necessary readmission, and contributes to patient satisfaction and improved outcomes of care.

Surveys for Community-Based Palliative Care (CBPC) Certification will begin on July 1. Certification is awarded for a three-year period, and the certification’s framework helps providers design, deliver, and validate patient-centered care and services. Key CBPC certification requirements include:

• A robust interdisciplinary care team
• Customized, comprehensive care plans
• After-hours care and services
• Use of evidence-based clinical practice guidelines
• A defined hand-off communications process

“This helps to address perhaps one of the key frustrations of hospitalists: the repeated readmissions of patients struggling with serious chronic illnesses,” Labson says. “It helps reduce the number of inappropriate hospital admissions and allows the hospitalist to focus on the admission and successful management of those patients that are appropriate for hospital intervention or acute-care intervention at that point.”

Drs. Vineet Arora and Hyung "Harry" Cho offer  insight on how mentorship—giving, and receiving—is an essential part of all stages of an hospitalist career, in academic or community-based HM.

Drs. Vineet Arora and Hyung "Harry" Cho offer  insight on how mentorship—giving, and receiving—is an essential part of all stages of an hospitalist career, in academic or community-based HM.

Drs. Vineet Arora and Hyung "Harry" Cho offer  insight on how mentorship—giving, and receiving—is an essential part of all stages of an hospitalist career, in academic or community-based HM.

Business Moves

Winter Haven Hospital in Winter Haven, Fla., is now offering pediatric hospitalist services thanks to an agreement with Watson Clinic, based in Lakeland, Fla. The new pediatric unit consists of eight beds and is supervised by three pediatric hospitalists. Winter Haven Hospital is a 468-bed nonprofit hospital and is one of 14 hospitals in the BayCare Health System, which serves the greater Tampa Bay region of Florida.

Business Moves

Winter Haven Hospital in Winter Haven, Fla., is now offering pediatric hospitalist services thanks to an agreement with Watson Clinic, based in Lakeland, Fla. The new pediatric unit consists of eight beds and is supervised by three pediatric hospitalists. Winter Haven Hospital is a 468-bed nonprofit hospital and is one of 14 hospitals in the BayCare Health System, which serves the greater Tampa Bay region of Florida.

Business Moves

Winter Haven Hospital in Winter Haven, Fla., is now offering pediatric hospitalist services thanks to an agreement with Watson Clinic, based in Lakeland, Fla. The new pediatric unit consists of eight beds and is supervised by three pediatric hospitalists. Winter Haven Hospital is a 468-bed nonprofit hospital and is one of 14 hospitals in the BayCare Health System, which serves the greater Tampa Bay region of Florida.

Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each column will focus on how the contributor applies one of the “Key Communication” areas in practice.

View a chart outlining key communication tactics

What I Say and Do

I counsel and deliver the diagnosis or give recommendations through a dialogue, instead of a monologue, using active listening.

Why I Do It

The monologue, or lecture, is among the least effective ways to instill behavior change. Research studies have demonstrated that, after a monologue, only around 20% to 60% of medical information is remembered by the end of a visit. Out of what is remembered, less than 50% is accurate. Furthermore, 47% of Americans have health literacy levels below the intermediate range, defined as the ability to determine when to take a medication with food from reading the label.

Lecturing the patient without first understanding what the patient knows and finds important, and understanding the barriers to plan implementation, runs the risk of decreased comprehension, a lack of understanding, or a lack of personal relevance—all leading to decreased adherence. Doing the opposite, by involving the patient in decision making, inspires change that comes from within in the context of the patient’s own needs. This approach is more enduring, emphasizes self-accountability, and ultimately leads to better outcomes.

How I Do It

I open up a dialogue using the Cleveland Clinic’s ARIA approach as adapted from the REDE model of healthcare communication.1

• First, assess: What does the patient know about diagnosis and treatment? How much and what type of education does the patient desire/need? What are the patient’s treatment preferences and health literacy?
• Second, reflect on what the patient just said. Validate meaning and emotion.
• Third, inform the patient within the context of the patient’s perspectives and preferences. Speak slowly and provide small chunks of information at a time. Use understandable language and visual aids. (This will increase recall by 60%.)
• Finally, assess the patient’s understanding and emotional reaction to information provided.
• Repeat the cycle to introduce other chunks of information.

Dr. Velez is director of faculty development in the Center for Excellence in Healthcare Communication at the Cleveland Clinic.

Reference

1. Windover A, Boissy A, Rice T, Gilligan T, Velez V, Merlino J. The REDE model of healthcare communication: optimizing relationship as a therapeutic agent. J Patient Exp. 2014;1(1):8-13.

Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each column will focus on how the contributor applies one of the “Key Communication” areas in practice.

View a chart outlining key communication tactics

What I Say and Do

I counsel and deliver the diagnosis or give recommendations through a dialogue, instead of a monologue, using active listening.

Why I Do It

The monologue, or lecture, is among the least effective ways to instill behavior change. Research studies have demonstrated that, after a monologue, only around 20% to 60% of medical information is remembered by the end of a visit. Out of what is remembered, less than 50% is accurate. Furthermore, 47% of Americans have health literacy levels below the intermediate range, defined as the ability to determine when to take a medication with food from reading the label.

Lecturing the patient without first understanding what the patient knows and finds important, and understanding the barriers to plan implementation, runs the risk of decreased comprehension, a lack of understanding, or a lack of personal relevance—all leading to decreased adherence. Doing the opposite, by involving the patient in decision making, inspires change that comes from within in the context of the patient’s own needs. This approach is more enduring, emphasizes self-accountability, and ultimately leads to better outcomes.

How I Do It

I open up a dialogue using the Cleveland Clinic’s ARIA approach as adapted from the REDE model of healthcare communication.1

• First, assess: What does the patient know about diagnosis and treatment? How much and what type of education does the patient desire/need? What are the patient’s treatment preferences and health literacy?
• Second, reflect on what the patient just said. Validate meaning and emotion.
• Third, inform the patient within the context of the patient’s perspectives and preferences. Speak slowly and provide small chunks of information at a time. Use understandable language and visual aids. (This will increase recall by 60%.)
• Finally, assess the patient’s understanding and emotional reaction to information provided.
• Repeat the cycle to introduce other chunks of information.

Dr. Velez is director of faculty development in the Center for Excellence in Healthcare Communication at the Cleveland Clinic.

Reference

1. Windover A, Boissy A, Rice T, Gilligan T, Velez V, Merlino J. The REDE model of healthcare communication: optimizing relationship as a therapeutic agent. J Patient Exp. 2014;1(1):8-13.

Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each column will focus on how the contributor applies one of the “Key Communication” areas in practice.

View a chart outlining key communication tactics

What I Say and Do

I counsel and deliver the diagnosis or give recommendations through a dialogue, instead of a monologue, using active listening.

Why I Do It

The monologue, or lecture, is among the least effective ways to instill behavior change. Research studies have demonstrated that, after a monologue, only around 20% to 60% of medical information is remembered by the end of a visit. Out of what is remembered, less than 50% is accurate. Furthermore, 47% of Americans have health literacy levels below the intermediate range, defined as the ability to determine when to take a medication with food from reading the label.

Lecturing the patient without first understanding what the patient knows and finds important, and understanding the barriers to plan implementation, runs the risk of decreased comprehension, a lack of understanding, or a lack of personal relevance—all leading to decreased adherence. Doing the opposite, by involving the patient in decision making, inspires change that comes from within in the context of the patient’s own needs. This approach is more enduring, emphasizes self-accountability, and ultimately leads to better outcomes.

How I Do It

I open up a dialogue using the Cleveland Clinic’s ARIA approach as adapted from the REDE model of healthcare communication.1

• First, assess: What does the patient know about diagnosis and treatment? How much and what type of education does the patient desire/need? What are the patient’s treatment preferences and health literacy?
• Second, reflect on what the patient just said. Validate meaning and emotion.
• Third, inform the patient within the context of the patient’s perspectives and preferences. Speak slowly and provide small chunks of information at a time. Use understandable language and visual aids. (This will increase recall by 60%.)
• Finally, assess the patient’s understanding and emotional reaction to information provided.
• Repeat the cycle to introduce other chunks of information.

Dr. Velez is director of faculty development in the Center for Excellence in Healthcare Communication at the Cleveland Clinic.

Reference

1. Windover A, Boissy A, Rice T, Gilligan T, Velez V, Merlino J. The REDE model of healthcare communication: optimizing relationship as a therapeutic agent. J Patient Exp. 2014;1(1):8-13.

Clinical question: What is the prevalence of depression or depressive symptoms in resident physicians?

Background: Depression in resident physicians can lead to poor-quality medical care, increased errors, and long-term morbidity. Prevalence of depression or depressive symptoms has varied in prior studies, and more data are needed to better understand the true prevalence.

Study design: Systematic review and meta-analysis.

Setting: Surgical and nonsurgical residency programs in North America, Asia, Europe, South America, and Africa

Synopsis: Thirty-one cross-sectional studies (9,447 individuals) and 23 longitudinal studies (8,113 individuals) from January 1963 to September 2015 were included in this analysis, with the majority using self-reporting to identify residents with depression or depressive symptoms. Overall prevalence of depression or depressive symptoms was 28.8%, with a range of 20.9% to 43.2%, depending on the screening tool (95% CI, 25.3%–32.5%; P<0.001). There was an increased prevalence in depression or depressive symptoms as the calendar year progressed (slope=0.5% per calendar year increase; 95% CI, 0.03%–0.09%), with no difference in prevalence rates between surgical versus nonsurgical residents, U.S. versus elsewhere, cross-sectional versus longitudinal, or interns versus upper-level residents.

Because studies were heterogeneous with respect to the screening tools and resident population, the prevalence of depression or depressive symptoms cannot be precisely determined.

Bottom line: Prevalence of depression or depressive symptoms ranged from 20.9% to 43.2%, with pooled prevalence of 28.8%, and increased with time.

Citation: Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and met-analysis. JAMA. 2015;314(22):2373-2383.

Clinical question: What is the prevalence of depression or depressive symptoms in resident physicians?

Background: Depression in resident physicians can lead to poor-quality medical care, increased errors, and long-term morbidity. Prevalence of depression or depressive symptoms has varied in prior studies, and more data are needed to better understand the true prevalence.

Study design: Systematic review and meta-analysis.

Setting: Surgical and nonsurgical residency programs in North America, Asia, Europe, South America, and Africa

Synopsis: Thirty-one cross-sectional studies (9,447 individuals) and 23 longitudinal studies (8,113 individuals) from January 1963 to September 2015 were included in this analysis, with the majority using self-reporting to identify residents with depression or depressive symptoms. Overall prevalence of depression or depressive symptoms was 28.8%, with a range of 20.9% to 43.2%, depending on the screening tool (95% CI, 25.3%–32.5%; P<0.001). There was an increased prevalence in depression or depressive symptoms as the calendar year progressed (slope=0.5% per calendar year increase; 95% CI, 0.03%–0.09%), with no difference in prevalence rates between surgical versus nonsurgical residents, U.S. versus elsewhere, cross-sectional versus longitudinal, or interns versus upper-level residents.

Because studies were heterogeneous with respect to the screening tools and resident population, the prevalence of depression or depressive symptoms cannot be precisely determined.

Bottom line: Prevalence of depression or depressive symptoms ranged from 20.9% to 43.2%, with pooled prevalence of 28.8%, and increased with time.

Citation: Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and met-analysis. JAMA. 2015;314(22):2373-2383.

Clinical question: What is the prevalence of depression or depressive symptoms in resident physicians?

Background: Depression in resident physicians can lead to poor-quality medical care, increased errors, and long-term morbidity. Prevalence of depression or depressive symptoms has varied in prior studies, and more data are needed to better understand the true prevalence.

Study design: Systematic review and meta-analysis.

Setting: Surgical and nonsurgical residency programs in North America, Asia, Europe, South America, and Africa

Synopsis: Thirty-one cross-sectional studies (9,447 individuals) and 23 longitudinal studies (8,113 individuals) from January 1963 to September 2015 were included in this analysis, with the majority using self-reporting to identify residents with depression or depressive symptoms. Overall prevalence of depression or depressive symptoms was 28.8%, with a range of 20.9% to 43.2%, depending on the screening tool (95% CI, 25.3%–32.5%; P<0.001). There was an increased prevalence in depression or depressive symptoms as the calendar year progressed (slope=0.5% per calendar year increase; 95% CI, 0.03%–0.09%), with no difference in prevalence rates between surgical versus nonsurgical residents, U.S. versus elsewhere, cross-sectional versus longitudinal, or interns versus upper-level residents.

Because studies were heterogeneous with respect to the screening tools and resident population, the prevalence of depression or depressive symptoms cannot be precisely determined.

Bottom line: Prevalence of depression or depressive symptoms ranged from 20.9% to 43.2%, with pooled prevalence of 28.8%, and increased with time.

Citation: Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and met-analysis. JAMA. 2015;314(22):2373-2383.

Hopefully, many of you were able to attend the Society of Hospital Medicine’s annual meeting this year in San Diego. (I know at least 4,000 of you made it!) Each year, the annual meeting is a time of catching up with hospitalists from around the country (many of whom I only see once a year) and catching up on what is going on in the medical industry.

This year was not particularly unique in that many sessions focused on the myriad challenges we should expect to see in the medical industry in the coming years. There was much discussion about future payment models; although there is ongoing ambiguity about exactly how these models are going to be operationalized, there is certainly no ambiguity that the Centers for Medicare & Medicaid Services (CMS) is hard driving the amount of payments that will be tied to some form of alternative payment model (50% by 2018).

We also heard about ongoing challenges in quality and safety, where a stunning number of patients continue to suffer preventable harm on a daily basis within our hospital walls. And we heard much about the ongoing and mounting opiate abuse epidemic. All of these are monumentally difficult challenges that remain unsolved and without a clear path forward to resolution.

Contrast that with the message from the U.S. Surgeon General during the opening plenary of the annual meeting. Vivek Murthy, MD, was named Surgeon General at a time in the U.S. when all of the above challenges are being added to the abounding issues of chronic disease, mental illness, and extraordinary healthcare costs. He is the highest leader in the nation ordained with trying to improve the health of all Americans at a time when we have never been unhealthier. But despite these monumental challenges, his message was not about the average American body mass index (BMI), smoking status, or heroin addiction. Much different, his message was chock full of amazing stories of community engagement and resilience, focused on innovation and fresh thinking, and about creative problem-solving despite lean and unforgiving budgets.

What Dr. Murthy offered were endless stories of hope and goodness, which he was able to find in each and every city he has visited in his short time as the nation’s “top doc.”

During his tenure, he has visited innumerable communities and engaged with locals in listening sessions. His takeaway from these sessions is “you wouldn’t believe how much good is out there.” One of his many stories was of a hospital and a YMCA that joined forces to improve the health and well-being of the hospital patients, employees, and entire community. This was at a time when both were struggling with lean budgets and stagnant progress in healthy living.

This pragmatic optimism reminds me a bit of one of my life mentors, my Aunt Karen. She is extremely realistic and grounded and knows in great detail the trials and tribulations of being alive for 66 years (including being a 10-year survivor of recurrent ovarian rhabdomyosarcoma). What Aunt Karen does that is so uniquely different than anyone else I know is that she creates goodness. I did not fully understand this until a few years ago, but I noticed that she goes out of her way to create extreme goodness out of extreme ordinariness. I have often joked that she purposely befriends pregnant women just to have an excuse to host a baby shower. She goes overboard to make any and every excuse to celebrate relatively ordinary life milestones (anniversaries, Valentine’s Day, St. Patrick’s Day). In her words, “you have to have a buffer for the funerals.”

Flip Your Switch

And so while Dr. Murthy and Aunt Karen have little else in common, they do share the priceless ability to help others see the goodness in everything around them even when surrounded by remarkable challenges and uncertainty. What a unique gift they have.

But are there simple ways we can all incorporate such goodness into our lives and start to routinely build in these buffers?

In your own personal life and work life, what are your buffers? How could you routinely and repeatedly “find the good” in all things around you?

A few months ago, I started searching for what I call “inbox buffers” as I noticed my email inbox was routinely chock full of requests for time, advice, or resources (all of which can be limited). I found a daily email called “The Daily Good.” It comes into my inbox early each morning and typically covers a human-interest story that is short, interesting, and inspiring. I have found these help me reset my mindset and attitude toward one that is more resilient and forgiving; in other words, it helps me find the good even within the crevices of a cranky email inbox. I have many other buffers, but I cite this one as it is simple, easy, free, predictable, dependable, and routinely inspiring!

So in this time when hospitalists are facing monumental change, unpredictable conflict, and unending challenges, we all need to purposely and repeatedly build in buffers to keep us hopeful and motivated and to seamlessly and routinely find the good in all we do. TH

Hopefully, many of you were able to attend the Society of Hospital Medicine’s annual meeting this year in San Diego. (I know at least 4,000 of you made it!) Each year, the annual meeting is a time of catching up with hospitalists from around the country (many of whom I only see once a year) and catching up on what is going on in the medical industry.

This year was not particularly unique in that many sessions focused on the myriad challenges we should expect to see in the medical industry in the coming years. There was much discussion about future payment models; although there is ongoing ambiguity about exactly how these models are going to be operationalized, there is certainly no ambiguity that the Centers for Medicare & Medicaid Services (CMS) is hard driving the amount of payments that will be tied to some form of alternative payment model (50% by 2018).

We also heard about ongoing challenges in quality and safety, where a stunning number of patients continue to suffer preventable harm on a daily basis within our hospital walls. And we heard much about the ongoing and mounting opiate abuse epidemic. All of these are monumentally difficult challenges that remain unsolved and without a clear path forward to resolution.

Contrast that with the message from the U.S. Surgeon General during the opening plenary of the annual meeting. Vivek Murthy, MD, was named Surgeon General at a time in the U.S. when all of the above challenges are being added to the abounding issues of chronic disease, mental illness, and extraordinary healthcare costs. He is the highest leader in the nation ordained with trying to improve the health of all Americans at a time when we have never been unhealthier. But despite these monumental challenges, his message was not about the average American body mass index (BMI), smoking status, or heroin addiction. Much different, his message was chock full of amazing stories of community engagement and resilience, focused on innovation and fresh thinking, and about creative problem-solving despite lean and unforgiving budgets.

What Dr. Murthy offered were endless stories of hope and goodness, which he was able to find in each and every city he has visited in his short time as the nation’s “top doc.”

During his tenure, he has visited innumerable communities and engaged with locals in listening sessions. His takeaway from these sessions is “you wouldn’t believe how much good is out there.” One of his many stories was of a hospital and a YMCA that joined forces to improve the health and well-being of the hospital patients, employees, and entire community. This was at a time when both were struggling with lean budgets and stagnant progress in healthy living.

This pragmatic optimism reminds me a bit of one of my life mentors, my Aunt Karen. She is extremely realistic and grounded and knows in great detail the trials and tribulations of being alive for 66 years (including being a 10-year survivor of recurrent ovarian rhabdomyosarcoma). What Aunt Karen does that is so uniquely different than anyone else I know is that she creates goodness. I did not fully understand this until a few years ago, but I noticed that she goes out of her way to create extreme goodness out of extreme ordinariness. I have often joked that she purposely befriends pregnant women just to have an excuse to host a baby shower. She goes overboard to make any and every excuse to celebrate relatively ordinary life milestones (anniversaries, Valentine’s Day, St. Patrick’s Day). In her words, “you have to have a buffer for the funerals.”

Flip Your Switch

And so while Dr. Murthy and Aunt Karen have little else in common, they do share the priceless ability to help others see the goodness in everything around them even when surrounded by remarkable challenges and uncertainty. What a unique gift they have.

But are there simple ways we can all incorporate such goodness into our lives and start to routinely build in these buffers?

In your own personal life and work life, what are your buffers? How could you routinely and repeatedly “find the good” in all things around you?

A few months ago, I started searching for what I call “inbox buffers” as I noticed my email inbox was routinely chock full of requests for time, advice, or resources (all of which can be limited). I found a daily email called “The Daily Good.” It comes into my inbox early each morning and typically covers a human-interest story that is short, interesting, and inspiring. I have found these help me reset my mindset and attitude toward one that is more resilient and forgiving; in other words, it helps me find the good even within the crevices of a cranky email inbox. I have many other buffers, but I cite this one as it is simple, easy, free, predictable, dependable, and routinely inspiring!

So in this time when hospitalists are facing monumental change, unpredictable conflict, and unending challenges, we all need to purposely and repeatedly build in buffers to keep us hopeful and motivated and to seamlessly and routinely find the good in all we do. TH

Hopefully, many of you were able to attend the Society of Hospital Medicine’s annual meeting this year in San Diego. (I know at least 4,000 of you made it!) Each year, the annual meeting is a time of catching up with hospitalists from around the country (many of whom I only see once a year) and catching up on what is going on in the medical industry.

This year was not particularly unique in that many sessions focused on the myriad challenges we should expect to see in the medical industry in the coming years. There was much discussion about future payment models; although there is ongoing ambiguity about exactly how these models are going to be operationalized, there is certainly no ambiguity that the Centers for Medicare & Medicaid Services (CMS) is hard driving the amount of payments that will be tied to some form of alternative payment model (50% by 2018).

We also heard about ongoing challenges in quality and safety, where a stunning number of patients continue to suffer preventable harm on a daily basis within our hospital walls. And we heard much about the ongoing and mounting opiate abuse epidemic. All of these are monumentally difficult challenges that remain unsolved and without a clear path forward to resolution.

Contrast that with the message from the U.S. Surgeon General during the opening plenary of the annual meeting. Vivek Murthy, MD, was named Surgeon General at a time in the U.S. when all of the above challenges are being added to the abounding issues of chronic disease, mental illness, and extraordinary healthcare costs. He is the highest leader in the nation ordained with trying to improve the health of all Americans at a time when we have never been unhealthier. But despite these monumental challenges, his message was not about the average American body mass index (BMI), smoking status, or heroin addiction. Much different, his message was chock full of amazing stories of community engagement and resilience, focused on innovation and fresh thinking, and about creative problem-solving despite lean and unforgiving budgets.

What Dr. Murthy offered were endless stories of hope and goodness, which he was able to find in each and every city he has visited in his short time as the nation’s “top doc.”

During his tenure, he has visited innumerable communities and engaged with locals in listening sessions. His takeaway from these sessions is “you wouldn’t believe how much good is out there.” One of his many stories was of a hospital and a YMCA that joined forces to improve the health and well-being of the hospital patients, employees, and entire community. This was at a time when both were struggling with lean budgets and stagnant progress in healthy living.

This pragmatic optimism reminds me a bit of one of my life mentors, my Aunt Karen. She is extremely realistic and grounded and knows in great detail the trials and tribulations of being alive for 66 years (including being a 10-year survivor of recurrent ovarian rhabdomyosarcoma). What Aunt Karen does that is so uniquely different than anyone else I know is that she creates goodness. I did not fully understand this until a few years ago, but I noticed that she goes out of her way to create extreme goodness out of extreme ordinariness. I have often joked that she purposely befriends pregnant women just to have an excuse to host a baby shower. She goes overboard to make any and every excuse to celebrate relatively ordinary life milestones (anniversaries, Valentine’s Day, St. Patrick’s Day). In her words, “you have to have a buffer for the funerals.”

Flip Your Switch

And so while Dr. Murthy and Aunt Karen have little else in common, they do share the priceless ability to help others see the goodness in everything around them even when surrounded by remarkable challenges and uncertainty. What a unique gift they have.

But are there simple ways we can all incorporate such goodness into our lives and start to routinely build in these buffers?

In your own personal life and work life, what are your buffers? How could you routinely and repeatedly “find the good” in all things around you?

A few months ago, I started searching for what I call “inbox buffers” as I noticed my email inbox was routinely chock full of requests for time, advice, or resources (all of which can be limited). I found a daily email called “The Daily Good.” It comes into my inbox early each morning and typically covers a human-interest story that is short, interesting, and inspiring. I have found these help me reset my mindset and attitude toward one that is more resilient and forgiving; in other words, it helps me find the good even within the crevices of a cranky email inbox. I have many other buffers, but I cite this one as it is simple, easy, free, predictable, dependable, and routinely inspiring!

So in this time when hospitalists are facing monumental change, unpredictable conflict, and unending challenges, we all need to purposely and repeatedly build in buffers to keep us hopeful and motivated and to seamlessly and routinely find the good in all we do. TH

U.S. Surgeon General Vivek Murthy, MD, MBA, talks about the role hospitalists can play in public health.

U.S. Surgeon General Vivek Murthy, MD, MBA, talks about the role hospitalists can play in public health.

U.S. Surgeon General Vivek Murthy, MD, MBA, talks about the role hospitalists can play in public health.

Alyssa Stephany, MD, then assistant professor at Duke and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, talks about the evolution in training stemming from her experience in the HM16 RIV competition. This year, she oversaw a study for which resident

Jennifer Ladd, MD, won an award for pediatric clinical vignette.

Alyssa Stephany, MD, then assistant professor at Duke and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, talks about the evolution in training stemming from her experience in the HM16 RIV competition. This year, she oversaw a study for which resident

Jennifer Ladd, MD, won an award for pediatric clinical vignette.

Alyssa Stephany, MD, then assistant professor at Duke and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, talks about the evolution in training stemming from her experience in the HM16 RIV competition. This year, she oversaw a study for which resident

Jennifer Ladd, MD, won an award for pediatric clinical vignette.

RIV winner Vineet Chopra, MD, MSc, assistant professor at the University of Michigan in Ann Arbor, talks about his research on the costs and complications associated with PICC line use.

RIV winner Vineet Chopra, MD, MSc, assistant professor at the University of Michigan in Ann Arbor, talks about his research on the costs and complications associated with PICC line use.

RIV winner Vineet Chopra, MD, MSc, assistant professor at the University of Michigan in Ann Arbor, talks about his research on the costs and complications associated with PICC line use.

Jordan Romano, DO, a hospitalist at Massachusetts General Hospital, talks about lessons gleaned at HM16 on the importance of taking small steps toward your goals of getting published and how burnout can be relative.

Jordan Romano, DO, a hospitalist at Massachusetts General Hospital, talks about lessons gleaned at HM16 on the importance of taking small steps toward your goals of getting published and how burnout can be relative.

Jordan Romano, DO, a hospitalist at Massachusetts General Hospital, talks about lessons gleaned at HM16 on the importance of taking small steps toward your goals of getting published and how burnout can be relative.