Career

Hospitalists and ED physicians at Newton Medical Center in New Jersey recently participated in an improvised, interactive learning experience with actors who portrayed problematic patients. “Developing Doctor-Patient Relations through Better Communication” is a curriculum to test and teach communication skills for doctors that was created by Anthony Orsini, MD, a neonatologist at Morristown Medical Center, Newton’s sister facility in the Atlantic Health System. Dr. Orsini founded the Breaking Bad News Foundation (www.bbnfoundation.org) more than a decade ago to help health professionals impart bad medical news to patients and families.

Physicians role-play with actors in such difficult scenarios as imparting a troubling diagnosis to a patient who does not want to hear it. This interaction is viewed remotely by instructors from the foundation and by peers, who then meet with the doctor to go over the videotaped encounter regarding its effectiveness, spoken messages, body language, and other communications.

The project to improve staff communication skills is enhancing teamwork between Newton’s hospitalists and emergency doctors, according to David Stuhlmiller, MD, the hospital’s director of emergency medicine.

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

Hospitalists and ED physicians at Newton Medical Center in New Jersey recently participated in an improvised, interactive learning experience with actors who portrayed problematic patients. “Developing Doctor-Patient Relations through Better Communication” is a curriculum to test and teach communication skills for doctors that was created by Anthony Orsini, MD, a neonatologist at Morristown Medical Center, Newton’s sister facility in the Atlantic Health System. Dr. Orsini founded the Breaking Bad News Foundation (www.bbnfoundation.org) more than a decade ago to help health professionals impart bad medical news to patients and families.

Physicians role-play with actors in such difficult scenarios as imparting a troubling diagnosis to a patient who does not want to hear it. This interaction is viewed remotely by instructors from the foundation and by peers, who then meet with the doctor to go over the videotaped encounter regarding its effectiveness, spoken messages, body language, and other communications.

The project to improve staff communication skills is enhancing teamwork between Newton’s hospitalists and emergency doctors, according to David Stuhlmiller, MD, the hospital’s director of emergency medicine.

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

Hospitalists and ED physicians at Newton Medical Center in New Jersey recently participated in an improvised, interactive learning experience with actors who portrayed problematic patients. “Developing Doctor-Patient Relations through Better Communication” is a curriculum to test and teach communication skills for doctors that was created by Anthony Orsini, MD, a neonatologist at Morristown Medical Center, Newton’s sister facility in the Atlantic Health System. Dr. Orsini founded the Breaking Bad News Foundation (www.bbnfoundation.org) more than a decade ago to help health professionals impart bad medical news to patients and families.

Physicians role-play with actors in such difficult scenarios as imparting a troubling diagnosis to a patient who does not want to hear it. This interaction is viewed remotely by instructors from the foundation and by peers, who then meet with the doctor to go over the videotaped encounter regarding its effectiveness, spoken messages, body language, and other communications.

The project to improve staff communication skills is enhancing teamwork between Newton’s hospitalists and emergency doctors, according to David Stuhlmiller, MD, the hospital’s director of emergency medicine.

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

Dr. Hospitalist

In this age of cost containment and fiscal frugality, how do you handle high-census periods without jeopardizing patient care?

–Michael P. Mason, Tulsa, Okla.

Dr. Hospitalist responds:

Your group must first define the term “high census,” because workload is based on many factors. Seeing 20 patients a day in a large inner-city hospital is much different from seeing 20 patients in a suburban hospital in an affluent part of town. Also, seeing 20 patients geographically located on the same floor is much easier than 20 patients spread all over the hospital. Mid-level or nurse case-management support also makes a difference.

Once defined, there are many different ways to handle the high census; each hospitalist group must decide what works for them.

Many groups rely on their compensation structure to entice their physicians to see higher numbers of patients. The pay structure may be production-based and entice many of the group members to see more patients. Typically, for the member that does not want to see the large volumes, there are usually colleagues who are more than happy to cover the excess patients.

Some groups employ a hybrid system, with their compensation based on production and salary. Generally, bonuses or incentives are applied after meeting a specific relative value unit (RVU) threshold. These thresholds vary and usually are raised periodically based on the percentage of staff able to collect. Again, some group members may volunteer to see the excess patients for higher compensation. It is up to the group to develop mechanisms to measure the quality of care of these high producers and monitor for burnout.

Then there are groups that have no volume incentives and everyone is paid a salary. Many groups that utilize any of these compensation models have group members “on call” to come in when needed and see the excess patients. Many pay the on-call person some nominal amount just for being on call, or a per-patient or hourly rate if they have to come in. Others make it a mandatory part of the schedule without any additional compensation.

Many groups have integrated advanced-practice providers (nurse practitioners and physician assistants) into their systems. They can help hospitalists improve efficiency by seeing patients that are less ill or awaiting placement, or by performing such labor-intensive tasks as admissions and discharges.

HM groups should collaborate with the hospital’s chief financial officer. Like clinicians, most administrators recognize it is very difficult to deliver high-quality and efficient care when the numbers get high. It is in their best interest to help devise strategies and models that deliver quality care and the metrics needed to sustain support.

HM has become such a large specialty that there is no-one-size-fits-all solution to high censuses. In the end, you have to be comfortable with the system created by your group, work to help improve it, or seek a better fit.

Do you have a problem or concern that you’d like Dr. Hospitalist to address? Email your questions to [email protected].

Dr. Hospitalist

In this age of cost containment and fiscal frugality, how do you handle high-census periods without jeopardizing patient care?

–Michael P. Mason, Tulsa, Okla.

Dr. Hospitalist responds:

Your group must first define the term “high census,” because workload is based on many factors. Seeing 20 patients a day in a large inner-city hospital is much different from seeing 20 patients in a suburban hospital in an affluent part of town. Also, seeing 20 patients geographically located on the same floor is much easier than 20 patients spread all over the hospital. Mid-level or nurse case-management support also makes a difference.

Once defined, there are many different ways to handle the high census; each hospitalist group must decide what works for them.

Many groups rely on their compensation structure to entice their physicians to see higher numbers of patients. The pay structure may be production-based and entice many of the group members to see more patients. Typically, for the member that does not want to see the large volumes, there are usually colleagues who are more than happy to cover the excess patients.

Some groups employ a hybrid system, with their compensation based on production and salary. Generally, bonuses or incentives are applied after meeting a specific relative value unit (RVU) threshold. These thresholds vary and usually are raised periodically based on the percentage of staff able to collect. Again, some group members may volunteer to see the excess patients for higher compensation. It is up to the group to develop mechanisms to measure the quality of care of these high producers and monitor for burnout.

Then there are groups that have no volume incentives and everyone is paid a salary. Many groups that utilize any of these compensation models have group members “on call” to come in when needed and see the excess patients. Many pay the on-call person some nominal amount just for being on call, or a per-patient or hourly rate if they have to come in. Others make it a mandatory part of the schedule without any additional compensation.

Many groups have integrated advanced-practice providers (nurse practitioners and physician assistants) into their systems. They can help hospitalists improve efficiency by seeing patients that are less ill or awaiting placement, or by performing such labor-intensive tasks as admissions and discharges.

HM groups should collaborate with the hospital’s chief financial officer. Like clinicians, most administrators recognize it is very difficult to deliver high-quality and efficient care when the numbers get high. It is in their best interest to help devise strategies and models that deliver quality care and the metrics needed to sustain support.

HM has become such a large specialty that there is no-one-size-fits-all solution to high censuses. In the end, you have to be comfortable with the system created by your group, work to help improve it, or seek a better fit.

Do you have a problem or concern that you’d like Dr. Hospitalist to address? Email your questions to [email protected].

Dr. Hospitalist

In this age of cost containment and fiscal frugality, how do you handle high-census periods without jeopardizing patient care?

–Michael P. Mason, Tulsa, Okla.

Dr. Hospitalist responds:

Your group must first define the term “high census,” because workload is based on many factors. Seeing 20 patients a day in a large inner-city hospital is much different from seeing 20 patients in a suburban hospital in an affluent part of town. Also, seeing 20 patients geographically located on the same floor is much easier than 20 patients spread all over the hospital. Mid-level or nurse case-management support also makes a difference.

Once defined, there are many different ways to handle the high census; each hospitalist group must decide what works for them.

Many groups rely on their compensation structure to entice their physicians to see higher numbers of patients. The pay structure may be production-based and entice many of the group members to see more patients. Typically, for the member that does not want to see the large volumes, there are usually colleagues who are more than happy to cover the excess patients.

Some groups employ a hybrid system, with their compensation based on production and salary. Generally, bonuses or incentives are applied after meeting a specific relative value unit (RVU) threshold. These thresholds vary and usually are raised periodically based on the percentage of staff able to collect. Again, some group members may volunteer to see the excess patients for higher compensation. It is up to the group to develop mechanisms to measure the quality of care of these high producers and monitor for burnout.

Then there are groups that have no volume incentives and everyone is paid a salary. Many groups that utilize any of these compensation models have group members “on call” to come in when needed and see the excess patients. Many pay the on-call person some nominal amount just for being on call, or a per-patient or hourly rate if they have to come in. Others make it a mandatory part of the schedule without any additional compensation.

Many groups have integrated advanced-practice providers (nurse practitioners and physician assistants) into their systems. They can help hospitalists improve efficiency by seeing patients that are less ill or awaiting placement, or by performing such labor-intensive tasks as admissions and discharges.

HM groups should collaborate with the hospital’s chief financial officer. Like clinicians, most administrators recognize it is very difficult to deliver high-quality and efficient care when the numbers get high. It is in their best interest to help devise strategies and models that deliver quality care and the metrics needed to sustain support.

HM has become such a large specialty that there is no-one-size-fits-all solution to high censuses. In the end, you have to be comfortable with the system created by your group, work to help improve it, or seek a better fit.

Do you have a problem or concern that you’d like Dr. Hospitalist to address? Email your questions to [email protected].

Percentage of practicing physicians who would not recommend a medical career to a young person, according to Filling The Void: 2013 Physician Outlook Practice Trends, a national physician practice survey conducted by health-care staffing firm Jackson Healthcare.⁶ “Physician discontent appears to be creating a void in the health-care field,” with dissatisfaction and burnout leading to early retirement, the report stated. Discontent is driven by decreased autonomy, decreased reimbursement, administrative and regulatory distractions, corporatization of medicine, and fear of litigation, according to the report. Thirty-six percent of the respondents reported a generally negative outlook about their career, compared with only 16% who had a generally favorable outlook.

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

Percentage of practicing physicians who would not recommend a medical career to a young person, according to Filling The Void: 2013 Physician Outlook Practice Trends, a national physician practice survey conducted by health-care staffing firm Jackson Healthcare.⁶ “Physician discontent appears to be creating a void in the health-care field,” with dissatisfaction and burnout leading to early retirement, the report stated. Discontent is driven by decreased autonomy, decreased reimbursement, administrative and regulatory distractions, corporatization of medicine, and fear of litigation, according to the report. Thirty-six percent of the respondents reported a generally negative outlook about their career, compared with only 16% who had a generally favorable outlook.

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

Percentage of practicing physicians who would not recommend a medical career to a young person, according to Filling The Void: 2013 Physician Outlook Practice Trends, a national physician practice survey conducted by health-care staffing firm Jackson Healthcare.⁶ “Physician discontent appears to be creating a void in the health-care field,” with dissatisfaction and burnout leading to early retirement, the report stated. Discontent is driven by decreased autonomy, decreased reimbursement, administrative and regulatory distractions, corporatization of medicine, and fear of litigation, according to the report. Thirty-six percent of the respondents reported a generally negative outlook about their career, compared with only 16% who had a generally favorable outlook.

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

Given the encouraging results published in Infection Control and Hospital Epidemiology regarding the effectiveness of copper-alloy surfaces in killing bacteria, one institution has decided to go full steam ahead with installing copper components.¹

The Ronald McDonald House of Charleston, S.C. (RMHC), a home for families of critically ill children who are being treated at the Medical University of South Carolina (MUSC), was the first nonprofit, temporary-residence facility in the U.S. to undertake an antimicrobial copper retrofit.

“We were the ideal public building site to test copper’s antimicrobial efficacy outside of ICUs,” says Robin Willis, RMHC’s antimicrobial project manager.

South Carolina Research Authority, which managed the study, approached RMHC about being the “guinea pig.”

“The families would get the benefits for a long time, and we would have additional data outside of a closed ICU,” Willis says. “Additionally, it gave vendors a testing ground for copper components.”

Surfaces that were identified in the study as having the highest bacteria counts (stair railings, sinks, faucets, tables, locksets, cabinet pulls, and chair arms) were replaced with solid, copper-based metals such as bronze and brass that are registered by the Environmental Protection Agency. The Copper Development Association donated the bulk of funds for the project. Copper manufacturers and installers donated their time and materials.

Initial discussions about the project began in 2010; copper installations started in November 2011. The facility remained open and fully functional throughout the project, which was completed in April 2012.

MUSC measured the amount of bacteria on touch surfaces prior to the copper retrofit, then compared the amount of bacteria on the new copper surfaces against their predecessors.

“Bacteria levels dropped more than 90 percent, around the clock, without cleaning agents,” Willis says.

The study’s lead investigator, Michael Schmidt, PhD, professor and vice chair of the department of microbiology and immunology at MUSC, says the practical application of antimicrobial copper “provides a strong, real-world example of the public-health benefits of copper materials, not only in a health-care setting, but also in hotels, restaurants, and other public gathering places.” TH

Karen Appold is a freelance writer in Pennsylvania.

Reference

1. Salgado CD, Sepkowitz KA, John JF, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol. 2013;34(5):479-486.

Given the encouraging results published in Infection Control and Hospital Epidemiology regarding the effectiveness of copper-alloy surfaces in killing bacteria, one institution has decided to go full steam ahead with installing copper components.¹

The Ronald McDonald House of Charleston, S.C. (RMHC), a home for families of critically ill children who are being treated at the Medical University of South Carolina (MUSC), was the first nonprofit, temporary-residence facility in the U.S. to undertake an antimicrobial copper retrofit.

“We were the ideal public building site to test copper’s antimicrobial efficacy outside of ICUs,” says Robin Willis, RMHC’s antimicrobial project manager.

South Carolina Research Authority, which managed the study, approached RMHC about being the “guinea pig.”

“The families would get the benefits for a long time, and we would have additional data outside of a closed ICU,” Willis says. “Additionally, it gave vendors a testing ground for copper components.”

Surfaces that were identified in the study as having the highest bacteria counts (stair railings, sinks, faucets, tables, locksets, cabinet pulls, and chair arms) were replaced with solid, copper-based metals such as bronze and brass that are registered by the Environmental Protection Agency. The Copper Development Association donated the bulk of funds for the project. Copper manufacturers and installers donated their time and materials.

Initial discussions about the project began in 2010; copper installations started in November 2011. The facility remained open and fully functional throughout the project, which was completed in April 2012.

MUSC measured the amount of bacteria on touch surfaces prior to the copper retrofit, then compared the amount of bacteria on the new copper surfaces against their predecessors.

“Bacteria levels dropped more than 90 percent, around the clock, without cleaning agents,” Willis says.

The study’s lead investigator, Michael Schmidt, PhD, professor and vice chair of the department of microbiology and immunology at MUSC, says the practical application of antimicrobial copper “provides a strong, real-world example of the public-health benefits of copper materials, not only in a health-care setting, but also in hotels, restaurants, and other public gathering places.” TH

Karen Appold is a freelance writer in Pennsylvania.

Reference

1. Salgado CD, Sepkowitz KA, John JF, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol. 2013;34(5):479-486.

Given the encouraging results published in Infection Control and Hospital Epidemiology regarding the effectiveness of copper-alloy surfaces in killing bacteria, one institution has decided to go full steam ahead with installing copper components.¹

The Ronald McDonald House of Charleston, S.C. (RMHC), a home for families of critically ill children who are being treated at the Medical University of South Carolina (MUSC), was the first nonprofit, temporary-residence facility in the U.S. to undertake an antimicrobial copper retrofit.

“We were the ideal public building site to test copper’s antimicrobial efficacy outside of ICUs,” says Robin Willis, RMHC’s antimicrobial project manager.

South Carolina Research Authority, which managed the study, approached RMHC about being the “guinea pig.”

“The families would get the benefits for a long time, and we would have additional data outside of a closed ICU,” Willis says. “Additionally, it gave vendors a testing ground for copper components.”

Surfaces that were identified in the study as having the highest bacteria counts (stair railings, sinks, faucets, tables, locksets, cabinet pulls, and chair arms) were replaced with solid, copper-based metals such as bronze and brass that are registered by the Environmental Protection Agency. The Copper Development Association donated the bulk of funds for the project. Copper manufacturers and installers donated their time and materials.

Initial discussions about the project began in 2010; copper installations started in November 2011. The facility remained open and fully functional throughout the project, which was completed in April 2012.

MUSC measured the amount of bacteria on touch surfaces prior to the copper retrofit, then compared the amount of bacteria on the new copper surfaces against their predecessors.

“Bacteria levels dropped more than 90 percent, around the clock, without cleaning agents,” Willis says.

The study’s lead investigator, Michael Schmidt, PhD, professor and vice chair of the department of microbiology and immunology at MUSC, says the practical application of antimicrobial copper “provides a strong, real-world example of the public-health benefits of copper materials, not only in a health-care setting, but also in hotels, restaurants, and other public gathering places.” TH

Karen Appold is a freelance writer in Pennsylvania.

Reference

1. Salgado CD, Sepkowitz KA, John JF, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol. 2013;34(5):479-486.

Click here to listen to more of our interview with Dr. Arora

Click here to listen to more of our interview with Dr. Grant

Click here to listen to more of our interview with Dr. Maynard

Click here to listen to more of our interview with Dr. Wise

Click here to listen to more of our interview with Dr. Arora

Click here to listen to more of our interview with Dr. Grant

Click here to listen to more of our interview with Dr. Maynard

Click here to listen to more of our interview with Dr. Wise

Click here to listen to more of our interview with Dr. Arora

Click here to listen to more of our interview with Dr. Grant

Click here to listen to more of our interview with Dr. Maynard

Click here to listen to more of our interview with Dr. Wise

Sorting out whether a hospitalist’s bonus and other compensation elements are in line with survey data often leads to confusion. The 2013 MGMA Physician Compensation and Production Survey report, based on 2012 data, shows median compensation of $240,352 for internal-medicine hospitalists (I’ll round it to $240,000 for the rest of this piece). So is your compensation in line with survey medians if your base pay is $230,000 and you have a performance bonus of up to $20,000?

The problem is that you can’t know in advance how much of the $20,000 performance bonus you will earn. And isn’t a bonus supposed to be on top of typical compensation? To be in line with the survey, shouldn’t your base pay equal the $240,000 median, with any available bonus dollars on top of that? (Base pay means all forms of compensation other than a performance bonus; it could be productivity-based compensation, pay connected to numbers of shifts or hours worked, or a fixed annual salary, etc.)

The short answer is no, and to demonstrate why, I’ll first review some facts about the survey itself, then apply that knowledge to the hospitalist marketplace.

I want to emphasize that in this article, I’m not taking a position on the right amount of workload, compensation, or bonus for any hospitalist practice. And I’m using survey medians just to simplify the discussion, not because they’re optimal for any particular practice.

Survey Data

The most important thing to know about the survey data is that the $240,000 figure takes into account all forms of pay, including extra shift pay and any bonuses that might have been paid to each provider in the data set. Such benefits as health insurance and retirement-plan contribution are not included in this figure.

There are several ways a hospitalist might have earned compensation that matches the survey median. He or she might have a fixed annual salary equal to the median with no bonus available or had a meaningful bonus (e.g. $10,000 to $20,000) available and failed to earn any of it. Or the base might have come to $230,000, and he or she earned half of the available $20,000 performance bonus. Many other permutations of bonus and other salary elements could occur to arrive at the same $240,000 figure.

The important thing to remember is that whatever bonus dollars were paid, they are included in the salary figure from the survey—not added on top of that figure. So if all bonus dollars earned were subtracted from the survey, the total “nonbonus” compensation would be lower than $240,000.

How much lower?

Typical Hospitalist Bonus Amounts

The MGMA survey doesn’t report the portion of compensation tied to a bonus, but SHM’s does. SHM’s 2012 State of Hospital Medicine Report, based on 2011 data (www.hospitalmedicine.org/survey), is based on the most recent data available, and it showed (on page 60) that an average of 7% of pay was tied to performance for nonacademic hospitalist groups serving adults only. This included any payments for good individual or group performance on quality, efficiency, service, satisfaction, and/or other nonproduction measures. In conversation, this often is referred to as a “bonus” rather than “performance compensation.”

One way to estimate the nonbonus compensation would be to reduce the total pay by 7%, which comes to $223,200. Keep in mind that there are all kinds of mathematical and methodological problems in manipulating the reported survey numbers from two separate surveys to derive additional benchmarks. But this seems like a reasonable guess.

An increasing portion of hospitalist groups have some pay tied to performance, and the portion of total pay tied to performance seems to be going up at least a little. It was 5% of pay in 2010 and 4% in 2011, compared with 7% in the 2012 survey.

Keep in mind two things. First, this 7% reflects the performance or bonus dollars actually paid out, not the total amount available. In other words, even if the median total bonus dollars available were 20% of compensation, hospitalists earned less than that. Some hospitalists earned all dollars available, and some earned only a portion of what was available. And second, some hospitalists fail to earn any bonus or don’t have one available at all. So the survey would show for them zero compensation tied to bonus.

Making Sense of the Numbers

If you follow the reasoning above, then you probably agree that if your goal is to match mean compensation from the MGMA survey (I’m not suggesting that is the best goal, merely using it for simplicity), then you would set nonbonus compensation 7% below median—as long as you’re likely to get the same portion of a bonus as the median practice.

In some practices, performance thresholds are set at a level that is very easy to achieve, meaning the hospitalists are almost guaranteed to get all of the bonus compensation available. To be consistent with survey medians, it would be appropriate for them to set nonbonus compensation by subtracting all bonus dollars from the survey median. For example, if a $20,000 bonus is available and all of it is likely to be earned by the hospitalists, then total nonbonus compensation would be $220,000.

However, what if the bonus requires significant improvements in performance by the doctors (which seems most appropriate to me; why have a bonus otherwise?) and it is likely they will earn only 25% of all bonus dollars available? If the total available bonus is $20,000, then something like 25%, or $5,000, should be subtracted from the median to yield a total nonbonus compensation of $235,000.

Simple Thinking

I think it makes most sense to set total nonbonus compensation below the targeted total compensation. Failure to achieve any performance thresholds means no bonus and compensation will be below target that year. Meeting some thresholds (some improvement in performance) should result in matching the target compensation, and truly terrific performance that meets or exceeds all thresholds should result in the doctor being paid above the target.

Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at [email protected].

Sorting out whether a hospitalist’s bonus and other compensation elements are in line with survey data often leads to confusion. The 2013 MGMA Physician Compensation and Production Survey report, based on 2012 data, shows median compensation of $240,352 for internal-medicine hospitalists (I’ll round it to $240,000 for the rest of this piece). So is your compensation in line with survey medians if your base pay is $230,000 and you have a performance bonus of up to $20,000?

The problem is that you can’t know in advance how much of the $20,000 performance bonus you will earn. And isn’t a bonus supposed to be on top of typical compensation? To be in line with the survey, shouldn’t your base pay equal the $240,000 median, with any available bonus dollars on top of that? (Base pay means all forms of compensation other than a performance bonus; it could be productivity-based compensation, pay connected to numbers of shifts or hours worked, or a fixed annual salary, etc.)

The short answer is no, and to demonstrate why, I’ll first review some facts about the survey itself, then apply that knowledge to the hospitalist marketplace.

I want to emphasize that in this article, I’m not taking a position on the right amount of workload, compensation, or bonus for any hospitalist practice. And I’m using survey medians just to simplify the discussion, not because they’re optimal for any particular practice.

Survey Data

The most important thing to know about the survey data is that the $240,000 figure takes into account all forms of pay, including extra shift pay and any bonuses that might have been paid to each provider in the data set. Such benefits as health insurance and retirement-plan contribution are not included in this figure.

There are several ways a hospitalist might have earned compensation that matches the survey median. He or she might have a fixed annual salary equal to the median with no bonus available or had a meaningful bonus (e.g. $10,000 to $20,000) available and failed to earn any of it. Or the base might have come to $230,000, and he or she earned half of the available $20,000 performance bonus. Many other permutations of bonus and other salary elements could occur to arrive at the same $240,000 figure.

The important thing to remember is that whatever bonus dollars were paid, they are included in the salary figure from the survey—not added on top of that figure. So if all bonus dollars earned were subtracted from the survey, the total “nonbonus” compensation would be lower than $240,000.

How much lower?

Typical Hospitalist Bonus Amounts

The MGMA survey doesn’t report the portion of compensation tied to a bonus, but SHM’s does. SHM’s 2012 State of Hospital Medicine Report, based on 2011 data (www.hospitalmedicine.org/survey), is based on the most recent data available, and it showed (on page 60) that an average of 7% of pay was tied to performance for nonacademic hospitalist groups serving adults only. This included any payments for good individual or group performance on quality, efficiency, service, satisfaction, and/or other nonproduction measures. In conversation, this often is referred to as a “bonus” rather than “performance compensation.”

One way to estimate the nonbonus compensation would be to reduce the total pay by 7%, which comes to $223,200. Keep in mind that there are all kinds of mathematical and methodological problems in manipulating the reported survey numbers from two separate surveys to derive additional benchmarks. But this seems like a reasonable guess.

An increasing portion of hospitalist groups have some pay tied to performance, and the portion of total pay tied to performance seems to be going up at least a little. It was 5% of pay in 2010 and 4% in 2011, compared with 7% in the 2012 survey.

Keep in mind two things. First, this 7% reflects the performance or bonus dollars actually paid out, not the total amount available. In other words, even if the median total bonus dollars available were 20% of compensation, hospitalists earned less than that. Some hospitalists earned all dollars available, and some earned only a portion of what was available. And second, some hospitalists fail to earn any bonus or don’t have one available at all. So the survey would show for them zero compensation tied to bonus.

Making Sense of the Numbers

If you follow the reasoning above, then you probably agree that if your goal is to match mean compensation from the MGMA survey (I’m not suggesting that is the best goal, merely using it for simplicity), then you would set nonbonus compensation 7% below median—as long as you’re likely to get the same portion of a bonus as the median practice.

In some practices, performance thresholds are set at a level that is very easy to achieve, meaning the hospitalists are almost guaranteed to get all of the bonus compensation available. To be consistent with survey medians, it would be appropriate for them to set nonbonus compensation by subtracting all bonus dollars from the survey median. For example, if a $20,000 bonus is available and all of it is likely to be earned by the hospitalists, then total nonbonus compensation would be $220,000.

However, what if the bonus requires significant improvements in performance by the doctors (which seems most appropriate to me; why have a bonus otherwise?) and it is likely they will earn only 25% of all bonus dollars available? If the total available bonus is $20,000, then something like 25%, or $5,000, should be subtracted from the median to yield a total nonbonus compensation of $235,000.

Simple Thinking

I think it makes most sense to set total nonbonus compensation below the targeted total compensation. Failure to achieve any performance thresholds means no bonus and compensation will be below target that year. Meeting some thresholds (some improvement in performance) should result in matching the target compensation, and truly terrific performance that meets or exceeds all thresholds should result in the doctor being paid above the target.

Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at [email protected].

Sorting out whether a hospitalist’s bonus and other compensation elements are in line with survey data often leads to confusion. The 2013 MGMA Physician Compensation and Production Survey report, based on 2012 data, shows median compensation of $240,352 for internal-medicine hospitalists (I’ll round it to $240,000 for the rest of this piece). So is your compensation in line with survey medians if your base pay is $230,000 and you have a performance bonus of up to $20,000?

The problem is that you can’t know in advance how much of the $20,000 performance bonus you will earn. And isn’t a bonus supposed to be on top of typical compensation? To be in line with the survey, shouldn’t your base pay equal the $240,000 median, with any available bonus dollars on top of that? (Base pay means all forms of compensation other than a performance bonus; it could be productivity-based compensation, pay connected to numbers of shifts or hours worked, or a fixed annual salary, etc.)

The short answer is no, and to demonstrate why, I’ll first review some facts about the survey itself, then apply that knowledge to the hospitalist marketplace.

I want to emphasize that in this article, I’m not taking a position on the right amount of workload, compensation, or bonus for any hospitalist practice. And I’m using survey medians just to simplify the discussion, not because they’re optimal for any particular practice.

Survey Data

The most important thing to know about the survey data is that the $240,000 figure takes into account all forms of pay, including extra shift pay and any bonuses that might have been paid to each provider in the data set. Such benefits as health insurance and retirement-plan contribution are not included in this figure.

There are several ways a hospitalist might have earned compensation that matches the survey median. He or she might have a fixed annual salary equal to the median with no bonus available or had a meaningful bonus (e.g. $10,000 to $20,000) available and failed to earn any of it. Or the base might have come to $230,000, and he or she earned half of the available $20,000 performance bonus. Many other permutations of bonus and other salary elements could occur to arrive at the same $240,000 figure.

The important thing to remember is that whatever bonus dollars were paid, they are included in the salary figure from the survey—not added on top of that figure. So if all bonus dollars earned were subtracted from the survey, the total “nonbonus” compensation would be lower than $240,000.

How much lower?

Typical Hospitalist Bonus Amounts

The MGMA survey doesn’t report the portion of compensation tied to a bonus, but SHM’s does. SHM’s 2012 State of Hospital Medicine Report, based on 2011 data (www.hospitalmedicine.org/survey), is based on the most recent data available, and it showed (on page 60) that an average of 7% of pay was tied to performance for nonacademic hospitalist groups serving adults only. This included any payments for good individual or group performance on quality, efficiency, service, satisfaction, and/or other nonproduction measures. In conversation, this often is referred to as a “bonus” rather than “performance compensation.”

One way to estimate the nonbonus compensation would be to reduce the total pay by 7%, which comes to $223,200. Keep in mind that there are all kinds of mathematical and methodological problems in manipulating the reported survey numbers from two separate surveys to derive additional benchmarks. But this seems like a reasonable guess.

An increasing portion of hospitalist groups have some pay tied to performance, and the portion of total pay tied to performance seems to be going up at least a little. It was 5% of pay in 2010 and 4% in 2011, compared with 7% in the 2012 survey.

Keep in mind two things. First, this 7% reflects the performance or bonus dollars actually paid out, not the total amount available. In other words, even if the median total bonus dollars available were 20% of compensation, hospitalists earned less than that. Some hospitalists earned all dollars available, and some earned only a portion of what was available. And second, some hospitalists fail to earn any bonus or don’t have one available at all. So the survey would show for them zero compensation tied to bonus.

Making Sense of the Numbers

If you follow the reasoning above, then you probably agree that if your goal is to match mean compensation from the MGMA survey (I’m not suggesting that is the best goal, merely using it for simplicity), then you would set nonbonus compensation 7% below median—as long as you’re likely to get the same portion of a bonus as the median practice.

In some practices, performance thresholds are set at a level that is very easy to achieve, meaning the hospitalists are almost guaranteed to get all of the bonus compensation available. To be consistent with survey medians, it would be appropriate for them to set nonbonus compensation by subtracting all bonus dollars from the survey median. For example, if a $20,000 bonus is available and all of it is likely to be earned by the hospitalists, then total nonbonus compensation would be $220,000.

However, what if the bonus requires significant improvements in performance by the doctors (which seems most appropriate to me; why have a bonus otherwise?) and it is likely they will earn only 25% of all bonus dollars available? If the total available bonus is $20,000, then something like 25%, or $5,000, should be subtracted from the median to yield a total nonbonus compensation of $235,000.

Simple Thinking

I think it makes most sense to set total nonbonus compensation below the targeted total compensation. Failure to achieve any performance thresholds means no bonus and compensation will be below target that year. Meeting some thresholds (some improvement in performance) should result in matching the target compensation, and truly terrific performance that meets or exceeds all thresholds should result in the doctor being paid above the target.

Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at [email protected].

According to a recent New York Times report, hand-hygiene compliance in hospitals can be as low as 30%, with serious implications regarding hospital-acquired infections.¹ While many initiatives have employed secret observers, vibrating badges, or hand-washing coaches, a Research, Innovations, and Clinical Vignettes (RIV) poster at HM13 outlined how a multidisciplinary committee at University of Colorado Hospital in Aurora applied principles of psychology to the challenge of compliance.²

The initiative focused on behavioral changes: surreptitiously auditing staff behaviors, real-time feedback, and immediate public corrections for observed nonadherence on the test unit from an infection-control champion. The study randomly assigned daily auditing responsibilities across all members of the nursing staff, including aides. Taking a page from soccer referees, auditors handed out red tickets to hygiene violators—and individually wrapped Life Savers to reinforce adherence.

When unprofessional behavior is the response to a verbal correction, leadership has to be prepared to act, explains hospitalist and lead author Ethan Cumbler, MD, FACP.

“We need to stop thinking about hospital staff and physicians as rational actors when it comes to hand hygiene, but as social animals who will respond to positive and negative reinforcements and group culture,” he says.

Noncompliant hand hygiene is largely unconscious behavior that needs to be brought to conscious attention but is amenable to change, Dr. Cumbler says, adding that “unit leadership steps in for repeated nonadherence or an unprofessional response to correction. We have never needed to intervene more than once with the same person.”

Hand-hygiene adherence reached 97% on the pilot unit in the second quarter of 2012 and has remained at that level, Dr. Cumbler says. Additionally, iatrogenic infections dropped to zero from 4.8 per 1,000 urinary catheter days, with bloodstream infections falling at a similar rate.

Similar results with hand-hygiene compliance have been reported at St. Mary’s Health Center in St. Louis, which has been testing a system that reminds nurses to wash their hands at various checkpoints in the hospital, tracking their compliance with a badge that turns green when registering the presence of hand sanitizer, thereby informing patients that the nurse’s hands are clean.

The system, developed by Biovigil Hygiene Technologies of Ann Arbor, Mich., started on two pilot units last year, where compliance has grown to 97% and 99%, respectively. System set-up can cost about $2,000 per patient room, plus monthly subscriptions per employee, but more hospitals in the system could sign on next year, reports the St. Louis Post-Dispatch.³

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

According to a recent New York Times report, hand-hygiene compliance in hospitals can be as low as 30%, with serious implications regarding hospital-acquired infections.¹ While many initiatives have employed secret observers, vibrating badges, or hand-washing coaches, a Research, Innovations, and Clinical Vignettes (RIV) poster at HM13 outlined how a multidisciplinary committee at University of Colorado Hospital in Aurora applied principles of psychology to the challenge of compliance.²

The initiative focused on behavioral changes: surreptitiously auditing staff behaviors, real-time feedback, and immediate public corrections for observed nonadherence on the test unit from an infection-control champion. The study randomly assigned daily auditing responsibilities across all members of the nursing staff, including aides. Taking a page from soccer referees, auditors handed out red tickets to hygiene violators—and individually wrapped Life Savers to reinforce adherence.

When unprofessional behavior is the response to a verbal correction, leadership has to be prepared to act, explains hospitalist and lead author Ethan Cumbler, MD, FACP.

“We need to stop thinking about hospital staff and physicians as rational actors when it comes to hand hygiene, but as social animals who will respond to positive and negative reinforcements and group culture,” he says.

Noncompliant hand hygiene is largely unconscious behavior that needs to be brought to conscious attention but is amenable to change, Dr. Cumbler says, adding that “unit leadership steps in for repeated nonadherence or an unprofessional response to correction. We have never needed to intervene more than once with the same person.”

Hand-hygiene adherence reached 97% on the pilot unit in the second quarter of 2012 and has remained at that level, Dr. Cumbler says. Additionally, iatrogenic infections dropped to zero from 4.8 per 1,000 urinary catheter days, with bloodstream infections falling at a similar rate.

Similar results with hand-hygiene compliance have been reported at St. Mary’s Health Center in St. Louis, which has been testing a system that reminds nurses to wash their hands at various checkpoints in the hospital, tracking their compliance with a badge that turns green when registering the presence of hand sanitizer, thereby informing patients that the nurse’s hands are clean.

The system, developed by Biovigil Hygiene Technologies of Ann Arbor, Mich., started on two pilot units last year, where compliance has grown to 97% and 99%, respectively. System set-up can cost about $2,000 per patient room, plus monthly subscriptions per employee, but more hospitals in the system could sign on next year, reports the St. Louis Post-Dispatch.³

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

According to a recent New York Times report, hand-hygiene compliance in hospitals can be as low as 30%, with serious implications regarding hospital-acquired infections.¹ While many initiatives have employed secret observers, vibrating badges, or hand-washing coaches, a Research, Innovations, and Clinical Vignettes (RIV) poster at HM13 outlined how a multidisciplinary committee at University of Colorado Hospital in Aurora applied principles of psychology to the challenge of compliance.²

The initiative focused on behavioral changes: surreptitiously auditing staff behaviors, real-time feedback, and immediate public corrections for observed nonadherence on the test unit from an infection-control champion. The study randomly assigned daily auditing responsibilities across all members of the nursing staff, including aides. Taking a page from soccer referees, auditors handed out red tickets to hygiene violators—and individually wrapped Life Savers to reinforce adherence.

When unprofessional behavior is the response to a verbal correction, leadership has to be prepared to act, explains hospitalist and lead author Ethan Cumbler, MD, FACP.

“We need to stop thinking about hospital staff and physicians as rational actors when it comes to hand hygiene, but as social animals who will respond to positive and negative reinforcements and group culture,” he says.

Noncompliant hand hygiene is largely unconscious behavior that needs to be brought to conscious attention but is amenable to change, Dr. Cumbler says, adding that “unit leadership steps in for repeated nonadherence or an unprofessional response to correction. We have never needed to intervene more than once with the same person.”

Hand-hygiene adherence reached 97% on the pilot unit in the second quarter of 2012 and has remained at that level, Dr. Cumbler says. Additionally, iatrogenic infections dropped to zero from 4.8 per 1,000 urinary catheter days, with bloodstream infections falling at a similar rate.

Similar results with hand-hygiene compliance have been reported at St. Mary’s Health Center in St. Louis, which has been testing a system that reminds nurses to wash their hands at various checkpoints in the hospital, tracking their compliance with a badge that turns green when registering the presence of hand sanitizer, thereby informing patients that the nurse’s hands are clean.

The system, developed by Biovigil Hygiene Technologies of Ann Arbor, Mich., started on two pilot units last year, where compliance has grown to 97% and 99%, respectively. System set-up can cost about $2,000 per patient room, plus monthly subscriptions per employee, but more hospitals in the system could sign on next year, reports the St. Louis Post-Dispatch.³

Larry Beresford is a freelance writer in San Francisco.

References

1. Hartocollis A. With money at risk, hospitals push staff to wash hands. The New York Times website. Available at: http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html?pagewanted=all&_r=0. Accessed May 28, 2013.
2. Cumbler E, Castillo L, Satorie L, et al. Culture change in infection control: applying psychological principles to improve hand hygiene. J Nurs Care Qual. 2013 May 10 [Epub ahead of print].
3. Bernhard B. High tech hand washing comes to St. Louis hospital. St. Louis Post-Dispatch website. Available at: http://www.stltoday.com/lifestyles/health-med-fit/health/high-tech-hand-washing-comes-to-st-louis-hospital/article_9379065d-85ff-5643-bae2-899254cb22fa.html. Accessed June 27, 2013.
4. Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier cardiac waste measures. Am J Med Qual. 2013 May 29 [Epub ahead of print].
5. Elixhauser A, Steiner C. Readmissions to U.S. hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Accessed July 15, 2013.
6. Jackson Healthcare. Filling the void: 2013 physician outlook & practice trends. Jackson Healthcare website. Available at: http://www.jacksonhealthcare.com/media/193525/jc-2013physiciantrends-void_ebk0513.pdf. Accessed July 15, 2013.

Feeling frustrated with your group’s patient-satisfaction performance? Wondering why your chief (fill in the blank) officer glazes over when you try to explain why your hospitalist group’s Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores for doctor communication are in a percentile rivaling the numeric age of your children?

It is likely that the C-suite administrator overseeing your hospitalist group has a portion of their pay based on HCAHPS or other patient-satisfaction (also called patient experience) scores. And for good reason: The Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) program that started Oct. 1, 2012, has placed your hospital’s Medicare reimbursement at risk based on its HCAHPS scores.

HVBP and Patient Satisfaction

Patient satisfaction will remain an important part of HVBP in the coming years. Table 1 (below) shows the domains that will be included in fiscal years 2014 (which starts Oct. 1, 2013), 2015, and 2016. Table 2 (below) depicts the percent weighting the patient-satisfaction domain will receive through 2016. You may recall that HVBP is a program in which all hospitals place 1% to 2% (2013 through 2017, starting at 1% and increasing each year by 0.25% so that by 2017%, it is 2%) of their CMS inpatient payments in a withhold pool and, based on performance, can make back some, all, or an amount in excess of the amount placed in the withhold pool.

click for large version

click for large version

End In Itself

A colleague of mine recently asked, “Is an increase in patient satisfaction associated with higher quality of care and better patient safety?” The point here: It doesn’t matter. Patient satisfaction is an end in itself, and we should strive to maximize it, or at least put ourselves in the place of the patient and design care accordingly.

For Hospitalists: A Starting Point

There is a conundrum for hospitalists vis-à-vis patient satisfaction. Follow this chain of logic: The hospitals at which we work are incented to perform well on the HCAHPS domains. Hospitals pay a lot for hospitalists. Hospitalists can impact many of the HCAHPS domains. So shouldn’t hospitalists be judged according to HCAHPS scores?

Yes and no.

HCAHPS as a survey is intended to measure a patient’s overall experience of receiving care in the hospital. For example, from the “Doctor Communication” domain, we have questions like “how often did doctors treat you with courtesy and respect?” And “how often did doctors explain things in a way you could understand?”

These questions, like all in HCAHPS, are not designed to get at individual doctor performance, or even performance of a group of doctors, such as hospitalists. Instead, they are designed to measure a patient’s overall experience with the hospitalization, and “Doctor Communication” questions are designed to assess satisfaction with “doctors” collectively.

The Need for Hospitalist-Specific Satisfaction Surveys

So while HCAHPS is not designed to measure hospitalist performance with regard to patient satisfaction, it is a reasonable interim step for hospitals to judge hospitalists according to HCAHPS. However, this should be a bridge to a strategy that adopts hospitalist-specific patient-satisfaction questionnaires in the future and not an end in itself.

Why? Perhaps the biggest reason is that HCAHPS scores are neither specific nor timely enough to form the basis of improvement efforts for hospitalists. If a hospitalist receives a low score on the “Doctor Communication” domain, the scores are likely to be three to nine months old. How can we legitimately assign (and then modify) behaviors based on those scores?

Further, because the survey is not built to measure patient satisfaction specifically with hospitalists, the results are unlikely to engender meaningful and sustained behavior change. Hospitalists I talk to are generally bewildered and confused by HCAHPS scores attributed to them or their groups. Even if they understand the scores, I almost never see true quality improvement (plan-do-study-act) based on specific HCAHPS results. Instead, I see hospitalists trying to adhere to “best practices,” with no adjustments made along the way based on performance.

Nearly all the prominent patient satisfaction vendors have developed a survey instrument specifically designed for hospitalists. Each has an approach to appropriately attribute performance to the hospitalist in question, and each has a battery of questions that is designed to capture patient satisfaction with the hospitalist. Although use of these surveys involves an added financial commitment, I submit that because hospitalists have an unparalleled proximity to hospitalized patients, such an investment is worthy of consideration and has an accompanying business case, thanks to HVBP. The results of these surveys may form the basis of legitimate, targeted feedback to hospitalists, who may then adjust their approach to patient interactions. Such performance improvement should result in improved HCAHPS scores.

In sum, hospitalists should pay close attention to patient satisfaction and embrace HCAHPS. However, we should be looking beyond HCAHPS to survey instruments that fairly and accurately measure our performance. Such surveys will be more widely accepted by the hospitalists they are measuring, and will allow hospitalists to perform meaningful quality improvement based on the results. Although hospitalist-specific surveys will require an investment, the increased patient satisfaction that results should be the basis of a favorable return on that investment.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is co-founder and past president of SHM. Email him at [email protected].

Feeling frustrated with your group’s patient-satisfaction performance? Wondering why your chief (fill in the blank) officer glazes over when you try to explain why your hospitalist group’s Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores for doctor communication are in a percentile rivaling the numeric age of your children?

It is likely that the C-suite administrator overseeing your hospitalist group has a portion of their pay based on HCAHPS or other patient-satisfaction (also called patient experience) scores. And for good reason: The Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) program that started Oct. 1, 2012, has placed your hospital’s Medicare reimbursement at risk based on its HCAHPS scores.

HVBP and Patient Satisfaction

Patient satisfaction will remain an important part of HVBP in the coming years. Table 1 (below) shows the domains that will be included in fiscal years 2014 (which starts Oct. 1, 2013), 2015, and 2016. Table 2 (below) depicts the percent weighting the patient-satisfaction domain will receive through 2016. You may recall that HVBP is a program in which all hospitals place 1% to 2% (2013 through 2017, starting at 1% and increasing each year by 0.25% so that by 2017%, it is 2%) of their CMS inpatient payments in a withhold pool and, based on performance, can make back some, all, or an amount in excess of the amount placed in the withhold pool.

click for large version

click for large version

End In Itself

A colleague of mine recently asked, “Is an increase in patient satisfaction associated with higher quality of care and better patient safety?” The point here: It doesn’t matter. Patient satisfaction is an end in itself, and we should strive to maximize it, or at least put ourselves in the place of the patient and design care accordingly.

For Hospitalists: A Starting Point

There is a conundrum for hospitalists vis-à-vis patient satisfaction. Follow this chain of logic: The hospitals at which we work are incented to perform well on the HCAHPS domains. Hospitals pay a lot for hospitalists. Hospitalists can impact many of the HCAHPS domains. So shouldn’t hospitalists be judged according to HCAHPS scores?

Yes and no.

HCAHPS as a survey is intended to measure a patient’s overall experience of receiving care in the hospital. For example, from the “Doctor Communication” domain, we have questions like “how often did doctors treat you with courtesy and respect?” And “how often did doctors explain things in a way you could understand?”

These questions, like all in HCAHPS, are not designed to get at individual doctor performance, or even performance of a group of doctors, such as hospitalists. Instead, they are designed to measure a patient’s overall experience with the hospitalization, and “Doctor Communication” questions are designed to assess satisfaction with “doctors” collectively.

The Need for Hospitalist-Specific Satisfaction Surveys

So while HCAHPS is not designed to measure hospitalist performance with regard to patient satisfaction, it is a reasonable interim step for hospitals to judge hospitalists according to HCAHPS. However, this should be a bridge to a strategy that adopts hospitalist-specific patient-satisfaction questionnaires in the future and not an end in itself.

Why? Perhaps the biggest reason is that HCAHPS scores are neither specific nor timely enough to form the basis of improvement efforts for hospitalists. If a hospitalist receives a low score on the “Doctor Communication” domain, the scores are likely to be three to nine months old. How can we legitimately assign (and then modify) behaviors based on those scores?

Further, because the survey is not built to measure patient satisfaction specifically with hospitalists, the results are unlikely to engender meaningful and sustained behavior change. Hospitalists I talk to are generally bewildered and confused by HCAHPS scores attributed to them or their groups. Even if they understand the scores, I almost never see true quality improvement (plan-do-study-act) based on specific HCAHPS results. Instead, I see hospitalists trying to adhere to “best practices,” with no adjustments made along the way based on performance.

Nearly all the prominent patient satisfaction vendors have developed a survey instrument specifically designed for hospitalists. Each has an approach to appropriately attribute performance to the hospitalist in question, and each has a battery of questions that is designed to capture patient satisfaction with the hospitalist. Although use of these surveys involves an added financial commitment, I submit that because hospitalists have an unparalleled proximity to hospitalized patients, such an investment is worthy of consideration and has an accompanying business case, thanks to HVBP. The results of these surveys may form the basis of legitimate, targeted feedback to hospitalists, who may then adjust their approach to patient interactions. Such performance improvement should result in improved HCAHPS scores.

In sum, hospitalists should pay close attention to patient satisfaction and embrace HCAHPS. However, we should be looking beyond HCAHPS to survey instruments that fairly and accurately measure our performance. Such surveys will be more widely accepted by the hospitalists they are measuring, and will allow hospitalists to perform meaningful quality improvement based on the results. Although hospitalist-specific surveys will require an investment, the increased patient satisfaction that results should be the basis of a favorable return on that investment.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is co-founder and past president of SHM. Email him at [email protected].

Feeling frustrated with your group’s patient-satisfaction performance? Wondering why your chief (fill in the blank) officer glazes over when you try to explain why your hospitalist group’s Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores for doctor communication are in a percentile rivaling the numeric age of your children?

It is likely that the C-suite administrator overseeing your hospitalist group has a portion of their pay based on HCAHPS or other patient-satisfaction (also called patient experience) scores. And for good reason: The Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) program that started Oct. 1, 2012, has placed your hospital’s Medicare reimbursement at risk based on its HCAHPS scores.

HVBP and Patient Satisfaction

Patient satisfaction will remain an important part of HVBP in the coming years. Table 1 (below) shows the domains that will be included in fiscal years 2014 (which starts Oct. 1, 2013), 2015, and 2016. Table 2 (below) depicts the percent weighting the patient-satisfaction domain will receive through 2016. You may recall that HVBP is a program in which all hospitals place 1% to 2% (2013 through 2017, starting at 1% and increasing each year by 0.25% so that by 2017%, it is 2%) of their CMS inpatient payments in a withhold pool and, based on performance, can make back some, all, or an amount in excess of the amount placed in the withhold pool.

click for large version

click for large version

End In Itself

A colleague of mine recently asked, “Is an increase in patient satisfaction associated with higher quality of care and better patient safety?” The point here: It doesn’t matter. Patient satisfaction is an end in itself, and we should strive to maximize it, or at least put ourselves in the place of the patient and design care accordingly.

For Hospitalists: A Starting Point

There is a conundrum for hospitalists vis-à-vis patient satisfaction. Follow this chain of logic: The hospitals at which we work are incented to perform well on the HCAHPS domains. Hospitals pay a lot for hospitalists. Hospitalists can impact many of the HCAHPS domains. So shouldn’t hospitalists be judged according to HCAHPS scores?

Yes and no.

HCAHPS as a survey is intended to measure a patient’s overall experience of receiving care in the hospital. For example, from the “Doctor Communication” domain, we have questions like “how often did doctors treat you with courtesy and respect?” And “how often did doctors explain things in a way you could understand?”

These questions, like all in HCAHPS, are not designed to get at individual doctor performance, or even performance of a group of doctors, such as hospitalists. Instead, they are designed to measure a patient’s overall experience with the hospitalization, and “Doctor Communication” questions are designed to assess satisfaction with “doctors” collectively.

The Need for Hospitalist-Specific Satisfaction Surveys

So while HCAHPS is not designed to measure hospitalist performance with regard to patient satisfaction, it is a reasonable interim step for hospitals to judge hospitalists according to HCAHPS. However, this should be a bridge to a strategy that adopts hospitalist-specific patient-satisfaction questionnaires in the future and not an end in itself.

Why? Perhaps the biggest reason is that HCAHPS scores are neither specific nor timely enough to form the basis of improvement efforts for hospitalists. If a hospitalist receives a low score on the “Doctor Communication” domain, the scores are likely to be three to nine months old. How can we legitimately assign (and then modify) behaviors based on those scores?

Further, because the survey is not built to measure patient satisfaction specifically with hospitalists, the results are unlikely to engender meaningful and sustained behavior change. Hospitalists I talk to are generally bewildered and confused by HCAHPS scores attributed to them or their groups. Even if they understand the scores, I almost never see true quality improvement (plan-do-study-act) based on specific HCAHPS results. Instead, I see hospitalists trying to adhere to “best practices,” with no adjustments made along the way based on performance.

Nearly all the prominent patient satisfaction vendors have developed a survey instrument specifically designed for hospitalists. Each has an approach to appropriately attribute performance to the hospitalist in question, and each has a battery of questions that is designed to capture patient satisfaction with the hospitalist. Although use of these surveys involves an added financial commitment, I submit that because hospitalists have an unparalleled proximity to hospitalized patients, such an investment is worthy of consideration and has an accompanying business case, thanks to HVBP. The results of these surveys may form the basis of legitimate, targeted feedback to hospitalists, who may then adjust their approach to patient interactions. Such performance improvement should result in improved HCAHPS scores.

In sum, hospitalists should pay close attention to patient satisfaction and embrace HCAHPS. However, we should be looking beyond HCAHPS to survey instruments that fairly and accurately measure our performance. Such surveys will be more widely accepted by the hospitalists they are measuring, and will allow hospitalists to perform meaningful quality improvement based on the results. Although hospitalist-specific surveys will require an investment, the increased patient satisfaction that results should be the basis of a favorable return on that investment.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is co-founder and past president of SHM. Email him at [email protected].

It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Growing up on a farm in rural Kentucky could have led to a career in the family business for Julianna Lindsey, MD, MBA, FHM. Except she knew at an early age that she wanted to be a doctor.

“My family physician was very influential on my decision to become a physician,” she says. “[He] mentored and encouraged me from a young age; it was very powerful for me.”

Dr. Lindsey earned bachelor’s degrees in biomedical science from the University of South Alabama and biochemistry from Western Kentucky University. She graduated from the University of Kentucky College of Medicine and completed her internal-medicine residency at the University of Kentucky. In 2011, she earned her master’s in business administration from the University of Tennessee.

Immediately following residency, she worked for the Veterans Affairs Medical Center in Lexington, Ky., as an ED physician. In 2002, she latched on to a career in HM when she and her husband, a gastroenterologist, relocated to Knoxville, Tenn. She recently launched a startup company, Synergy Surgicalists, with two orthopedic surgeons, and also provides process-improvement and leadership-development consulting.

She says she was told early in her career to know your goals and stay focused.

“That has been the guiding light for me throughout my career,” says Dr. Lindsey, one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group. “My goal is to make medical care better and safer for hospitalized patients. We increasingly need to figure out how to do that with fewer and fewer resources. Regardless, we can never move backward on delivering better and safer care to patients.”

Question: How did you decide to become a hospitalist?

Answer: I have always been drawn to the practice of acute-care medicine. I enjoy taking care of patients and their families in their times of need. From the purely diagnostic standpoint, I very much enjoy the critical decision-making required in the diagnosis and treatment of the acutely ill patient.

Q: What do you like most about working as a hospitalist?

A: I enjoy the opportunity to “dig in” and positively affect processes and patient outcomes throughout hospitals.

Q: What do you dislike most?

A: Fighting the “scope creep” that is continually pushing on us as hospitalists. Hospitalists are constantly being asked to admit patients whose problems are outside the scope of our practice as medically trained physicians. A few examples of this include acute surgical abdomens, intracranial hemorrhages, and blunt-trauma cases.

Q: What’s the biggest change you’ve seen in HM in your career?

A: The explosion of hospitalist programs throughout the country. Hospitalists programs are now even being built by payors and long-term-care facilities.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In order to improve upon a process, you must know the process; to truly know the process, you must live the process. If you are not at the bedside delivering care to patients, there will be a disconnect between you, as a leader, and your physicians, who are at the bedside delivering care.

Q: What are your interests outside of patient care?

A: I believe the success—or failure—of a hospital, physician group, corporation, etc. is directly related to leadership. I enjoy leadership development because I see that as “mission critical” to the success of delivering better and safer patient care in any health-care system. As physicians, most of us never receive meaningful leadership training, yet are expected to come out of residency ready to lead. I enjoy providing physicians the tools to lead effectively. It makes the careers of physician leaders more fulfilling, as well as the careers of those physicians who are “following.”

Q: What is your biggest professional challenge?

A: Continuing to provide better and safer patient care with diminishing resources.

Q: What is your biggest professional reward?

A: Making a difference in the lives of patients. It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Q: When you aren’t working, what is important to you?

A: My husband and children are the most important aspect of my life. My husband is a gastroenterologist; we have been married for 13 years. We have two healthy, happy kiddos ages 8 and 10.

Q: What’s next professionally? Where do you see yourself in 10 years?

A: I am partnering with two orthopedic surgeons in a startup company, Synergy Surgicalists. Our company mirrors the hospitalist model utilizing general and orthopedic surgeons. It’s very exciting to have the opportunity to bring value to hospitals and patients on a larger scale. Also, for the immediate future, I have accepted the role of interim executive medical director for hospital medicine for University of Texas Southwestern and Parkland hospitals. We are completely restructuring those programs in preparation for moving into two beautiful new (and very large) hospitals. I’m very excited about working with a truly excellent group of physicians and leaders while we are recruiting a permanent executive director and expanding our ranks.

Q: If you weren’t a doctor, what would you be doing right now?

A: I cannot imagine not being a physician. I suppose if pressed, I imagine I would have landed somewhere in the financial industry. I am also a musician, but have a hard time seeing myself employed in that industry.

Q: What’s the best book you’ve read recently?

A: “Widow Walk” by Gerard LaSalle. He is a physician author who pens a beautiful story. It’s just an enjoyable read of American historical fiction set in the Pacific Northwest.

Q: How many Apple products do you interface with in a given week?

A: Sadly, I interface with 11 (11!) different Apple products in any given week. (Even sadder: I just came into an iPod Shuffle, so I’m up to 12 … )

Q: What’s next in your Netflix queue?

A: “Fringe,” Season 2, Episode 19.

Richard Quinn is a freelance writer in New Jersey.

It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Growing up on a farm in rural Kentucky could have led to a career in the family business for Julianna Lindsey, MD, MBA, FHM. Except she knew at an early age that she wanted to be a doctor.

“My family physician was very influential on my decision to become a physician,” she says. “[He] mentored and encouraged me from a young age; it was very powerful for me.”

Dr. Lindsey earned bachelor’s degrees in biomedical science from the University of South Alabama and biochemistry from Western Kentucky University. She graduated from the University of Kentucky College of Medicine and completed her internal-medicine residency at the University of Kentucky. In 2011, she earned her master’s in business administration from the University of Tennessee.

Immediately following residency, she worked for the Veterans Affairs Medical Center in Lexington, Ky., as an ED physician. In 2002, she latched on to a career in HM when she and her husband, a gastroenterologist, relocated to Knoxville, Tenn. She recently launched a startup company, Synergy Surgicalists, with two orthopedic surgeons, and also provides process-improvement and leadership-development consulting.

She says she was told early in her career to know your goals and stay focused.

“That has been the guiding light for me throughout my career,” says Dr. Lindsey, one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group. “My goal is to make medical care better and safer for hospitalized patients. We increasingly need to figure out how to do that with fewer and fewer resources. Regardless, we can never move backward on delivering better and safer care to patients.”

Question: How did you decide to become a hospitalist?

Answer: I have always been drawn to the practice of acute-care medicine. I enjoy taking care of patients and their families in their times of need. From the purely diagnostic standpoint, I very much enjoy the critical decision-making required in the diagnosis and treatment of the acutely ill patient.

Q: What do you like most about working as a hospitalist?

A: I enjoy the opportunity to “dig in” and positively affect processes and patient outcomes throughout hospitals.

Q: What do you dislike most?

A: Fighting the “scope creep” that is continually pushing on us as hospitalists. Hospitalists are constantly being asked to admit patients whose problems are outside the scope of our practice as medically trained physicians. A few examples of this include acute surgical abdomens, intracranial hemorrhages, and blunt-trauma cases.

Q: What’s the biggest change you’ve seen in HM in your career?

A: The explosion of hospitalist programs throughout the country. Hospitalists programs are now even being built by payors and long-term-care facilities.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In order to improve upon a process, you must know the process; to truly know the process, you must live the process. If you are not at the bedside delivering care to patients, there will be a disconnect between you, as a leader, and your physicians, who are at the bedside delivering care.

Q: What are your interests outside of patient care?

A: I believe the success—or failure—of a hospital, physician group, corporation, etc. is directly related to leadership. I enjoy leadership development because I see that as “mission critical” to the success of delivering better and safer patient care in any health-care system. As physicians, most of us never receive meaningful leadership training, yet are expected to come out of residency ready to lead. I enjoy providing physicians the tools to lead effectively. It makes the careers of physician leaders more fulfilling, as well as the careers of those physicians who are “following.”

Q: What is your biggest professional challenge?

A: Continuing to provide better and safer patient care with diminishing resources.

Q: What is your biggest professional reward?

A: Making a difference in the lives of patients. It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Q: When you aren’t working, what is important to you?

A: My husband and children are the most important aspect of my life. My husband is a gastroenterologist; we have been married for 13 years. We have two healthy, happy kiddos ages 8 and 10.

Q: What’s next professionally? Where do you see yourself in 10 years?

A: I am partnering with two orthopedic surgeons in a startup company, Synergy Surgicalists. Our company mirrors the hospitalist model utilizing general and orthopedic surgeons. It’s very exciting to have the opportunity to bring value to hospitals and patients on a larger scale. Also, for the immediate future, I have accepted the role of interim executive medical director for hospital medicine for University of Texas Southwestern and Parkland hospitals. We are completely restructuring those programs in preparation for moving into two beautiful new (and very large) hospitals. I’m very excited about working with a truly excellent group of physicians and leaders while we are recruiting a permanent executive director and expanding our ranks.

Q: If you weren’t a doctor, what would you be doing right now?

A: I cannot imagine not being a physician. I suppose if pressed, I imagine I would have landed somewhere in the financial industry. I am also a musician, but have a hard time seeing myself employed in that industry.

Q: What’s the best book you’ve read recently?

A: “Widow Walk” by Gerard LaSalle. He is a physician author who pens a beautiful story. It’s just an enjoyable read of American historical fiction set in the Pacific Northwest.

Q: How many Apple products do you interface with in a given week?

A: Sadly, I interface with 11 (11!) different Apple products in any given week. (Even sadder: I just came into an iPod Shuffle, so I’m up to 12 … )

Q: What’s next in your Netflix queue?

A: “Fringe,” Season 2, Episode 19.

Richard Quinn is a freelance writer in New Jersey.

It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Growing up on a farm in rural Kentucky could have led to a career in the family business for Julianna Lindsey, MD, MBA, FHM. Except she knew at an early age that she wanted to be a doctor.

“My family physician was very influential on my decision to become a physician,” she says. “[He] mentored and encouraged me from a young age; it was very powerful for me.”

Dr. Lindsey earned bachelor’s degrees in biomedical science from the University of South Alabama and biochemistry from Western Kentucky University. She graduated from the University of Kentucky College of Medicine and completed her internal-medicine residency at the University of Kentucky. In 2011, she earned her master’s in business administration from the University of Tennessee.

Immediately following residency, she worked for the Veterans Affairs Medical Center in Lexington, Ky., as an ED physician. In 2002, she latched on to a career in HM when she and her husband, a gastroenterologist, relocated to Knoxville, Tenn. She recently launched a startup company, Synergy Surgicalists, with two orthopedic surgeons, and also provides process-improvement and leadership-development consulting.

She says she was told early in her career to know your goals and stay focused.

“That has been the guiding light for me throughout my career,” says Dr. Lindsey, one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group. “My goal is to make medical care better and safer for hospitalized patients. We increasingly need to figure out how to do that with fewer and fewer resources. Regardless, we can never move backward on delivering better and safer care to patients.”

Question: How did you decide to become a hospitalist?

Answer: I have always been drawn to the practice of acute-care medicine. I enjoy taking care of patients and their families in their times of need. From the purely diagnostic standpoint, I very much enjoy the critical decision-making required in the diagnosis and treatment of the acutely ill patient.

Q: What do you like most about working as a hospitalist?

A: I enjoy the opportunity to “dig in” and positively affect processes and patient outcomes throughout hospitals.

Q: What do you dislike most?

A: Fighting the “scope creep” that is continually pushing on us as hospitalists. Hospitalists are constantly being asked to admit patients whose problems are outside the scope of our practice as medically trained physicians. A few examples of this include acute surgical abdomens, intracranial hemorrhages, and blunt-trauma cases.

Q: What’s the biggest change you’ve seen in HM in your career?

A: The explosion of hospitalist programs throughout the country. Hospitalists programs are now even being built by payors and long-term-care facilities.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In order to improve upon a process, you must know the process; to truly know the process, you must live the process. If you are not at the bedside delivering care to patients, there will be a disconnect between you, as a leader, and your physicians, who are at the bedside delivering care.

Q: What are your interests outside of patient care?

A: I believe the success—or failure—of a hospital, physician group, corporation, etc. is directly related to leadership. I enjoy leadership development because I see that as “mission critical” to the success of delivering better and safer patient care in any health-care system. As physicians, most of us never receive meaningful leadership training, yet are expected to come out of residency ready to lead. I enjoy providing physicians the tools to lead effectively. It makes the careers of physician leaders more fulfilling, as well as the careers of those physicians who are “following.”

Q: What is your biggest professional challenge?

A: Continuing to provide better and safer patient care with diminishing resources.

Q: What is your biggest professional reward?

A: Making a difference in the lives of patients. It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Q: When you aren’t working, what is important to you?

A: My husband and children are the most important aspect of my life. My husband is a gastroenterologist; we have been married for 13 years. We have two healthy, happy kiddos ages 8 and 10.

Q: What’s next professionally? Where do you see yourself in 10 years?

A: I am partnering with two orthopedic surgeons in a startup company, Synergy Surgicalists. Our company mirrors the hospitalist model utilizing general and orthopedic surgeons. It’s very exciting to have the opportunity to bring value to hospitals and patients on a larger scale. Also, for the immediate future, I have accepted the role of interim executive medical director for hospital medicine for University of Texas Southwestern and Parkland hospitals. We are completely restructuring those programs in preparation for moving into two beautiful new (and very large) hospitals. I’m very excited about working with a truly excellent group of physicians and leaders while we are recruiting a permanent executive director and expanding our ranks.

Q: If you weren’t a doctor, what would you be doing right now?

A: I cannot imagine not being a physician. I suppose if pressed, I imagine I would have landed somewhere in the financial industry. I am also a musician, but have a hard time seeing myself employed in that industry.

Q: What’s the best book you’ve read recently?

A: “Widow Walk” by Gerard LaSalle. He is a physician author who pens a beautiful story. It’s just an enjoyable read of American historical fiction set in the Pacific Northwest.

Q: How many Apple products do you interface with in a given week?

A: Sadly, I interface with 11 (11!) different Apple products in any given week. (Even sadder: I just came into an iPod Shuffle, so I’m up to 12 … )

Q: What’s next in your Netflix queue?

A: “Fringe,” Season 2, Episode 19.

Richard Quinn is a freelance writer in New Jersey.

SHM asked Academic Hospitalist Academy course co-directors Jeffrey Glasheen, MD, SFHM, and Bradley Sharpe, MD, SFHM, why academic hospitalists should attend this year’s academy.

Question: What has you personally excited about this year’s Academic Hospitalist Academy?

Dr. Sharpe: I’ll be honest—it is one of my favorite weeks of the year. It is a tremendous opportunity to engage with academic hospitalists and help them develop the core skills they need to be successful.

Dr. Glasheen: For me, it’s about the energy, the talent, and the excitement that the attendees bring to the course. It ends up being a tremendously energizing week for me personally. To see the talent in the room begin to find outlets for success is truly invigorating.

Q: If you were talking one on one with an academic hospitalist, what would you say to encourage them to attend?

Dr. Sharpe: Based on previous attendees, these four days could truly change your life. We are confident you will leave with newfound energy and enthusiasm and key building blocks to help you be successful when you go back home. Don’t miss it.

Dr. Glasheen: There is a magical transformation that happens every year. Very talented individuals enter the program. Nearly uniformly, they are struggling with the same issues around mentorship, sense of purpose, direction, and resources for success. They all want to be successful but sense there is something that is missing, and within the course of four days, they find it.

Q: What have you heard from previous AHA attendees?

Dr. Sharpe: Here are a couple of emails I received: “I can’t say enough about the AHA. It was possibly the most important 3 days of my young career. Thank you both for the knowledge and guidance.” “I have fond memories of the whole AHA conference. The great Jeff Wiese!!! But most of all, the small group sessions were extremely helpful.”

Dr. Glasheen: To a person, they all say the meeting is “transformational.” They gain skills in teaching, confidence in evaluating learners, methods for scholarly success, and a roadmap for navigating the tricky world on academic medicine. But beyond that, they gain a peer network. They leave tied in with 80 other national colleagues that are struggling with the same issues. This network becomes their home away from home—people they can turn to with a question, catch up with at a national meeting, and look to as exemplars in the field.

SHM asked Academic Hospitalist Academy course co-directors Jeffrey Glasheen, MD, SFHM, and Bradley Sharpe, MD, SFHM, why academic hospitalists should attend this year’s academy.

Question: What has you personally excited about this year’s Academic Hospitalist Academy?

Dr. Sharpe: I’ll be honest—it is one of my favorite weeks of the year. It is a tremendous opportunity to engage with academic hospitalists and help them develop the core skills they need to be successful.

Dr. Glasheen: For me, it’s about the energy, the talent, and the excitement that the attendees bring to the course. It ends up being a tremendously energizing week for me personally. To see the talent in the room begin to find outlets for success is truly invigorating.

Q: If you were talking one on one with an academic hospitalist, what would you say to encourage them to attend?

Dr. Sharpe: Based on previous attendees, these four days could truly change your life. We are confident you will leave with newfound energy and enthusiasm and key building blocks to help you be successful when you go back home. Don’t miss it.

Dr. Glasheen: There is a magical transformation that happens every year. Very talented individuals enter the program. Nearly uniformly, they are struggling with the same issues around mentorship, sense of purpose, direction, and resources for success. They all want to be successful but sense there is something that is missing, and within the course of four days, they find it.

Q: What have you heard from previous AHA attendees?

Dr. Sharpe: Here are a couple of emails I received: “I can’t say enough about the AHA. It was possibly the most important 3 days of my young career. Thank you both for the knowledge and guidance.” “I have fond memories of the whole AHA conference. The great Jeff Wiese!!! But most of all, the small group sessions were extremely helpful.”

Dr. Glasheen: To a person, they all say the meeting is “transformational.” They gain skills in teaching, confidence in evaluating learners, methods for scholarly success, and a roadmap for navigating the tricky world on academic medicine. But beyond that, they gain a peer network. They leave tied in with 80 other national colleagues that are struggling with the same issues. This network becomes their home away from home—people they can turn to with a question, catch up with at a national meeting, and look to as exemplars in the field.

SHM asked Academic Hospitalist Academy course co-directors Jeffrey Glasheen, MD, SFHM, and Bradley Sharpe, MD, SFHM, why academic hospitalists should attend this year’s academy.

Question: What has you personally excited about this year’s Academic Hospitalist Academy?

Dr. Sharpe: I’ll be honest—it is one of my favorite weeks of the year. It is a tremendous opportunity to engage with academic hospitalists and help them develop the core skills they need to be successful.

Dr. Glasheen: For me, it’s about the energy, the talent, and the excitement that the attendees bring to the course. It ends up being a tremendously energizing week for me personally. To see the talent in the room begin to find outlets for success is truly invigorating.

Q: If you were talking one on one with an academic hospitalist, what would you say to encourage them to attend?

Dr. Sharpe: Based on previous attendees, these four days could truly change your life. We are confident you will leave with newfound energy and enthusiasm and key building blocks to help you be successful when you go back home. Don’t miss it.

Dr. Glasheen: There is a magical transformation that happens every year. Very talented individuals enter the program. Nearly uniformly, they are struggling with the same issues around mentorship, sense of purpose, direction, and resources for success. They all want to be successful but sense there is something that is missing, and within the course of four days, they find it.

Q: What have you heard from previous AHA attendees?

Dr. Sharpe: Here are a couple of emails I received: “I can’t say enough about the AHA. It was possibly the most important 3 days of my young career. Thank you both for the knowledge and guidance.” “I have fond memories of the whole AHA conference. The great Jeff Wiese!!! But most of all, the small group sessions were extremely helpful.”

Dr. Glasheen: To a person, they all say the meeting is “transformational.” They gain skills in teaching, confidence in evaluating learners, methods for scholarly success, and a roadmap for navigating the tricky world on academic medicine. But beyond that, they gain a peer network. They leave tied in with 80 other national colleagues that are struggling with the same issues. This network becomes their home away from home—people they can turn to with a question, catch up with at a national meeting, and look to as exemplars in the field.