Leadership Training

The current health care environment is undergoing a rapid transformation. In evolutionary biology, a theory exists called punctuated equilibrium. This theory suggests there are long periods of little or no morphological change amongst species and then, geologically speaking, short periods of rapid change in response to pressures within the environment. This rapid period of change adds significant diversity to the landscape of existing species. In health care, we are undergoing a period of “punctuation.”

A testament to the degree of change is a scan of the various consolidation activities occurring across the health care space. Some are more traditional, such as mergers of health systems with different or competing geographical footprints or hospitalist management companies that provide similar services and desire to increase their market share. Others that are more interesting are those that include mergers of seemingly different business lines or offerings, like CVS Health and Aetna; Humana and Kindred; or even organizations such as Amazon, Berkshire Hathaway, and JP Morgan hiring Atul Gawande as the CEO of their newly formed health care venture. The latter examples serve as an illustration of the reorganization that is occurring within health care delivery. This represents, at the very least, a blurring of the lines – if not a deconstruction and complete rebuild – of traditional lines of separation between payers, providers, employers, and retailers.

In other words, the silos are coming down, significant diversity in the landscape of existing species. A common theme across these changes is that most – if not all – participants will share some portion of the financial risk associated with these evolving models. High-deductible health plans, alternative payment models (APMs), and advanced APMs are examples of tactics and models that distribute the financial risk. The consolidations referenced above will likely continue to encourage distribution of the financial risk across patients, providers, employers, and payers.

A key theme coming into focus is that the evolving care delivery system will not be defined by bricks and mortar. Rather, it will follow the patient and go wherever he or she goes to meet his or her specific needs. This is why we’re seeing mergers comprised of a variety of assets, including personnel, technology, critical supplies (such as pharmaceuticals), and funding resources. This very purposeful and deliberate melting pot phenomenon will restructure and reformat the care delivery model.

To be successful within this new landscape, there will need to be a renewed focus on working within a collaborative model. The days of a single entity or provider being able to serve as the “be all” or “do all” is over, and the days of practicing medicine as the Lone Ranger are anachronistic. Instead, there is a need for health care providers to embrace and lead a team-based care model. Team-based care should have the patient at the center of the care delivery model and leverage the expertise of the various team members to practice at the “top of their expertise.”

In hospital medicine, this includes a variety of team members – from physicians, nurse practitioners, physician assistants, and clinical pharmacists to case managers, physical therapists, subject matter experts in quality improvement, and analysts – who identify operational priorities from the data rather than reporting predefined goals on dashboards. Although possibly a good start, this is by no means an exhaustive list of team members. The team will be defined by the goals the health care team aspires to achieve. These goals may include closer alignment with payers, employers, and post-acute partners; the goals will influence the composition of the team. Once the team is defined, the challenge will be to effectively integrate team members, so they are contributing their expertise to the patient care being delivered.

Some ingredients for effective team-based care include the following:

• Developing an effective process for engagement and providing a voice for all team members. Interdisciplinary team rounds where there is an established time for team members to plan and operationalize their plans around patient care can serve as an example of this type of structured process.
• Creating well-defined roles and responsibilities with key performance indicators to promote accountability. The team will have outcomes they are measuring and striving to impact, and each team member will have a role in achieving those goals. Being able to parse out and measure how each team member contributes to the overall outcome can be beneficial. This provides an opportunity for each team member to play a meaningful role in accomplishing the overall goal and allows for a measurement process to track success. For example, an overall team goal may be to have a specific percentage of eligible discharges completed by 11:00 a.m. To accomplish this goal, there may be specific objectives for the clinicians to have discharge orders in the chart by 9:30 a.m. and for case management to have communicated with any post-acute services the day before discharge. These specific accountability measures facilitate accomplishing the larger team goal.
• Developing a culture of safety and transparency. Effective teams promote an environment where all members are empowered and encouraged to speak and share their perspective and knowledge. Communication is based on the value it provides to accomplishing the team’s goals rather than based on a hierarchy which determines who contributes and when.
• Defining and then redefining the competencies required of the team to promote continued development and growth. In this time of dynamic change, the skill sets that helped us get where we are today may be different then the skill sets that are needed for success in the future. There will continue to be a need for functional and knowledge-based competencies in addition to the need to focus on competencies that engender a culture of team-based care. For example, hospitalist leaders will need to understand evidence-based medicine to support appropriate management of a septic patient and simultaneously understand evidence-based management/leadership to affect sepsis care across his or her health care system.

With this change in the health care environment come new and exciting opportunities. Hospital medicine has always elected to assume a leadership role in these times of change, these periods of “punctuation.” Development of effective team-based care is a great place for those of us working in hospital medicine to demonstrate our leadership as we care for our patients.

Dr. Frost is national medical director, hospital-based services, at LifePoint Health, Brentwood, Tenn. He is president-elect of the Society of Hospital Medicine.

The current health care environment is undergoing a rapid transformation. In evolutionary biology, a theory exists called punctuated equilibrium. This theory suggests there are long periods of little or no morphological change amongst species and then, geologically speaking, short periods of rapid change in response to pressures within the environment. This rapid period of change adds significant diversity to the landscape of existing species. In health care, we are undergoing a period of “punctuation.”

A testament to the degree of change is a scan of the various consolidation activities occurring across the health care space. Some are more traditional, such as mergers of health systems with different or competing geographical footprints or hospitalist management companies that provide similar services and desire to increase their market share. Others that are more interesting are those that include mergers of seemingly different business lines or offerings, like CVS Health and Aetna; Humana and Kindred; or even organizations such as Amazon, Berkshire Hathaway, and JP Morgan hiring Atul Gawande as the CEO of their newly formed health care venture. The latter examples serve as an illustration of the reorganization that is occurring within health care delivery. This represents, at the very least, a blurring of the lines – if not a deconstruction and complete rebuild – of traditional lines of separation between payers, providers, employers, and retailers.

In other words, the silos are coming down, significant diversity in the landscape of existing species. A common theme across these changes is that most – if not all – participants will share some portion of the financial risk associated with these evolving models. High-deductible health plans, alternative payment models (APMs), and advanced APMs are examples of tactics and models that distribute the financial risk. The consolidations referenced above will likely continue to encourage distribution of the financial risk across patients, providers, employers, and payers.

A key theme coming into focus is that the evolving care delivery system will not be defined by bricks and mortar. Rather, it will follow the patient and go wherever he or she goes to meet his or her specific needs. This is why we’re seeing mergers comprised of a variety of assets, including personnel, technology, critical supplies (such as pharmaceuticals), and funding resources. This very purposeful and deliberate melting pot phenomenon will restructure and reformat the care delivery model.

To be successful within this new landscape, there will need to be a renewed focus on working within a collaborative model. The days of a single entity or provider being able to serve as the “be all” or “do all” is over, and the days of practicing medicine as the Lone Ranger are anachronistic. Instead, there is a need for health care providers to embrace and lead a team-based care model. Team-based care should have the patient at the center of the care delivery model and leverage the expertise of the various team members to practice at the “top of their expertise.”

In hospital medicine, this includes a variety of team members – from physicians, nurse practitioners, physician assistants, and clinical pharmacists to case managers, physical therapists, subject matter experts in quality improvement, and analysts – who identify operational priorities from the data rather than reporting predefined goals on dashboards. Although possibly a good start, this is by no means an exhaustive list of team members. The team will be defined by the goals the health care team aspires to achieve. These goals may include closer alignment with payers, employers, and post-acute partners; the goals will influence the composition of the team. Once the team is defined, the challenge will be to effectively integrate team members, so they are contributing their expertise to the patient care being delivered.

Some ingredients for effective team-based care include the following:

• Developing an effective process for engagement and providing a voice for all team members. Interdisciplinary team rounds where there is an established time for team members to plan and operationalize their plans around patient care can serve as an example of this type of structured process.
• Creating well-defined roles and responsibilities with key performance indicators to promote accountability. The team will have outcomes they are measuring and striving to impact, and each team member will have a role in achieving those goals. Being able to parse out and measure how each team member contributes to the overall outcome can be beneficial. This provides an opportunity for each team member to play a meaningful role in accomplishing the overall goal and allows for a measurement process to track success. For example, an overall team goal may be to have a specific percentage of eligible discharges completed by 11:00 a.m. To accomplish this goal, there may be specific objectives for the clinicians to have discharge orders in the chart by 9:30 a.m. and for case management to have communicated with any post-acute services the day before discharge. These specific accountability measures facilitate accomplishing the larger team goal.
• Developing a culture of safety and transparency. Effective teams promote an environment where all members are empowered and encouraged to speak and share their perspective and knowledge. Communication is based on the value it provides to accomplishing the team’s goals rather than based on a hierarchy which determines who contributes and when.
• Defining and then redefining the competencies required of the team to promote continued development and growth. In this time of dynamic change, the skill sets that helped us get where we are today may be different then the skill sets that are needed for success in the future. There will continue to be a need for functional and knowledge-based competencies in addition to the need to focus on competencies that engender a culture of team-based care. For example, hospitalist leaders will need to understand evidence-based medicine to support appropriate management of a septic patient and simultaneously understand evidence-based management/leadership to affect sepsis care across his or her health care system.

With this change in the health care environment come new and exciting opportunities. Hospital medicine has always elected to assume a leadership role in these times of change, these periods of “punctuation.” Development of effective team-based care is a great place for those of us working in hospital medicine to demonstrate our leadership as we care for our patients.

Dr. Frost is national medical director, hospital-based services, at LifePoint Health, Brentwood, Tenn. He is president-elect of the Society of Hospital Medicine.

The current health care environment is undergoing a rapid transformation. In evolutionary biology, a theory exists called punctuated equilibrium. This theory suggests there are long periods of little or no morphological change amongst species and then, geologically speaking, short periods of rapid change in response to pressures within the environment. This rapid period of change adds significant diversity to the landscape of existing species. In health care, we are undergoing a period of “punctuation.”

A testament to the degree of change is a scan of the various consolidation activities occurring across the health care space. Some are more traditional, such as mergers of health systems with different or competing geographical footprints or hospitalist management companies that provide similar services and desire to increase their market share. Others that are more interesting are those that include mergers of seemingly different business lines or offerings, like CVS Health and Aetna; Humana and Kindred; or even organizations such as Amazon, Berkshire Hathaway, and JP Morgan hiring Atul Gawande as the CEO of their newly formed health care venture. The latter examples serve as an illustration of the reorganization that is occurring within health care delivery. This represents, at the very least, a blurring of the lines – if not a deconstruction and complete rebuild – of traditional lines of separation between payers, providers, employers, and retailers.

In other words, the silos are coming down, significant diversity in the landscape of existing species. A common theme across these changes is that most – if not all – participants will share some portion of the financial risk associated with these evolving models. High-deductible health plans, alternative payment models (APMs), and advanced APMs are examples of tactics and models that distribute the financial risk. The consolidations referenced above will likely continue to encourage distribution of the financial risk across patients, providers, employers, and payers.

A key theme coming into focus is that the evolving care delivery system will not be defined by bricks and mortar. Rather, it will follow the patient and go wherever he or she goes to meet his or her specific needs. This is why we’re seeing mergers comprised of a variety of assets, including personnel, technology, critical supplies (such as pharmaceuticals), and funding resources. This very purposeful and deliberate melting pot phenomenon will restructure and reformat the care delivery model.

To be successful within this new landscape, there will need to be a renewed focus on working within a collaborative model. The days of a single entity or provider being able to serve as the “be all” or “do all” is over, and the days of practicing medicine as the Lone Ranger are anachronistic. Instead, there is a need for health care providers to embrace and lead a team-based care model. Team-based care should have the patient at the center of the care delivery model and leverage the expertise of the various team members to practice at the “top of their expertise.”

In hospital medicine, this includes a variety of team members – from physicians, nurse practitioners, physician assistants, and clinical pharmacists to case managers, physical therapists, subject matter experts in quality improvement, and analysts – who identify operational priorities from the data rather than reporting predefined goals on dashboards. Although possibly a good start, this is by no means an exhaustive list of team members. The team will be defined by the goals the health care team aspires to achieve. These goals may include closer alignment with payers, employers, and post-acute partners; the goals will influence the composition of the team. Once the team is defined, the challenge will be to effectively integrate team members, so they are contributing their expertise to the patient care being delivered.

Some ingredients for effective team-based care include the following:

• Developing an effective process for engagement and providing a voice for all team members. Interdisciplinary team rounds where there is an established time for team members to plan and operationalize their plans around patient care can serve as an example of this type of structured process.
• Creating well-defined roles and responsibilities with key performance indicators to promote accountability. The team will have outcomes they are measuring and striving to impact, and each team member will have a role in achieving those goals. Being able to parse out and measure how each team member contributes to the overall outcome can be beneficial. This provides an opportunity for each team member to play a meaningful role in accomplishing the overall goal and allows for a measurement process to track success. For example, an overall team goal may be to have a specific percentage of eligible discharges completed by 11:00 a.m. To accomplish this goal, there may be specific objectives for the clinicians to have discharge orders in the chart by 9:30 a.m. and for case management to have communicated with any post-acute services the day before discharge. These specific accountability measures facilitate accomplishing the larger team goal.
• Developing a culture of safety and transparency. Effective teams promote an environment where all members are empowered and encouraged to speak and share their perspective and knowledge. Communication is based on the value it provides to accomplishing the team’s goals rather than based on a hierarchy which determines who contributes and when.
• Defining and then redefining the competencies required of the team to promote continued development and growth. In this time of dynamic change, the skill sets that helped us get where we are today may be different then the skill sets that are needed for success in the future. There will continue to be a need for functional and knowledge-based competencies in addition to the need to focus on competencies that engender a culture of team-based care. For example, hospitalist leaders will need to understand evidence-based medicine to support appropriate management of a septic patient and simultaneously understand evidence-based management/leadership to affect sepsis care across his or her health care system.

With this change in the health care environment come new and exciting opportunities. Hospital medicine has always elected to assume a leadership role in these times of change, these periods of “punctuation.” Development of effective team-based care is a great place for those of us working in hospital medicine to demonstrate our leadership as we care for our patients.

Dr. Frost is national medical director, hospital-based services, at LifePoint Health, Brentwood, Tenn. He is president-elect of the Society of Hospital Medicine.

This fall I attended the 2018 Society of Hospital Medicine Leadership Academy, held in Vancouver. Once again, this conference sold out weeks ahead of time, and 300 hospitalists took time out of their busy schedules for learning and fun. There have been about 18 Leadership Academies over the years, with approximately 3,000 total participants, but this one may have been the best to date.

Why was it so good? Here are my top four reasons that Leadership Academy 2018 was the best ever:

Setting: Vancouver is just beautiful. My family has a strong maritime background, and I am a water person with saltwater in my veins. My inner sailor was overjoyed with the hotel’s views of False Creek and Vancouver Harbor, and I loved the mix of yachts and working boats. I even saw a seaplane! The hotel was a great match for the 300 hospitalists who traveled to the JW Marriott for 4 days of learning and relaxing. It was the perfect blend, whether for work or play; the hotel and city did not disappoint.

Networking: What’s more fun than getting to know 300 like-minded, leadership-oriented hospitalists for a few days? I am always energized by seeing old friends and making new ones. I really enjoy hearing about the professional adventures hospitalists at all career points are going through. Plus, I get really good advice on my own career! I also appreciate that a number of hospital medicine leaders (and even giants) come to SHM’s Leadership Academy. Over half of the SHM Board of Directors were there, as were a number of current and previous SHM presidents (Mark Williams, Jeff Wiese, Burke Kealey, Bob Harrington, Nasim Afsar, Rusty Holman, Ron Greeno, Chris Frost, and John Nelson), as well as Larry Wellikson, the CEO who has led our society through its many successes. All of these hospitalist leaders are there, having fun and networking, alongside everyone else.

Faculty: The faculty for all four courses (yes, Leadership Academy junkies, we’ve added a fourth course!) are absolutely phenomenal. I think the faculty are just the right blend of expert hospitalists (Jeff Glasheen, Rusty Holman, Jeff Wiese, Mark Williams, John Nelson) and national experts outside of hospital medicine. For example, Lenny Marcus of Harvard T.H. Chan School of Public Health, Boston, brings his experience coaching the Department of Defense, the White House, the Department of Homeland Security, and many others to the Influential Management and Mastering Teamwork courses. Lenny’s experience working with national leaders through disasters like the Boston Marathon bombing, Hurricane Katrina, and the Ebola outbreak make for more than riveting stories; there are real, tangible lessons for hospitalist leaders trying to improve clinical care. Nancy Spector is a pediatrician, nationally recognized for her work in mentoring, and is the executive director of Drexel University’s Executive Leadership in Academic Medicine. We have been fortunate to have her join the Academies, and Nancy successfully led the first group of hospitalists through the launch of SHM’s fourth leadership course, which I will describe in more detail below.

High energy & continued growth: There continues to be an enormous amount of energy around the Leadership Academy. The Vancouver courses sold out months ahead of the actual meeting! Hospitalists across the country continue to take on leadership roles and have told us that they value the skills they have learned from the courses.
 

Hospitalist leaders want more

In addition to the current 4-day courses (Strategic Essentials, Influential Management, and Mastering Teamwork), hospitalists are looking for a course that continues skill building once they return home.

That’s why SHM has developed a fourth Leadership Academy course. This course, called the Capstone Course, was launched in Vancouver and consists of 2 days of on-site skill development and team building (during the first 2 days of the traditional Leadership Academy) and 6 months of a longitudinal learning collaborative. The six-month learning collaborative component consists of a learning “pod” of five or six fellow hospitalists and monthly virtual meetings around crucial leadership topics. They are facilitated by an experienced Leadership Academy facilitator.

Dr. Spector is the lead faculty; her expertise made the Capstone launch a huge success. She will work with SHM and the Capstone participants throughout the entire 6 months to ensure the Capstone course is as high-quality as the previous three Academy courses.

If you haven’t been, I invite you to attend our next Leadership Academy. Over the years, despite being course director, I have learned many take-home skills from colleagues and leaders in the field that I use often. Just to name a few:

• Flexing my communications style: Tim Keogh’s lecture opened my eyes to the fact that not everyone is a data-driven introvert. I now know that some people need a social warm up, while others just want the facts, and that there are “huggers and shakers.” (In summary, it’s fine to shake hands with a hugger, but be wary of hugging a shaker.)
• I send birthday emails after I heard Jeff Wiese’s talk.
• Lenny Marcus taught me to be aware when I am “in the basement” emotionally. I now know to wait to send emails or confront others until I can get out of the basement.

And that’s just scratching the surface!

In closing, the Vancouver Leadership Academy was fantastic. Good friends, great professional development, a setting that was amazing, and an Academy that remains relevant and dynamic to our specialty. I can’t wait to see how the 2019 Leadership Academy shapes up for its debut in Nashville. My inner sailor may have to give way to my inner musician! I hope to see you and 300 of my closest friends there.

Learn more about SHM’s Leadership Academy at shmleadershipacademy.org.
 

Dr. Howell is a professor of medicine at Johns Hopkins University, Baltimore, and chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center. He is also chief operating officer at the Society of Hospital Medicine and course director of the SHM Leadership Academy.

This fall I attended the 2018 Society of Hospital Medicine Leadership Academy, held in Vancouver. Once again, this conference sold out weeks ahead of time, and 300 hospitalists took time out of their busy schedules for learning and fun. There have been about 18 Leadership Academies over the years, with approximately 3,000 total participants, but this one may have been the best to date.

Why was it so good? Here are my top four reasons that Leadership Academy 2018 was the best ever:

Setting: Vancouver is just beautiful. My family has a strong maritime background, and I am a water person with saltwater in my veins. My inner sailor was overjoyed with the hotel’s views of False Creek and Vancouver Harbor, and I loved the mix of yachts and working boats. I even saw a seaplane! The hotel was a great match for the 300 hospitalists who traveled to the JW Marriott for 4 days of learning and relaxing. It was the perfect blend, whether for work or play; the hotel and city did not disappoint.

Networking: What’s more fun than getting to know 300 like-minded, leadership-oriented hospitalists for a few days? I am always energized by seeing old friends and making new ones. I really enjoy hearing about the professional adventures hospitalists at all career points are going through. Plus, I get really good advice on my own career! I also appreciate that a number of hospital medicine leaders (and even giants) come to SHM’s Leadership Academy. Over half of the SHM Board of Directors were there, as were a number of current and previous SHM presidents (Mark Williams, Jeff Wiese, Burke Kealey, Bob Harrington, Nasim Afsar, Rusty Holman, Ron Greeno, Chris Frost, and John Nelson), as well as Larry Wellikson, the CEO who has led our society through its many successes. All of these hospitalist leaders are there, having fun and networking, alongside everyone else.

Faculty: The faculty for all four courses (yes, Leadership Academy junkies, we’ve added a fourth course!) are absolutely phenomenal. I think the faculty are just the right blend of expert hospitalists (Jeff Glasheen, Rusty Holman, Jeff Wiese, Mark Williams, John Nelson) and national experts outside of hospital medicine. For example, Lenny Marcus of Harvard T.H. Chan School of Public Health, Boston, brings his experience coaching the Department of Defense, the White House, the Department of Homeland Security, and many others to the Influential Management and Mastering Teamwork courses. Lenny’s experience working with national leaders through disasters like the Boston Marathon bombing, Hurricane Katrina, and the Ebola outbreak make for more than riveting stories; there are real, tangible lessons for hospitalist leaders trying to improve clinical care. Nancy Spector is a pediatrician, nationally recognized for her work in mentoring, and is the executive director of Drexel University’s Executive Leadership in Academic Medicine. We have been fortunate to have her join the Academies, and Nancy successfully led the first group of hospitalists through the launch of SHM’s fourth leadership course, which I will describe in more detail below.

High energy & continued growth: There continues to be an enormous amount of energy around the Leadership Academy. The Vancouver courses sold out months ahead of the actual meeting! Hospitalists across the country continue to take on leadership roles and have told us that they value the skills they have learned from the courses.
 

Hospitalist leaders want more

In addition to the current 4-day courses (Strategic Essentials, Influential Management, and Mastering Teamwork), hospitalists are looking for a course that continues skill building once they return home.

That’s why SHM has developed a fourth Leadership Academy course. This course, called the Capstone Course, was launched in Vancouver and consists of 2 days of on-site skill development and team building (during the first 2 days of the traditional Leadership Academy) and 6 months of a longitudinal learning collaborative. The six-month learning collaborative component consists of a learning “pod” of five or six fellow hospitalists and monthly virtual meetings around crucial leadership topics. They are facilitated by an experienced Leadership Academy facilitator.

Dr. Spector is the lead faculty; her expertise made the Capstone launch a huge success. She will work with SHM and the Capstone participants throughout the entire 6 months to ensure the Capstone course is as high-quality as the previous three Academy courses.

If you haven’t been, I invite you to attend our next Leadership Academy. Over the years, despite being course director, I have learned many take-home skills from colleagues and leaders in the field that I use often. Just to name a few:

• Flexing my communications style: Tim Keogh’s lecture opened my eyes to the fact that not everyone is a data-driven introvert. I now know that some people need a social warm up, while others just want the facts, and that there are “huggers and shakers.” (In summary, it’s fine to shake hands with a hugger, but be wary of hugging a shaker.)
• I send birthday emails after I heard Jeff Wiese’s talk.
• Lenny Marcus taught me to be aware when I am “in the basement” emotionally. I now know to wait to send emails or confront others until I can get out of the basement.

And that’s just scratching the surface!

In closing, the Vancouver Leadership Academy was fantastic. Good friends, great professional development, a setting that was amazing, and an Academy that remains relevant and dynamic to our specialty. I can’t wait to see how the 2019 Leadership Academy shapes up for its debut in Nashville. My inner sailor may have to give way to my inner musician! I hope to see you and 300 of my closest friends there.

Learn more about SHM’s Leadership Academy at shmleadershipacademy.org.
 

Dr. Howell is a professor of medicine at Johns Hopkins University, Baltimore, and chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center. He is also chief operating officer at the Society of Hospital Medicine and course director of the SHM Leadership Academy.

This fall I attended the 2018 Society of Hospital Medicine Leadership Academy, held in Vancouver. Once again, this conference sold out weeks ahead of time, and 300 hospitalists took time out of their busy schedules for learning and fun. There have been about 18 Leadership Academies over the years, with approximately 3,000 total participants, but this one may have been the best to date.

Why was it so good? Here are my top four reasons that Leadership Academy 2018 was the best ever:

Setting: Vancouver is just beautiful. My family has a strong maritime background, and I am a water person with saltwater in my veins. My inner sailor was overjoyed with the hotel’s views of False Creek and Vancouver Harbor, and I loved the mix of yachts and working boats. I even saw a seaplane! The hotel was a great match for the 300 hospitalists who traveled to the JW Marriott for 4 days of learning and relaxing. It was the perfect blend, whether for work or play; the hotel and city did not disappoint.

Networking: What’s more fun than getting to know 300 like-minded, leadership-oriented hospitalists for a few days? I am always energized by seeing old friends and making new ones. I really enjoy hearing about the professional adventures hospitalists at all career points are going through. Plus, I get really good advice on my own career! I also appreciate that a number of hospital medicine leaders (and even giants) come to SHM’s Leadership Academy. Over half of the SHM Board of Directors were there, as were a number of current and previous SHM presidents (Mark Williams, Jeff Wiese, Burke Kealey, Bob Harrington, Nasim Afsar, Rusty Holman, Ron Greeno, Chris Frost, and John Nelson), as well as Larry Wellikson, the CEO who has led our society through its many successes. All of these hospitalist leaders are there, having fun and networking, alongside everyone else.

Faculty: The faculty for all four courses (yes, Leadership Academy junkies, we’ve added a fourth course!) are absolutely phenomenal. I think the faculty are just the right blend of expert hospitalists (Jeff Glasheen, Rusty Holman, Jeff Wiese, Mark Williams, John Nelson) and national experts outside of hospital medicine. For example, Lenny Marcus of Harvard T.H. Chan School of Public Health, Boston, brings his experience coaching the Department of Defense, the White House, the Department of Homeland Security, and many others to the Influential Management and Mastering Teamwork courses. Lenny’s experience working with national leaders through disasters like the Boston Marathon bombing, Hurricane Katrina, and the Ebola outbreak make for more than riveting stories; there are real, tangible lessons for hospitalist leaders trying to improve clinical care. Nancy Spector is a pediatrician, nationally recognized for her work in mentoring, and is the executive director of Drexel University’s Executive Leadership in Academic Medicine. We have been fortunate to have her join the Academies, and Nancy successfully led the first group of hospitalists through the launch of SHM’s fourth leadership course, which I will describe in more detail below.

High energy & continued growth: There continues to be an enormous amount of energy around the Leadership Academy. The Vancouver courses sold out months ahead of the actual meeting! Hospitalists across the country continue to take on leadership roles and have told us that they value the skills they have learned from the courses.
 

Hospitalist leaders want more

In addition to the current 4-day courses (Strategic Essentials, Influential Management, and Mastering Teamwork), hospitalists are looking for a course that continues skill building once they return home.

That’s why SHM has developed a fourth Leadership Academy course. This course, called the Capstone Course, was launched in Vancouver and consists of 2 days of on-site skill development and team building (during the first 2 days of the traditional Leadership Academy) and 6 months of a longitudinal learning collaborative. The six-month learning collaborative component consists of a learning “pod” of five or six fellow hospitalists and monthly virtual meetings around crucial leadership topics. They are facilitated by an experienced Leadership Academy facilitator.

Dr. Spector is the lead faculty; her expertise made the Capstone launch a huge success. She will work with SHM and the Capstone participants throughout the entire 6 months to ensure the Capstone course is as high-quality as the previous three Academy courses.

If you haven’t been, I invite you to attend our next Leadership Academy. Over the years, despite being course director, I have learned many take-home skills from colleagues and leaders in the field that I use often. Just to name a few:

• Flexing my communications style: Tim Keogh’s lecture opened my eyes to the fact that not everyone is a data-driven introvert. I now know that some people need a social warm up, while others just want the facts, and that there are “huggers and shakers.” (In summary, it’s fine to shake hands with a hugger, but be wary of hugging a shaker.)
• I send birthday emails after I heard Jeff Wiese’s talk.
• Lenny Marcus taught me to be aware when I am “in the basement” emotionally. I now know to wait to send emails or confront others until I can get out of the basement.

And that’s just scratching the surface!

In closing, the Vancouver Leadership Academy was fantastic. Good friends, great professional development, a setting that was amazing, and an Academy that remains relevant and dynamic to our specialty. I can’t wait to see how the 2019 Leadership Academy shapes up for its debut in Nashville. My inner sailor may have to give way to my inner musician! I hope to see you and 300 of my closest friends there.

Learn more about SHM’s Leadership Academy at shmleadershipacademy.org.
 

Dr. Howell is a professor of medicine at Johns Hopkins University, Baltimore, and chief of the division of hospital medicine at Johns Hopkins Bayview Medical Center. He is also chief operating officer at the Society of Hospital Medicine and course director of the SHM Leadership Academy.

Nidhi Goel, MD, MHS, is a Med-Peds hospitalist and assistant professor of internal medicine and pediatrics at the University of Maryland, Baltimore. Since August 2017, she has been the president of the Maryland chapter of SHM.

Can you talk about your background and how you became interested in hospital medicine?

I grew up in the Baltimore area, and I went to medical school at the University of Maryland in Baltimore. I trained in internal medicine and pediatrics, also at the University of Maryland. Then I joined the faculty after I finished residency in 2014. I practiced as a hospitalist in internal medicine and pediatrics and was also a teaching hospitalist.

Early in my residency, I worked with teaching hospitalists. I rotated on the hospitalist teams, and I was inspired by their perspective on taking care of patients through a lens of quality and safety. I gained a greater appreciation for the risks associated with taking care of a patient in the hospital setting, and the opportunities to mitigate those risks and provide really high quality patient care. It made me realize that was what I wanted to do – and also to teach residents and students how to do the same.
 

So it was a philosophical attraction to the hospitalist approach?

Yes, and intellectually I’d say that I liked taking care of really complicated, very sick patients. I found that to be interesting – and rewarding when they got better.

Tell us more about what kind of research you do.

I work primarily on projects centered on quality and safety; they involve both adult internal medicine and pediatric patients. Currently on the adult medicine side, we have a project looking at improving outcomes for sepsis in the hospital setting. On the pediatric side, I’ve done a lot of work related to throughput – trying to increase the efficiency of our admissions – and especially our discharge process. Moving patients through the system efficiently has become a significant quality issue, especially during the winter months when our volumes pick up.

How long have you been involved in the Maryland SHM chapter, and what are the rewards of participation?

Early in my residency, I got involved in the chapter because some of the hospitalist faculty I worked with were chapter officers. They believed that the chapter was a good place for residents to be exposed to research and to other hospitalists for networking and camaraderie. So they began inviting us to Maryland chapter meetings, and I found those meetings to be very enlightening – from the practical and research content related to hospital medicine, and to networking with other hospitalists.

I was invited to be part of the Maryland chapter advisory board when I was still a resident, so that I might present trainee perspectives on how the chapter could continue to grow and target some of their activities for the benefit of residents. I stayed involved with the chapter after I finished residency, and when the opportunity presented itself to become an officer, and I decided to take it. I thought serving as a chapter officer would be a really interesting chance to meet more people in the field and to continue to innovate within the chapter setting.
 

Tell us more about the Maryland chapter.

We are a large chapter and we’re very, very active. Around 7 or 8 years ago, the Maryland chapter reached a significant turning point because the officers that were in place at that time had a vision for building the chapter. That was a major inflexion point in how active the chapter became, leading to the kinds of activities that we do now, and the variety of memberships.

One thing that I’m super proud of our chapter for is that we’ve really tried to continue building on the diversity that is represented in our membership. We have members stretching geographically all through the Baltimore and the Washington corridor, as well as out to western Maryland and the Eastern shore. The Maryland chapter has been able to attract members from different organizations throughout the state and from a diversity of practice settings. We have active members who are not just physicians, but also a nurse practitioners, physician assistants, and clinical pharmacists. We have members from throughout the health care delivery process, which really enriches the discussion and the value of the chapter as a whole.
 

What kind of initiatives and programs is the chapter working on?

Every year we have an abstracts competition at our fall meeting. Whoever wins that competition is allowed to present at the national SHM conference, which is a great opportunity. We’re really pushing that competition to make it an even more robust experience.

One thing that we had heard from some of our members, and that we recognized as a need as well, was to make our career guidance a little bit more robust. To that end, we’re creating a separate job fair that is almost like an employment workshop – to help people to buff up their CVs, to talk about interviewing skills, contracts, salary negotiations, as well as exposing job candidates to various hospital groups from throughout the area. That’s something that we’re really excited about. It’s going to take a lot of work, but I think it could be a really high-yield event for our members.

We’re also encouraging our nonphysician members to take more active leadership roles in the chapter; several of our nonphysician members on our chapter advisory board, including pharmacists and physician assistants, and we are trying to make sure that we’re also liaising with some of the professional organizations that represent our nonphysician members. So, for example, the clinical pharmacist who’s on our advisory board also is president of the Maryland chapter of the Society for Hospital Pharmacists. She brings a lot of really great ideas and interesting perspectives, and she’s brought a lot of exposure of our SHM chapter to the clinical pharmacy community as well.
 

What about more long-term goals for your chapter? What’s on the horizon?

We’re targeting early-career hospitalists and helping them to develop their career goals in whatever fashion they see as appropriate.

So, as someone who’s in academics, obviously research and publications are very important for me, but they’re not necessarily as important for other hospitalists. I think our early-career hospitalists are increasingly looking to incorporate things into their practice aside from direct patient care. Our members have interests in various elements of hospital medicine, including patient safety and quality improvement initiatives, clinical informatics, advocacy (especially related to the myriad aspects of health care reform), and strategies surrounding billing and denials. I think having our chapter help our members to realize some of those opportunities and develop their skills in a way that’s personally meaningful to them, as well as good for their marketability as they build their careers, would be a really positive step.

The ultimate goal of the chapter is to service members, so whatever long-term goals we have right now could definitely be fluid as time goes on.
 

What are some concerns of the chapter?

One area of significant discussion among hospitalists in Maryland has been global budgets. Our system of reimbursement is unique in the nation. It’s a system that aims to emphasize high-value care: the idea is to prioritize quality over quantity.

This system requires that hospitals rethink how we provide care in the inpatient setting, and how we create a continuum of care to the post-acute setting. It poses a lot of challenges, but also a lot of opportunities. Hospitalists are positioned perfectly to play a substantial role in implementing solutions.
 

Why might readers want to consider getting involved in their local SHM chapters?

I think it’s really beneficial to have the exposure that being involved with an SHM chapter brings – to people, to perspectives, to knowledge. There’s not really a downside to being involved with a chapter. You can take as little or as much as you want out of it, but I think most of our members find it to be a very enriching experience. Being involved in a chapter means you can have a voice, so that the chapter ends up serving you and your needs as well.

Nidhi Goel, MD, MHS, is a Med-Peds hospitalist and assistant professor of internal medicine and pediatrics at the University of Maryland, Baltimore. Since August 2017, she has been the president of the Maryland chapter of SHM.

Can you talk about your background and how you became interested in hospital medicine?

I grew up in the Baltimore area, and I went to medical school at the University of Maryland in Baltimore. I trained in internal medicine and pediatrics, also at the University of Maryland. Then I joined the faculty after I finished residency in 2014. I practiced as a hospitalist in internal medicine and pediatrics and was also a teaching hospitalist.

Early in my residency, I worked with teaching hospitalists. I rotated on the hospitalist teams, and I was inspired by their perspective on taking care of patients through a lens of quality and safety. I gained a greater appreciation for the risks associated with taking care of a patient in the hospital setting, and the opportunities to mitigate those risks and provide really high quality patient care. It made me realize that was what I wanted to do – and also to teach residents and students how to do the same.
 

So it was a philosophical attraction to the hospitalist approach?

Yes, and intellectually I’d say that I liked taking care of really complicated, very sick patients. I found that to be interesting – and rewarding when they got better.

Tell us more about what kind of research you do.

I work primarily on projects centered on quality and safety; they involve both adult internal medicine and pediatric patients. Currently on the adult medicine side, we have a project looking at improving outcomes for sepsis in the hospital setting. On the pediatric side, I’ve done a lot of work related to throughput – trying to increase the efficiency of our admissions – and especially our discharge process. Moving patients through the system efficiently has become a significant quality issue, especially during the winter months when our volumes pick up.

How long have you been involved in the Maryland SHM chapter, and what are the rewards of participation?

Early in my residency, I got involved in the chapter because some of the hospitalist faculty I worked with were chapter officers. They believed that the chapter was a good place for residents to be exposed to research and to other hospitalists for networking and camaraderie. So they began inviting us to Maryland chapter meetings, and I found those meetings to be very enlightening – from the practical and research content related to hospital medicine, and to networking with other hospitalists.

I was invited to be part of the Maryland chapter advisory board when I was still a resident, so that I might present trainee perspectives on how the chapter could continue to grow and target some of their activities for the benefit of residents. I stayed involved with the chapter after I finished residency, and when the opportunity presented itself to become an officer, and I decided to take it. I thought serving as a chapter officer would be a really interesting chance to meet more people in the field and to continue to innovate within the chapter setting.
 

Tell us more about the Maryland chapter.

We are a large chapter and we’re very, very active. Around 7 or 8 years ago, the Maryland chapter reached a significant turning point because the officers that were in place at that time had a vision for building the chapter. That was a major inflexion point in how active the chapter became, leading to the kinds of activities that we do now, and the variety of memberships.

One thing that I’m super proud of our chapter for is that we’ve really tried to continue building on the diversity that is represented in our membership. We have members stretching geographically all through the Baltimore and the Washington corridor, as well as out to western Maryland and the Eastern shore. The Maryland chapter has been able to attract members from different organizations throughout the state and from a diversity of practice settings. We have active members who are not just physicians, but also a nurse practitioners, physician assistants, and clinical pharmacists. We have members from throughout the health care delivery process, which really enriches the discussion and the value of the chapter as a whole.
 

What kind of initiatives and programs is the chapter working on?

Every year we have an abstracts competition at our fall meeting. Whoever wins that competition is allowed to present at the national SHM conference, which is a great opportunity. We’re really pushing that competition to make it an even more robust experience.

One thing that we had heard from some of our members, and that we recognized as a need as well, was to make our career guidance a little bit more robust. To that end, we’re creating a separate job fair that is almost like an employment workshop – to help people to buff up their CVs, to talk about interviewing skills, contracts, salary negotiations, as well as exposing job candidates to various hospital groups from throughout the area. That’s something that we’re really excited about. It’s going to take a lot of work, but I think it could be a really high-yield event for our members.

We’re also encouraging our nonphysician members to take more active leadership roles in the chapter; several of our nonphysician members on our chapter advisory board, including pharmacists and physician assistants, and we are trying to make sure that we’re also liaising with some of the professional organizations that represent our nonphysician members. So, for example, the clinical pharmacist who’s on our advisory board also is president of the Maryland chapter of the Society for Hospital Pharmacists. She brings a lot of really great ideas and interesting perspectives, and she’s brought a lot of exposure of our SHM chapter to the clinical pharmacy community as well.
 

What about more long-term goals for your chapter? What’s on the horizon?

We’re targeting early-career hospitalists and helping them to develop their career goals in whatever fashion they see as appropriate.

So, as someone who’s in academics, obviously research and publications are very important for me, but they’re not necessarily as important for other hospitalists. I think our early-career hospitalists are increasingly looking to incorporate things into their practice aside from direct patient care. Our members have interests in various elements of hospital medicine, including patient safety and quality improvement initiatives, clinical informatics, advocacy (especially related to the myriad aspects of health care reform), and strategies surrounding billing and denials. I think having our chapter help our members to realize some of those opportunities and develop their skills in a way that’s personally meaningful to them, as well as good for their marketability as they build their careers, would be a really positive step.

The ultimate goal of the chapter is to service members, so whatever long-term goals we have right now could definitely be fluid as time goes on.
 

What are some concerns of the chapter?

One area of significant discussion among hospitalists in Maryland has been global budgets. Our system of reimbursement is unique in the nation. It’s a system that aims to emphasize high-value care: the idea is to prioritize quality over quantity.

This system requires that hospitals rethink how we provide care in the inpatient setting, and how we create a continuum of care to the post-acute setting. It poses a lot of challenges, but also a lot of opportunities. Hospitalists are positioned perfectly to play a substantial role in implementing solutions.
 

Why might readers want to consider getting involved in their local SHM chapters?

I think it’s really beneficial to have the exposure that being involved with an SHM chapter brings – to people, to perspectives, to knowledge. There’s not really a downside to being involved with a chapter. You can take as little or as much as you want out of it, but I think most of our members find it to be a very enriching experience. Being involved in a chapter means you can have a voice, so that the chapter ends up serving you and your needs as well.

Nidhi Goel, MD, MHS, is a Med-Peds hospitalist and assistant professor of internal medicine and pediatrics at the University of Maryland, Baltimore. Since August 2017, she has been the president of the Maryland chapter of SHM.

Can you talk about your background and how you became interested in hospital medicine?

I grew up in the Baltimore area, and I went to medical school at the University of Maryland in Baltimore. I trained in internal medicine and pediatrics, also at the University of Maryland. Then I joined the faculty after I finished residency in 2014. I practiced as a hospitalist in internal medicine and pediatrics and was also a teaching hospitalist.

Early in my residency, I worked with teaching hospitalists. I rotated on the hospitalist teams, and I was inspired by their perspective on taking care of patients through a lens of quality and safety. I gained a greater appreciation for the risks associated with taking care of a patient in the hospital setting, and the opportunities to mitigate those risks and provide really high quality patient care. It made me realize that was what I wanted to do – and also to teach residents and students how to do the same.
 

So it was a philosophical attraction to the hospitalist approach?

Yes, and intellectually I’d say that I liked taking care of really complicated, very sick patients. I found that to be interesting – and rewarding when they got better.

Tell us more about what kind of research you do.

I work primarily on projects centered on quality and safety; they involve both adult internal medicine and pediatric patients. Currently on the adult medicine side, we have a project looking at improving outcomes for sepsis in the hospital setting. On the pediatric side, I’ve done a lot of work related to throughput – trying to increase the efficiency of our admissions – and especially our discharge process. Moving patients through the system efficiently has become a significant quality issue, especially during the winter months when our volumes pick up.

How long have you been involved in the Maryland SHM chapter, and what are the rewards of participation?

Early in my residency, I got involved in the chapter because some of the hospitalist faculty I worked with were chapter officers. They believed that the chapter was a good place for residents to be exposed to research and to other hospitalists for networking and camaraderie. So they began inviting us to Maryland chapter meetings, and I found those meetings to be very enlightening – from the practical and research content related to hospital medicine, and to networking with other hospitalists.

I was invited to be part of the Maryland chapter advisory board when I was still a resident, so that I might present trainee perspectives on how the chapter could continue to grow and target some of their activities for the benefit of residents. I stayed involved with the chapter after I finished residency, and when the opportunity presented itself to become an officer, and I decided to take it. I thought serving as a chapter officer would be a really interesting chance to meet more people in the field and to continue to innovate within the chapter setting.
 

Tell us more about the Maryland chapter.

We are a large chapter and we’re very, very active. Around 7 or 8 years ago, the Maryland chapter reached a significant turning point because the officers that were in place at that time had a vision for building the chapter. That was a major inflexion point in how active the chapter became, leading to the kinds of activities that we do now, and the variety of memberships.

One thing that I’m super proud of our chapter for is that we’ve really tried to continue building on the diversity that is represented in our membership. We have members stretching geographically all through the Baltimore and the Washington corridor, as well as out to western Maryland and the Eastern shore. The Maryland chapter has been able to attract members from different organizations throughout the state and from a diversity of practice settings. We have active members who are not just physicians, but also a nurse practitioners, physician assistants, and clinical pharmacists. We have members from throughout the health care delivery process, which really enriches the discussion and the value of the chapter as a whole.
 

What kind of initiatives and programs is the chapter working on?

Every year we have an abstracts competition at our fall meeting. Whoever wins that competition is allowed to present at the national SHM conference, which is a great opportunity. We’re really pushing that competition to make it an even more robust experience.

One thing that we had heard from some of our members, and that we recognized as a need as well, was to make our career guidance a little bit more robust. To that end, we’re creating a separate job fair that is almost like an employment workshop – to help people to buff up their CVs, to talk about interviewing skills, contracts, salary negotiations, as well as exposing job candidates to various hospital groups from throughout the area. That’s something that we’re really excited about. It’s going to take a lot of work, but I think it could be a really high-yield event for our members.

We’re also encouraging our nonphysician members to take more active leadership roles in the chapter; several of our nonphysician members on our chapter advisory board, including pharmacists and physician assistants, and we are trying to make sure that we’re also liaising with some of the professional organizations that represent our nonphysician members. So, for example, the clinical pharmacist who’s on our advisory board also is president of the Maryland chapter of the Society for Hospital Pharmacists. She brings a lot of really great ideas and interesting perspectives, and she’s brought a lot of exposure of our SHM chapter to the clinical pharmacy community as well.
 

What about more long-term goals for your chapter? What’s on the horizon?

We’re targeting early-career hospitalists and helping them to develop their career goals in whatever fashion they see as appropriate.

So, as someone who’s in academics, obviously research and publications are very important for me, but they’re not necessarily as important for other hospitalists. I think our early-career hospitalists are increasingly looking to incorporate things into their practice aside from direct patient care. Our members have interests in various elements of hospital medicine, including patient safety and quality improvement initiatives, clinical informatics, advocacy (especially related to the myriad aspects of health care reform), and strategies surrounding billing and denials. I think having our chapter help our members to realize some of those opportunities and develop their skills in a way that’s personally meaningful to them, as well as good for their marketability as they build their careers, would be a really positive step.

The ultimate goal of the chapter is to service members, so whatever long-term goals we have right now could definitely be fluid as time goes on.
 

What are some concerns of the chapter?

One area of significant discussion among hospitalists in Maryland has been global budgets. Our system of reimbursement is unique in the nation. It’s a system that aims to emphasize high-value care: the idea is to prioritize quality over quantity.

This system requires that hospitals rethink how we provide care in the inpatient setting, and how we create a continuum of care to the post-acute setting. It poses a lot of challenges, but also a lot of opportunities. Hospitalists are positioned perfectly to play a substantial role in implementing solutions.
 

Why might readers want to consider getting involved in their local SHM chapters?

I think it’s really beneficial to have the exposure that being involved with an SHM chapter brings – to people, to perspectives, to knowledge. There’s not really a downside to being involved with a chapter. You can take as little or as much as you want out of it, but I think most of our members find it to be a very enriching experience. Being involved in a chapter means you can have a voice, so that the chapter ends up serving you and your needs as well.

George Kasarala, MD, recently was named the hospitalist medical director at Nash UNC Health Care in Rocky Mount, N.C. Dr. Kasarala will guide Nash UNC’s team of hospitalists, a program that has partnered with Sound Physicians.

Dr. Kasarala has a wealth of hospitalist experience, serving in a variety of positions since 2012. He comes to Nash UNC from Vidant Medical Center in Greenville, N.C. Prior to that, he was the associate hospitalist program director at the Apogee Hospitalist program in Elkhart, Ind.

In addition to his medical degree from Saint Louis University, Dr. Kasarala holds a master of business administration from the University of Findlay (Ohio).

Donald W. Woodburn, MD, has been selected as the new medical director at Carolinas Primary Care in Wadesboro, S.C. The longtime internist and hospitalist will stay in his role directing primary care for the facility, which is operated by Atrium Health.

A 35-year veteran in the medical field, Dr. Woodburn most recently was medical director for AnMed Hospitalist Services in Anderson, S.C. He has been a medical director in New York, Florida, and South Carolina since earning his medical degree from Howard University in Washington.
 

Rita Goyal, MD, has been hired as chief medical officer of ConcertCare, a health care technology company based in Birmingham, Ala. Dr. Goyal has expertise in both medicine and business was cited as the key to her appointment. She founded a Web-based medical consultation business in 2017, virtualMDvisit.net.

Dr. Goyal is an academic hospitalist at the University of Alabama, Birmingham, and will continue to serve as a hospitalist and in the University’s urgent care system.



Nirupma Sharma, MD, has been named chief of the newly minted division of pediatric hospital medicine at Augusta (Ga.) University Health. Dr. Sharma will oversee the pediatric hospitalist staff, including education, research, and clinical assistance.

Dr. Sharma has been the medical director of the 4C unit at Children’s Hospital of Georgia in Augusta. She also has served as associate director of the Medical College of Georgia’s department of pediatrics clerkship program.

Vineet Arora, MD, MHM, was recently named one of the top 10 doctors to follow on Twitter by Becker’s Hospital Review. Dr. Arora is an academic hospitalist at University of Chicago Medicine.

Using the hashtag #meded, Dr. Arora provides a wealth of medical knowledge on Twitter, currently boasting more than 29,000 followers on that social media platform. She also serves as the Journal of Hospital Medicine’s deputy social media editor, and blogs about topics trending in resident education.
 

BUSINESS MOVES

Aspirus Iron River (Mich.) Hospital has partnered with iNDIGO Health Partners to create a telehealth hospitalist program at night. iNDIGO, a private hospitalist group, will utilize two-way video to treat Aspirus patients during overnight hours.

The telehealth providers with iNDIGO are part of the staff at Aspirus Iron River and are familiar with the facility’s procedures. The remote physicians will be in contact with staff at the hospital, providing direction after meeting with patients via the video system.

The Hospitals of Providence Memorial Campus in El Paso, Tex., intends to have specialists on site at all times for expectant mothers after recently adopting an obstetric hospitalist program. The OB hospitalists will be available to treat patient concerns and medical emergencies that occur outside of normal hours for patients’ primary obstetricians.

All OB hospitalists will be board-certified OB physicians. The goal is to decrease wait times for expectant mothers, who can receive immediate assessments and treatment upon arrival in the emergency department.






 

George Kasarala, MD, recently was named the hospitalist medical director at Nash UNC Health Care in Rocky Mount, N.C. Dr. Kasarala will guide Nash UNC’s team of hospitalists, a program that has partnered with Sound Physicians.

Dr. Kasarala has a wealth of hospitalist experience, serving in a variety of positions since 2012. He comes to Nash UNC from Vidant Medical Center in Greenville, N.C. Prior to that, he was the associate hospitalist program director at the Apogee Hospitalist program in Elkhart, Ind.

In addition to his medical degree from Saint Louis University, Dr. Kasarala holds a master of business administration from the University of Findlay (Ohio).

Donald W. Woodburn, MD, has been selected as the new medical director at Carolinas Primary Care in Wadesboro, S.C. The longtime internist and hospitalist will stay in his role directing primary care for the facility, which is operated by Atrium Health.

A 35-year veteran in the medical field, Dr. Woodburn most recently was medical director for AnMed Hospitalist Services in Anderson, S.C. He has been a medical director in New York, Florida, and South Carolina since earning his medical degree from Howard University in Washington.
 

Rita Goyal, MD, has been hired as chief medical officer of ConcertCare, a health care technology company based in Birmingham, Ala. Dr. Goyal has expertise in both medicine and business was cited as the key to her appointment. She founded a Web-based medical consultation business in 2017, virtualMDvisit.net.

Dr. Goyal is an academic hospitalist at the University of Alabama, Birmingham, and will continue to serve as a hospitalist and in the University’s urgent care system.



Nirupma Sharma, MD, has been named chief of the newly minted division of pediatric hospital medicine at Augusta (Ga.) University Health. Dr. Sharma will oversee the pediatric hospitalist staff, including education, research, and clinical assistance.

Dr. Sharma has been the medical director of the 4C unit at Children’s Hospital of Georgia in Augusta. She also has served as associate director of the Medical College of Georgia’s department of pediatrics clerkship program.

Vineet Arora, MD, MHM, was recently named one of the top 10 doctors to follow on Twitter by Becker’s Hospital Review. Dr. Arora is an academic hospitalist at University of Chicago Medicine.

Using the hashtag #meded, Dr. Arora provides a wealth of medical knowledge on Twitter, currently boasting more than 29,000 followers on that social media platform. She also serves as the Journal of Hospital Medicine’s deputy social media editor, and blogs about topics trending in resident education.
 

BUSINESS MOVES

Aspirus Iron River (Mich.) Hospital has partnered with iNDIGO Health Partners to create a telehealth hospitalist program at night. iNDIGO, a private hospitalist group, will utilize two-way video to treat Aspirus patients during overnight hours.

The telehealth providers with iNDIGO are part of the staff at Aspirus Iron River and are familiar with the facility’s procedures. The remote physicians will be in contact with staff at the hospital, providing direction after meeting with patients via the video system.

The Hospitals of Providence Memorial Campus in El Paso, Tex., intends to have specialists on site at all times for expectant mothers after recently adopting an obstetric hospitalist program. The OB hospitalists will be available to treat patient concerns and medical emergencies that occur outside of normal hours for patients’ primary obstetricians.

All OB hospitalists will be board-certified OB physicians. The goal is to decrease wait times for expectant mothers, who can receive immediate assessments and treatment upon arrival in the emergency department.






 

George Kasarala, MD, recently was named the hospitalist medical director at Nash UNC Health Care in Rocky Mount, N.C. Dr. Kasarala will guide Nash UNC’s team of hospitalists, a program that has partnered with Sound Physicians.

Dr. Kasarala has a wealth of hospitalist experience, serving in a variety of positions since 2012. He comes to Nash UNC from Vidant Medical Center in Greenville, N.C. Prior to that, he was the associate hospitalist program director at the Apogee Hospitalist program in Elkhart, Ind.

In addition to his medical degree from Saint Louis University, Dr. Kasarala holds a master of business administration from the University of Findlay (Ohio).

Donald W. Woodburn, MD, has been selected as the new medical director at Carolinas Primary Care in Wadesboro, S.C. The longtime internist and hospitalist will stay in his role directing primary care for the facility, which is operated by Atrium Health.

A 35-year veteran in the medical field, Dr. Woodburn most recently was medical director for AnMed Hospitalist Services in Anderson, S.C. He has been a medical director in New York, Florida, and South Carolina since earning his medical degree from Howard University in Washington.
 

Rita Goyal, MD, has been hired as chief medical officer of ConcertCare, a health care technology company based in Birmingham, Ala. Dr. Goyal has expertise in both medicine and business was cited as the key to her appointment. She founded a Web-based medical consultation business in 2017, virtualMDvisit.net.

Dr. Goyal is an academic hospitalist at the University of Alabama, Birmingham, and will continue to serve as a hospitalist and in the University’s urgent care system.



Nirupma Sharma, MD, has been named chief of the newly minted division of pediatric hospital medicine at Augusta (Ga.) University Health. Dr. Sharma will oversee the pediatric hospitalist staff, including education, research, and clinical assistance.

Dr. Sharma has been the medical director of the 4C unit at Children’s Hospital of Georgia in Augusta. She also has served as associate director of the Medical College of Georgia’s department of pediatrics clerkship program.

Vineet Arora, MD, MHM, was recently named one of the top 10 doctors to follow on Twitter by Becker’s Hospital Review. Dr. Arora is an academic hospitalist at University of Chicago Medicine.

Using the hashtag #meded, Dr. Arora provides a wealth of medical knowledge on Twitter, currently boasting more than 29,000 followers on that social media platform. She also serves as the Journal of Hospital Medicine’s deputy social media editor, and blogs about topics trending in resident education.
 

BUSINESS MOVES

Aspirus Iron River (Mich.) Hospital has partnered with iNDIGO Health Partners to create a telehealth hospitalist program at night. iNDIGO, a private hospitalist group, will utilize two-way video to treat Aspirus patients during overnight hours.

The telehealth providers with iNDIGO are part of the staff at Aspirus Iron River and are familiar with the facility’s procedures. The remote physicians will be in contact with staff at the hospital, providing direction after meeting with patients via the video system.

The Hospitals of Providence Memorial Campus in El Paso, Tex., intends to have specialists on site at all times for expectant mothers after recently adopting an obstetric hospitalist program. The OB hospitalists will be available to treat patient concerns and medical emergencies that occur outside of normal hours for patients’ primary obstetricians.

All OB hospitalists will be board-certified OB physicians. The goal is to decrease wait times for expectant mothers, who can receive immediate assessments and treatment upon arrival in the emergency department.






 

Hospitals and health systems are increasingly looking to physicians to provide leadership at the most senior executive level. While the chief medical officer (CMO) or similar role has given physicians a seat at the executive table at many organizations, physicians are also being sought for the CEO role at the head of that table.

A commonly referenced study from 2011 by Amanda Goodall, MD, in Social Science & Medicine concluded that, among a cohort of highly ranked hospitals, overall quality metrics were approximately 25% higher in hospitals where a physician was CEO, in comparison to hospitals with non-physician CEOs (2011 Aug;73[4]:535-9). In addition, new positions at both the hospital and health system level are coming into existence: Examples include chief (or VP) of population health, chief innovation officer, chief quality officer, chief patient experience officer, and others.

There is every reason to think that these senior executive physician roles can – and in many cases perhaps should – be filled by hospitalists. Hospital medicine is an ideal “proving ground” for future physician executives and leaders. I believe that the best practitioners of hospital medicine are also the best candidates for hospital, health care, and health system physician executive leadership, because many of the characteristics essential for success as an executive are the same characteristics that are essential for success as a hospitalist. Strong candidates should have the following characteristics:

• A patient-centered perspective. Perhaps the most important characteristic of a leader is empathy. To appreciate the complex, and often (if not usual) challenging emotional states of our patients keeps us connected at the most fundamental, human level to the work we do and to our patients and families. Empathy can – and should – extend to fellow caregivers as well, and allows us to practice and lead teams in the most human of professions. No leader – in health care, anyway – can last long without being able to demonstrate empathy, through words and behavior.
• A systems-based practice: A hospitalist must be able to have a foot in each of two canoes – to be able to see each patient and their family individually and develop preference-based plans of care, and also to be able to focus on process, structure, and outcomes for the hospital system as a whole. The former trait is imbued in us during training and is the critical foundation for the patient-physician relationship. The latter, however, is something different entirely and reflects an ability to have perspective on the entire ecosystem of care – and apply principles of process and quality improvement to achieve forward looking results. That’s leadership.
• Team leadership: Another fundamental attribute of leaders is to assemble a talented and diverse team around an objective, and then to delegate both tasks and their ownership, deferring to expertise. Hospitalists – the best ones, anyway – similarly recognize that for the vast majority of a patient’s hospital stay, the most important caregiver in a patient’s care is someone other than themselves. At any given time, it might be the nurse, aide, pharmacist, care manager, transporter, radiology tech, urologist, housekeeper, surgical resident, or anyone involved in that patient’s care. The hospitalist’s greatest value is in developing the plan of care with the patient and their family, and then communicating – and therefore delegating – that plan to individuals with the expertise to execute that plan. I believe the biggest difficulty hospitalists have in assuming leadership roles is getting out of the comfortable weeds of daily clinical operations and instead focusing on goals, strategies, and teams to accomplish them. The best hospitalists are doing this already as part of their daily care.
• The ability to manage relationships: Hospitalists manage and work among a team of diverse talents. They also often have accountability relationships to a myriad of clinical and administrative leaders in the hospital, each of whom may be in a position of authority to place demands on the hospitalists: A partial list might include the CEO, the chief medical officer, chief nurse, chief of staff, other medical staff departments, academic leaders, and of course, patients and their families. Functioning in a “matrixed” organization – in which lines of authority can go in many directions, depending on the situation – is standard fare, even at the executive level, and the key competency is open and frequent communication.
• Experience: Already, hospitalists assume leadership roles in their hospitals – leaders in quality, medical informatics, patient experience, and continuous improvement. In these roles, physicians work with senior executives and other hospital leaders to both set goals and implement strategies, providing visibility and working relationships that can be helpful to aspiring leaders.

Perhaps more so than most other specialties, then, hospitalists demonstrate foundational leadership skills in their day-to-day practice – an ideal start to a leadership path. This is not to say or suggest that a career devoted purely to clinical practice is somehow inferior – far from it. However, as health care organizations turn to the medical community to provider leadership, hospitalists are well positioned to develop and be developed as executive leaders.

How can the Society of Hospital Medicine help? While management degrees become a common pathway for many, some health systems and professional organizations support their membership with a leadership development curriculum which may be a better place to start. In my opinion, SHM provides one of the most thorough and relevant experiences available. The SHM Leadership Academy focuses on developing a broad set of additional leadership competencies across a spectrum of experience. The format varies depending on the course, but all rely heavily upon experienced hospitalist leaders – in fact, many current and former Board members and officers volunteer their time to facilitate and teach at the Academy, including at the entry level. It’s a powerful way to learn from others who have started walking the leadership path.
 

Dr. Harte is a past president of SHM and president of Cleveland Clinic Akron General and Southern Region.

Hospitals and health systems are increasingly looking to physicians to provide leadership at the most senior executive level. While the chief medical officer (CMO) or similar role has given physicians a seat at the executive table at many organizations, physicians are also being sought for the CEO role at the head of that table.

A commonly referenced study from 2011 by Amanda Goodall, MD, in Social Science & Medicine concluded that, among a cohort of highly ranked hospitals, overall quality metrics were approximately 25% higher in hospitals where a physician was CEO, in comparison to hospitals with non-physician CEOs (2011 Aug;73[4]:535-9). In addition, new positions at both the hospital and health system level are coming into existence: Examples include chief (or VP) of population health, chief innovation officer, chief quality officer, chief patient experience officer, and others.

There is every reason to think that these senior executive physician roles can – and in many cases perhaps should – be filled by hospitalists. Hospital medicine is an ideal “proving ground” for future physician executives and leaders. I believe that the best practitioners of hospital medicine are also the best candidates for hospital, health care, and health system physician executive leadership, because many of the characteristics essential for success as an executive are the same characteristics that are essential for success as a hospitalist. Strong candidates should have the following characteristics:

• A patient-centered perspective. Perhaps the most important characteristic of a leader is empathy. To appreciate the complex, and often (if not usual) challenging emotional states of our patients keeps us connected at the most fundamental, human level to the work we do and to our patients and families. Empathy can – and should – extend to fellow caregivers as well, and allows us to practice and lead teams in the most human of professions. No leader – in health care, anyway – can last long without being able to demonstrate empathy, through words and behavior.
• A systems-based practice: A hospitalist must be able to have a foot in each of two canoes – to be able to see each patient and their family individually and develop preference-based plans of care, and also to be able to focus on process, structure, and outcomes for the hospital system as a whole. The former trait is imbued in us during training and is the critical foundation for the patient-physician relationship. The latter, however, is something different entirely and reflects an ability to have perspective on the entire ecosystem of care – and apply principles of process and quality improvement to achieve forward looking results. That’s leadership.
• Team leadership: Another fundamental attribute of leaders is to assemble a talented and diverse team around an objective, and then to delegate both tasks and their ownership, deferring to expertise. Hospitalists – the best ones, anyway – similarly recognize that for the vast majority of a patient’s hospital stay, the most important caregiver in a patient’s care is someone other than themselves. At any given time, it might be the nurse, aide, pharmacist, care manager, transporter, radiology tech, urologist, housekeeper, surgical resident, or anyone involved in that patient’s care. The hospitalist’s greatest value is in developing the plan of care with the patient and their family, and then communicating – and therefore delegating – that plan to individuals with the expertise to execute that plan. I believe the biggest difficulty hospitalists have in assuming leadership roles is getting out of the comfortable weeds of daily clinical operations and instead focusing on goals, strategies, and teams to accomplish them. The best hospitalists are doing this already as part of their daily care.
• The ability to manage relationships: Hospitalists manage and work among a team of diverse talents. They also often have accountability relationships to a myriad of clinical and administrative leaders in the hospital, each of whom may be in a position of authority to place demands on the hospitalists: A partial list might include the CEO, the chief medical officer, chief nurse, chief of staff, other medical staff departments, academic leaders, and of course, patients and their families. Functioning in a “matrixed” organization – in which lines of authority can go in many directions, depending on the situation – is standard fare, even at the executive level, and the key competency is open and frequent communication.
• Experience: Already, hospitalists assume leadership roles in their hospitals – leaders in quality, medical informatics, patient experience, and continuous improvement. In these roles, physicians work with senior executives and other hospital leaders to both set goals and implement strategies, providing visibility and working relationships that can be helpful to aspiring leaders.

Perhaps more so than most other specialties, then, hospitalists demonstrate foundational leadership skills in their day-to-day practice – an ideal start to a leadership path. This is not to say or suggest that a career devoted purely to clinical practice is somehow inferior – far from it. However, as health care organizations turn to the medical community to provider leadership, hospitalists are well positioned to develop and be developed as executive leaders.

How can the Society of Hospital Medicine help? While management degrees become a common pathway for many, some health systems and professional organizations support their membership with a leadership development curriculum which may be a better place to start. In my opinion, SHM provides one of the most thorough and relevant experiences available. The SHM Leadership Academy focuses on developing a broad set of additional leadership competencies across a spectrum of experience. The format varies depending on the course, but all rely heavily upon experienced hospitalist leaders – in fact, many current and former Board members and officers volunteer their time to facilitate and teach at the Academy, including at the entry level. It’s a powerful way to learn from others who have started walking the leadership path.
 

Dr. Harte is a past president of SHM and president of Cleveland Clinic Akron General and Southern Region.

Hospitals and health systems are increasingly looking to physicians to provide leadership at the most senior executive level. While the chief medical officer (CMO) or similar role has given physicians a seat at the executive table at many organizations, physicians are also being sought for the CEO role at the head of that table.

A commonly referenced study from 2011 by Amanda Goodall, MD, in Social Science & Medicine concluded that, among a cohort of highly ranked hospitals, overall quality metrics were approximately 25% higher in hospitals where a physician was CEO, in comparison to hospitals with non-physician CEOs (2011 Aug;73[4]:535-9). In addition, new positions at both the hospital and health system level are coming into existence: Examples include chief (or VP) of population health, chief innovation officer, chief quality officer, chief patient experience officer, and others.

There is every reason to think that these senior executive physician roles can – and in many cases perhaps should – be filled by hospitalists. Hospital medicine is an ideal “proving ground” for future physician executives and leaders. I believe that the best practitioners of hospital medicine are also the best candidates for hospital, health care, and health system physician executive leadership, because many of the characteristics essential for success as an executive are the same characteristics that are essential for success as a hospitalist. Strong candidates should have the following characteristics:

• A patient-centered perspective. Perhaps the most important characteristic of a leader is empathy. To appreciate the complex, and often (if not usual) challenging emotional states of our patients keeps us connected at the most fundamental, human level to the work we do and to our patients and families. Empathy can – and should – extend to fellow caregivers as well, and allows us to practice and lead teams in the most human of professions. No leader – in health care, anyway – can last long without being able to demonstrate empathy, through words and behavior.
• A systems-based practice: A hospitalist must be able to have a foot in each of two canoes – to be able to see each patient and their family individually and develop preference-based plans of care, and also to be able to focus on process, structure, and outcomes for the hospital system as a whole. The former trait is imbued in us during training and is the critical foundation for the patient-physician relationship. The latter, however, is something different entirely and reflects an ability to have perspective on the entire ecosystem of care – and apply principles of process and quality improvement to achieve forward looking results. That’s leadership.
• Team leadership: Another fundamental attribute of leaders is to assemble a talented and diverse team around an objective, and then to delegate both tasks and their ownership, deferring to expertise. Hospitalists – the best ones, anyway – similarly recognize that for the vast majority of a patient’s hospital stay, the most important caregiver in a patient’s care is someone other than themselves. At any given time, it might be the nurse, aide, pharmacist, care manager, transporter, radiology tech, urologist, housekeeper, surgical resident, or anyone involved in that patient’s care. The hospitalist’s greatest value is in developing the plan of care with the patient and their family, and then communicating – and therefore delegating – that plan to individuals with the expertise to execute that plan. I believe the biggest difficulty hospitalists have in assuming leadership roles is getting out of the comfortable weeds of daily clinical operations and instead focusing on goals, strategies, and teams to accomplish them. The best hospitalists are doing this already as part of their daily care.
• The ability to manage relationships: Hospitalists manage and work among a team of diverse talents. They also often have accountability relationships to a myriad of clinical and administrative leaders in the hospital, each of whom may be in a position of authority to place demands on the hospitalists: A partial list might include the CEO, the chief medical officer, chief nurse, chief of staff, other medical staff departments, academic leaders, and of course, patients and their families. Functioning in a “matrixed” organization – in which lines of authority can go in many directions, depending on the situation – is standard fare, even at the executive level, and the key competency is open and frequent communication.
• Experience: Already, hospitalists assume leadership roles in their hospitals – leaders in quality, medical informatics, patient experience, and continuous improvement. In these roles, physicians work with senior executives and other hospital leaders to both set goals and implement strategies, providing visibility and working relationships that can be helpful to aspiring leaders.

Perhaps more so than most other specialties, then, hospitalists demonstrate foundational leadership skills in their day-to-day practice – an ideal start to a leadership path. This is not to say or suggest that a career devoted purely to clinical practice is somehow inferior – far from it. However, as health care organizations turn to the medical community to provider leadership, hospitalists are well positioned to develop and be developed as executive leaders.

How can the Society of Hospital Medicine help? While management degrees become a common pathway for many, some health systems and professional organizations support their membership with a leadership development curriculum which may be a better place to start. In my opinion, SHM provides one of the most thorough and relevant experiences available. The SHM Leadership Academy focuses on developing a broad set of additional leadership competencies across a spectrum of experience. The format varies depending on the course, but all rely heavily upon experienced hospitalist leaders – in fact, many current and former Board members and officers volunteer their time to facilitate and teach at the Academy, including at the entry level. It’s a powerful way to learn from others who have started walking the leadership path.
 

Dr. Harte is a past president of SHM and president of Cleveland Clinic Akron General and Southern Region.

Over the course of a career, it is not uncommon for people to become narrower and more focused in their work purview and interests. Competence in select procedures and practices imparts confidence and reliability in performance and results. One develops a reputation for those skills and capabilities, and others call upon them.

Rewards and incentives encourage advancement and promotion along established career paths, further accelerating specialization and concentration. At the top of your game, you advocate for and ease into your comfort zone. That zone is defined by the knowns of practice and the certainties they provide.

For those who prefer to practice in the confines of a narrow clinical sphere, that strategy could be the pathway to career success.

However, for those promoted to leadership positions, the inward and insulated focus today is counterproductive and even dangerous. Many times, physicians advance to a senior position because it is the next step in a preset career ladder, the reward for acumen in clinical skills, or simply out of boredom, with hope for a new landscape and a higher wage. But just because one has a high rank or impressive title does not mean that one is fulfilling the mandates of leadership. It takes more than that. You must be attuned to what is known and unknown in building stability and progress for those you lead.

A brief historic angle: For years, medicine occupied a sweet spot within the health care system. The profession protected its perks and privileges deriving from its untouchable status. With it came superiority, dominance, and protectionism. It was an inward, parochial focus of thinking, status, and reward. The problem was: This insulated mindset prompted a blind spot. The profession missed changes and transformation that were occurring just beyond the comfort zone. Those changes were unknowns in planning and perspective.

In the 1990s, medicine as a whole woke up to calls for change and a new order. The rise of the hospitalist was in part an outgrowth of that wake-up call. It reshaped power structures, status, and lucrative business arrangements within the profession. For many, the sweet spot soured.

The problem with collapsing into a sweet spot today is that so much is changing: all that is known and much that is unknown. Finances, technology, and demand are all in flux. The health care system finds itself in a quantity/quality/cost paradox. Volume accelerates, but at what cost to quality and morale? If someone or something can accomplish similar outcomes at less cost, why not go with the cheaper option? These questions can best be addressed by seeing them in the context of larger changes happening in the health system.

A new view for leaders

The “meta” in metaleadership hopes to provide a broader, disciplined slant on this phenomenon. That prefix – used to modify many concepts and terms – refers to a wider, more expansive view or a more comprehensive and transcendent perch on a topic. A “meta-” prefix invites a critical analysis of the original topic with the addition of new perspectives and insights, as with a meta-analysis.

Why then the need now for a “meta” view among health care leaders? It is easy in the course of career progression to lose track of the bigger picture of what you are doing and how it fits into changes occurring in society and for the profession. Even if your focus is on a particular clinical procedure, how does what you are doing fit into larger metatrends and changes? How might you tangibly contribute to the evolution of those trends? If you are in a leadership position, how do you fit your practice or department into the bigger picture? How might this enterprise perspective speak to your career trajectory?

To inform these questions, build your platform for knowns and unknowns. There are four combinations in the “known-unknown” equation. They are each important and provocative for leaders. Your awareness of them prompts curiosity about “meta” problems and problem solving.

• There are the “known-knowns”: what you know and you know you know it. The problem here is that you may assume that you know something that you don’t.
• There are the “known-unknowns”: Clear and curious about what you need to learn, you develop pathways to find out.
• There are the “unknown-knowns”: what others know and you don’t; a point of vulnerability if you are not careful to discover and figure this out.
• And finally, the “unknown-unknowns”: the mysteries of what could lie ahead that no one yet fully comprehends.

The task for the “metaleader”? Be clear on what you know, and seek always to learn and discover those unknowns. The better you factor them into your assessments, the better you are able to shape trends and the less likely you are to be overrun by them.

Just as you become more specialized with time, as a leader, you can leverage your experience to widen your lens and see more, understand it better, and – with that knowledge – chart a pathway that corresponds with where the health system is going. With this wider mindset, you fashion a fresh and innovative perspective on what is happening with health care and the options for constructively addressing new constraints and opportunities. You think big, reach far, and with this broader understanding, foment a lively set of perspectives and options that would otherwise not be available for those you lead. And when seen as a puzzle to learn and solve, the “meta” perch provides an engaging angle on the game of health care change. You too can be a player.

Dr. Marcus is coauthor of “Renegotiating Health Care: Resolving Conflict to Build Collaboration,” 2nd ed. (San Francisco: Jossey-Bass Publishers, 2011) and is director of the program for health care negotiation and conflict resolution at Harvard T.H. Chan School of Public Health, Boston. Dr. Marcus teaches regularly in the SHM Leadership Academy. He can be reached at [email protected].

Over the course of a career, it is not uncommon for people to become narrower and more focused in their work purview and interests. Competence in select procedures and practices imparts confidence and reliability in performance and results. One develops a reputation for those skills and capabilities, and others call upon them.

Rewards and incentives encourage advancement and promotion along established career paths, further accelerating specialization and concentration. At the top of your game, you advocate for and ease into your comfort zone. That zone is defined by the knowns of practice and the certainties they provide.

For those who prefer to practice in the confines of a narrow clinical sphere, that strategy could be the pathway to career success.

However, for those promoted to leadership positions, the inward and insulated focus today is counterproductive and even dangerous. Many times, physicians advance to a senior position because it is the next step in a preset career ladder, the reward for acumen in clinical skills, or simply out of boredom, with hope for a new landscape and a higher wage. But just because one has a high rank or impressive title does not mean that one is fulfilling the mandates of leadership. It takes more than that. You must be attuned to what is known and unknown in building stability and progress for those you lead.

A brief historic angle: For years, medicine occupied a sweet spot within the health care system. The profession protected its perks and privileges deriving from its untouchable status. With it came superiority, dominance, and protectionism. It was an inward, parochial focus of thinking, status, and reward. The problem was: This insulated mindset prompted a blind spot. The profession missed changes and transformation that were occurring just beyond the comfort zone. Those changes were unknowns in planning and perspective.

In the 1990s, medicine as a whole woke up to calls for change and a new order. The rise of the hospitalist was in part an outgrowth of that wake-up call. It reshaped power structures, status, and lucrative business arrangements within the profession. For many, the sweet spot soured.

The problem with collapsing into a sweet spot today is that so much is changing: all that is known and much that is unknown. Finances, technology, and demand are all in flux. The health care system finds itself in a quantity/quality/cost paradox. Volume accelerates, but at what cost to quality and morale? If someone or something can accomplish similar outcomes at less cost, why not go with the cheaper option? These questions can best be addressed by seeing them in the context of larger changes happening in the health system.

A new view for leaders

The “meta” in metaleadership hopes to provide a broader, disciplined slant on this phenomenon. That prefix – used to modify many concepts and terms – refers to a wider, more expansive view or a more comprehensive and transcendent perch on a topic. A “meta-” prefix invites a critical analysis of the original topic with the addition of new perspectives and insights, as with a meta-analysis.

Why then the need now for a “meta” view among health care leaders? It is easy in the course of career progression to lose track of the bigger picture of what you are doing and how it fits into changes occurring in society and for the profession. Even if your focus is on a particular clinical procedure, how does what you are doing fit into larger metatrends and changes? How might you tangibly contribute to the evolution of those trends? If you are in a leadership position, how do you fit your practice or department into the bigger picture? How might this enterprise perspective speak to your career trajectory?

To inform these questions, build your platform for knowns and unknowns. There are four combinations in the “known-unknown” equation. They are each important and provocative for leaders. Your awareness of them prompts curiosity about “meta” problems and problem solving.

• There are the “known-knowns”: what you know and you know you know it. The problem here is that you may assume that you know something that you don’t.
• There are the “known-unknowns”: Clear and curious about what you need to learn, you develop pathways to find out.
• There are the “unknown-knowns”: what others know and you don’t; a point of vulnerability if you are not careful to discover and figure this out.
• And finally, the “unknown-unknowns”: the mysteries of what could lie ahead that no one yet fully comprehends.

The task for the “metaleader”? Be clear on what you know, and seek always to learn and discover those unknowns. The better you factor them into your assessments, the better you are able to shape trends and the less likely you are to be overrun by them.

Just as you become more specialized with time, as a leader, you can leverage your experience to widen your lens and see more, understand it better, and – with that knowledge – chart a pathway that corresponds with where the health system is going. With this wider mindset, you fashion a fresh and innovative perspective on what is happening with health care and the options for constructively addressing new constraints and opportunities. You think big, reach far, and with this broader understanding, foment a lively set of perspectives and options that would otherwise not be available for those you lead. And when seen as a puzzle to learn and solve, the “meta” perch provides an engaging angle on the game of health care change. You too can be a player.

Dr. Marcus is coauthor of “Renegotiating Health Care: Resolving Conflict to Build Collaboration,” 2nd ed. (San Francisco: Jossey-Bass Publishers, 2011) and is director of the program for health care negotiation and conflict resolution at Harvard T.H. Chan School of Public Health, Boston. Dr. Marcus teaches regularly in the SHM Leadership Academy. He can be reached at [email protected].

Over the course of a career, it is not uncommon for people to become narrower and more focused in their work purview and interests. Competence in select procedures and practices imparts confidence and reliability in performance and results. One develops a reputation for those skills and capabilities, and others call upon them.

Rewards and incentives encourage advancement and promotion along established career paths, further accelerating specialization and concentration. At the top of your game, you advocate for and ease into your comfort zone. That zone is defined by the knowns of practice and the certainties they provide.

For those who prefer to practice in the confines of a narrow clinical sphere, that strategy could be the pathway to career success.

However, for those promoted to leadership positions, the inward and insulated focus today is counterproductive and even dangerous. Many times, physicians advance to a senior position because it is the next step in a preset career ladder, the reward for acumen in clinical skills, or simply out of boredom, with hope for a new landscape and a higher wage. But just because one has a high rank or impressive title does not mean that one is fulfilling the mandates of leadership. It takes more than that. You must be attuned to what is known and unknown in building stability and progress for those you lead.

A brief historic angle: For years, medicine occupied a sweet spot within the health care system. The profession protected its perks and privileges deriving from its untouchable status. With it came superiority, dominance, and protectionism. It was an inward, parochial focus of thinking, status, and reward. The problem was: This insulated mindset prompted a blind spot. The profession missed changes and transformation that were occurring just beyond the comfort zone. Those changes were unknowns in planning and perspective.

In the 1990s, medicine as a whole woke up to calls for change and a new order. The rise of the hospitalist was in part an outgrowth of that wake-up call. It reshaped power structures, status, and lucrative business arrangements within the profession. For many, the sweet spot soured.

The problem with collapsing into a sweet spot today is that so much is changing: all that is known and much that is unknown. Finances, technology, and demand are all in flux. The health care system finds itself in a quantity/quality/cost paradox. Volume accelerates, but at what cost to quality and morale? If someone or something can accomplish similar outcomes at less cost, why not go with the cheaper option? These questions can best be addressed by seeing them in the context of larger changes happening in the health system.

A new view for leaders

The “meta” in metaleadership hopes to provide a broader, disciplined slant on this phenomenon. That prefix – used to modify many concepts and terms – refers to a wider, more expansive view or a more comprehensive and transcendent perch on a topic. A “meta-” prefix invites a critical analysis of the original topic with the addition of new perspectives and insights, as with a meta-analysis.

Why then the need now for a “meta” view among health care leaders? It is easy in the course of career progression to lose track of the bigger picture of what you are doing and how it fits into changes occurring in society and for the profession. Even if your focus is on a particular clinical procedure, how does what you are doing fit into larger metatrends and changes? How might you tangibly contribute to the evolution of those trends? If you are in a leadership position, how do you fit your practice or department into the bigger picture? How might this enterprise perspective speak to your career trajectory?

To inform these questions, build your platform for knowns and unknowns. There are four combinations in the “known-unknown” equation. They are each important and provocative for leaders. Your awareness of them prompts curiosity about “meta” problems and problem solving.

• There are the “known-knowns”: what you know and you know you know it. The problem here is that you may assume that you know something that you don’t.
• There are the “known-unknowns”: Clear and curious about what you need to learn, you develop pathways to find out.
• There are the “unknown-knowns”: what others know and you don’t; a point of vulnerability if you are not careful to discover and figure this out.
• And finally, the “unknown-unknowns”: the mysteries of what could lie ahead that no one yet fully comprehends.

The task for the “metaleader”? Be clear on what you know, and seek always to learn and discover those unknowns. The better you factor them into your assessments, the better you are able to shape trends and the less likely you are to be overrun by them.

Just as you become more specialized with time, as a leader, you can leverage your experience to widen your lens and see more, understand it better, and – with that knowledge – chart a pathway that corresponds with where the health system is going. With this wider mindset, you fashion a fresh and innovative perspective on what is happening with health care and the options for constructively addressing new constraints and opportunities. You think big, reach far, and with this broader understanding, foment a lively set of perspectives and options that would otherwise not be available for those you lead. And when seen as a puzzle to learn and solve, the “meta” perch provides an engaging angle on the game of health care change. You too can be a player.

Dr. Marcus is coauthor of “Renegotiating Health Care: Resolving Conflict to Build Collaboration,” 2nd ed. (San Francisco: Jossey-Bass Publishers, 2011) and is director of the program for health care negotiation and conflict resolution at Harvard T.H. Chan School of Public Health, Boston. Dr. Marcus teaches regularly in the SHM Leadership Academy. He can be reached at [email protected].

Mel C. Anderson, MD, FACP, section chief of hospital medicine for the Veterans Administration of Eastern Colorado, and his hospitalist colleagues share a mission to care for the men and women who served their country in the armed forces and are now being served by the VA.

“That mission binds us together in a deep and impactful way,” he said. “One of the greatest joys of my life has been to dedicate, with the teams I lead, our hearts and minds to serving this population of veterans.”

Approximately 400 hospitalists work nationwide in the VA, the country’s largest integrated health system, typically in groups of about a dozen. Not every VA medical center employs hospitalists; this depends on local tradition and size of the facility. Dr. Anderson was for several years the lone hospitalist at the VA Medical Center in Denver, starting in 2005, and now he heads a group of 17. The Denver facility employs five inpatient teams plus nocturnists, supported by residents, interns, and medical students in training from the University of Colorado at Denver, Aurora, to deliver all of its inpatient medical care.

“We also have an open ICU here. Hospitalists are able to follow their patients across the hospital, and we can make the decision to move them to the ICU,” Dr. Anderson said. The Denver group also established a hospitalist-staffed postdischarge clinic, where patients can reconnect with their hospital team. “It’s not to supplant primary care but to help promote safe transit as the patient moves back to the community,” he said. “We’ve also developed a surgery consult service for orthopedics and other surgical subspecialties.”

The VA’s integrated electronic medical record facilitates communication between hospitalists and primary care physicians, with instant messaging for updating the PCPs on the patient’s hospital stay.

The Denver VA hospitalists value their collegial culture, Dr. Anderson said. “We are invested in our group and in one another and in life-long learning. I often ask my group for their feedback. It’s one of the singular joys of my career to lead such a wonderful group, which has been built up person by person. I hired every single member. As much as their clinical skills and the achievements on their curriculum vitae were important, I also paid attention to their interpersonal communication skills.”

Members of the Denver hospitalist group also share an academic focus and commitment to scholarship and research. Dr. Anderson’s academic emphasis is on how to promote teaching and faculty development through organized bedside rounding and how to orient students to teaching as a potential career path. He is associate program director for medicine residencies at the University of Colorado and leads its Clinician/Educator Pathway.

The VA hospital’s interdisciplinary bedside rounding initiative involves the medicine team – students, residents, attending – and pharmacist, plus the patient’s bedside nurse and nurse care coordinator. “We have worked on fostering an interdisciplinary culture, and we’re very proud of the rounding model we developed here. We all round together at the bedside, and typically that might include 7 or 8 people,” Dr. Anderson explained.

“In planning this program, we used a Rapid Performance Improvement Project team with a nurse, pharmacist, and physical therapist helping us envision how to redesign rounds to overcome the time constraints,” he said. “We altered nurses’ work flow to permit them to join the rounding for their patients, and we moved morning medication administration to 7 a.m., so it wouldn’t get in the way of the rounding. We now audit rates of physician-to-nurse communication on rounds and how often we successfully achieve the nurse’s participation.”¹ This approach has also cut rates of phone pages from nurses to house staff, and substantially increased job satisfaction.
 

What’s different in the VA?

The work of hospitalists in the VA is mostly similar to other hospital settings, but perhaps with more intensity, Dr. Anderson said. There are comorbidities such as higher rates of PTSD, alcohol use disorder, substance abuse, and mental health issues – all of which have an effect over time on patients. But veterans also have different attitudes about, for example, pain.

“When patients are asked to rate their pain on a scale of 0 to 10, for a veteran of a foreign war, 2 out of 10 is not the same as someone else’s 2 out of 10. How do we compensate for that difference?” he said. “And while awareness of PTSD and efforts to mitigate its impact have made incredible gains over the past 15 years, we still see a lot of these issues and their manifestations in social challenges such as homelessness. We are fortunate to have VA outpatient services and homeless veteran programs to help with these issues.”

There is a different paradigm for care at the VA, Dr. Anderson said. “We are a not-for-profit institution with the welfare of veterans as our primary aim. Beyond their health and wellness, that means supporting them in other ways and reaching out into the community. As doctors and nurses we feel a kinship around that mission, although we also have to be stewards of taxpayer dollars. We recognize that the VA is a large and complicated, somewhat inertia-laden organization in which making changes can be very challenging. But there are also opportunities as a national organization to effect changes on a national scale.”

Dr. Anderson chairs the VA’s Hospitalist Field Advisory Committee (HFAC), a group of about eight hospitalists empaneled to advise the system’s Office of Specialty Care Services on clinical policy and program development. They serve 3-year terms and meet monthly by phone and annually in Washington. The HFAC’s last annual meeting occurred in mid-September 2018 in Washington with a focus on developing a hospital medicine annual survey and needs assessment, revisiting strategic goals, and convening multilateral meetings with the chiefs of medicine and emergency medicine FACs.

“Our biggest emphasis is clinical – this includes clinical pathways, best practices for managing PTSD or acute coronary syndrome, and the like. We also share management issues, such as how to configure medical records or arrange night coverage. This is a national conversation to share what some sites have already experienced and learned,” Dr. Anderson said.

“We also have a VA Academic Hospitalist Subcommittee, working together on multisite research studies and on resident education protocols. Because we’re a large system, we’re able to connect with one another and leverage what we’ve learned. I get emails almost every day about research topics from colleagues across the country,” he said. A collaborative website and email distribution list allows doctors to post questions to their peers nationwide.
 

A calling for hospital medicine

Before moving to Denver, Dr. Anderson served as a major in the Air Force Medical Corps and was based at the David Grant US Air Force Medical Center on Travis Air Force Base in California – which is where he did his residency. In the course of a “traditionalist” internal medical training, including 4-month stints on hospital wards in addition to outpatient services, he realized he had a calling for hospital medicine.

In a job at the Providence (R.I.) VA Medical Center, he exclusively practiced outpatient care, but he found that he missed key aspects of inpatient work, such as the intensity of the clinical issues and teaching encounters. “I cold-called the hospital’s chief of medicine and volunteered to start mentoring inpatient residents,” Dr. Anderson said. “That was 17 years ago.”

Another abiding interest derived from Dr. Anderson’s military service is travel medicine. While a physician in the Air Force, he was deployed to Haiti in 1995 and to Nicaragua in 2000, where he treated thousands of patients – both U.S. service personnel and local populations.

“In Haiti, our primary mission was for U.S. troops who were still based there following the 1994 Operation Uphold Democracy intervention, but there were a lot fewer of them, so we mostly kept busy providing care to Haitian nationals,” he said. “That work was eye opening, to say the least,” and led to a professional interest in tropical illnesses. “Since then, I’ve been a visiting professor for the University of Colorado posted to the University of Zimbabwe in Harare in 2012 and 2016.”

What gives Dr. Anderson such joy and enthusiasm for his VA work? “I am a curious lifelong learner. Every day, there are 10 new things I need to learn, whether clinically or operationally in a big hospital system or just the day-to-day realities of leading a group of physicians. I never feel like I’m treading water,” he said. He is also energized by teaching – seeing “the light bulb go on” for the students he is instructing – and by serving as a role model for doctors in training.

“As I contemplate all the simultaneous balls I have in the air, including our recent move into a new hospital building, sometimes I think it is kind of crazy to be doing as much as I do,” he said. “But I also take time away, balancing work versus nonwork.” He spends quality time with his wife of 21 years, 17-year-old daughter, other relatives, and friends, as well as on physical activity, reading books about philosophy, and his hobby of rebuilding motorcycles, which he says offers a kind of meditative calm.

“I also feel a deep sense of service – to patients, colleagues, students, and to the mission of the VA,” Dr. Anderson said. “There is truly something special about caring for the veteran. It’s hard to articulate, but it really keeps us coming back for more. I’ve had vets sing to me, tell jokes, do magic tricks, share their war stories. I’ve had patients open up to me in ways that were both profound and humbling.”
 

References

1. Young E et al. Impact of altered medication administration time on interdisciplinary bedside rounds on academic medical ward. J Nurs Care Qual. 2017 Jul/Sep;32(3):218-225.

Mel C. Anderson, MD, FACP, section chief of hospital medicine for the Veterans Administration of Eastern Colorado, and his hospitalist colleagues share a mission to care for the men and women who served their country in the armed forces and are now being served by the VA.

“That mission binds us together in a deep and impactful way,” he said. “One of the greatest joys of my life has been to dedicate, with the teams I lead, our hearts and minds to serving this population of veterans.”

Approximately 400 hospitalists work nationwide in the VA, the country’s largest integrated health system, typically in groups of about a dozen. Not every VA medical center employs hospitalists; this depends on local tradition and size of the facility. Dr. Anderson was for several years the lone hospitalist at the VA Medical Center in Denver, starting in 2005, and now he heads a group of 17. The Denver facility employs five inpatient teams plus nocturnists, supported by residents, interns, and medical students in training from the University of Colorado at Denver, Aurora, to deliver all of its inpatient medical care.

“We also have an open ICU here. Hospitalists are able to follow their patients across the hospital, and we can make the decision to move them to the ICU,” Dr. Anderson said. The Denver group also established a hospitalist-staffed postdischarge clinic, where patients can reconnect with their hospital team. “It’s not to supplant primary care but to help promote safe transit as the patient moves back to the community,” he said. “We’ve also developed a surgery consult service for orthopedics and other surgical subspecialties.”

The VA’s integrated electronic medical record facilitates communication between hospitalists and primary care physicians, with instant messaging for updating the PCPs on the patient’s hospital stay.

The Denver VA hospitalists value their collegial culture, Dr. Anderson said. “We are invested in our group and in one another and in life-long learning. I often ask my group for their feedback. It’s one of the singular joys of my career to lead such a wonderful group, which has been built up person by person. I hired every single member. As much as their clinical skills and the achievements on their curriculum vitae were important, I also paid attention to their interpersonal communication skills.”

Members of the Denver hospitalist group also share an academic focus and commitment to scholarship and research. Dr. Anderson’s academic emphasis is on how to promote teaching and faculty development through organized bedside rounding and how to orient students to teaching as a potential career path. He is associate program director for medicine residencies at the University of Colorado and leads its Clinician/Educator Pathway.

The VA hospital’s interdisciplinary bedside rounding initiative involves the medicine team – students, residents, attending – and pharmacist, plus the patient’s bedside nurse and nurse care coordinator. “We have worked on fostering an interdisciplinary culture, and we’re very proud of the rounding model we developed here. We all round together at the bedside, and typically that might include 7 or 8 people,” Dr. Anderson explained.

“In planning this program, we used a Rapid Performance Improvement Project team with a nurse, pharmacist, and physical therapist helping us envision how to redesign rounds to overcome the time constraints,” he said. “We altered nurses’ work flow to permit them to join the rounding for their patients, and we moved morning medication administration to 7 a.m., so it wouldn’t get in the way of the rounding. We now audit rates of physician-to-nurse communication on rounds and how often we successfully achieve the nurse’s participation.”¹ This approach has also cut rates of phone pages from nurses to house staff, and substantially increased job satisfaction.
 

What’s different in the VA?

The work of hospitalists in the VA is mostly similar to other hospital settings, but perhaps with more intensity, Dr. Anderson said. There are comorbidities such as higher rates of PTSD, alcohol use disorder, substance abuse, and mental health issues – all of which have an effect over time on patients. But veterans also have different attitudes about, for example, pain.

“When patients are asked to rate their pain on a scale of 0 to 10, for a veteran of a foreign war, 2 out of 10 is not the same as someone else’s 2 out of 10. How do we compensate for that difference?” he said. “And while awareness of PTSD and efforts to mitigate its impact have made incredible gains over the past 15 years, we still see a lot of these issues and their manifestations in social challenges such as homelessness. We are fortunate to have VA outpatient services and homeless veteran programs to help with these issues.”

There is a different paradigm for care at the VA, Dr. Anderson said. “We are a not-for-profit institution with the welfare of veterans as our primary aim. Beyond their health and wellness, that means supporting them in other ways and reaching out into the community. As doctors and nurses we feel a kinship around that mission, although we also have to be stewards of taxpayer dollars. We recognize that the VA is a large and complicated, somewhat inertia-laden organization in which making changes can be very challenging. But there are also opportunities as a national organization to effect changes on a national scale.”

Dr. Anderson chairs the VA’s Hospitalist Field Advisory Committee (HFAC), a group of about eight hospitalists empaneled to advise the system’s Office of Specialty Care Services on clinical policy and program development. They serve 3-year terms and meet monthly by phone and annually in Washington. The HFAC’s last annual meeting occurred in mid-September 2018 in Washington with a focus on developing a hospital medicine annual survey and needs assessment, revisiting strategic goals, and convening multilateral meetings with the chiefs of medicine and emergency medicine FACs.

“Our biggest emphasis is clinical – this includes clinical pathways, best practices for managing PTSD or acute coronary syndrome, and the like. We also share management issues, such as how to configure medical records or arrange night coverage. This is a national conversation to share what some sites have already experienced and learned,” Dr. Anderson said.

“We also have a VA Academic Hospitalist Subcommittee, working together on multisite research studies and on resident education protocols. Because we’re a large system, we’re able to connect with one another and leverage what we’ve learned. I get emails almost every day about research topics from colleagues across the country,” he said. A collaborative website and email distribution list allows doctors to post questions to their peers nationwide.
 

A calling for hospital medicine

Before moving to Denver, Dr. Anderson served as a major in the Air Force Medical Corps and was based at the David Grant US Air Force Medical Center on Travis Air Force Base in California – which is where he did his residency. In the course of a “traditionalist” internal medical training, including 4-month stints on hospital wards in addition to outpatient services, he realized he had a calling for hospital medicine.

In a job at the Providence (R.I.) VA Medical Center, he exclusively practiced outpatient care, but he found that he missed key aspects of inpatient work, such as the intensity of the clinical issues and teaching encounters. “I cold-called the hospital’s chief of medicine and volunteered to start mentoring inpatient residents,” Dr. Anderson said. “That was 17 years ago.”

Another abiding interest derived from Dr. Anderson’s military service is travel medicine. While a physician in the Air Force, he was deployed to Haiti in 1995 and to Nicaragua in 2000, where he treated thousands of patients – both U.S. service personnel and local populations.

“In Haiti, our primary mission was for U.S. troops who were still based there following the 1994 Operation Uphold Democracy intervention, but there were a lot fewer of them, so we mostly kept busy providing care to Haitian nationals,” he said. “That work was eye opening, to say the least,” and led to a professional interest in tropical illnesses. “Since then, I’ve been a visiting professor for the University of Colorado posted to the University of Zimbabwe in Harare in 2012 and 2016.”

What gives Dr. Anderson such joy and enthusiasm for his VA work? “I am a curious lifelong learner. Every day, there are 10 new things I need to learn, whether clinically or operationally in a big hospital system or just the day-to-day realities of leading a group of physicians. I never feel like I’m treading water,” he said. He is also energized by teaching – seeing “the light bulb go on” for the students he is instructing – and by serving as a role model for doctors in training.

“As I contemplate all the simultaneous balls I have in the air, including our recent move into a new hospital building, sometimes I think it is kind of crazy to be doing as much as I do,” he said. “But I also take time away, balancing work versus nonwork.” He spends quality time with his wife of 21 years, 17-year-old daughter, other relatives, and friends, as well as on physical activity, reading books about philosophy, and his hobby of rebuilding motorcycles, which he says offers a kind of meditative calm.

“I also feel a deep sense of service – to patients, colleagues, students, and to the mission of the VA,” Dr. Anderson said. “There is truly something special about caring for the veteran. It’s hard to articulate, but it really keeps us coming back for more. I’ve had vets sing to me, tell jokes, do magic tricks, share their war stories. I’ve had patients open up to me in ways that were both profound and humbling.”
 

References

1. Young E et al. Impact of altered medication administration time on interdisciplinary bedside rounds on academic medical ward. J Nurs Care Qual. 2017 Jul/Sep;32(3):218-225.

Mel C. Anderson, MD, FACP, section chief of hospital medicine for the Veterans Administration of Eastern Colorado, and his hospitalist colleagues share a mission to care for the men and women who served their country in the armed forces and are now being served by the VA.

“That mission binds us together in a deep and impactful way,” he said. “One of the greatest joys of my life has been to dedicate, with the teams I lead, our hearts and minds to serving this population of veterans.”

Approximately 400 hospitalists work nationwide in the VA, the country’s largest integrated health system, typically in groups of about a dozen. Not every VA medical center employs hospitalists; this depends on local tradition and size of the facility. Dr. Anderson was for several years the lone hospitalist at the VA Medical Center in Denver, starting in 2005, and now he heads a group of 17. The Denver facility employs five inpatient teams plus nocturnists, supported by residents, interns, and medical students in training from the University of Colorado at Denver, Aurora, to deliver all of its inpatient medical care.

“We also have an open ICU here. Hospitalists are able to follow their patients across the hospital, and we can make the decision to move them to the ICU,” Dr. Anderson said. The Denver group also established a hospitalist-staffed postdischarge clinic, where patients can reconnect with their hospital team. “It’s not to supplant primary care but to help promote safe transit as the patient moves back to the community,” he said. “We’ve also developed a surgery consult service for orthopedics and other surgical subspecialties.”

The VA’s integrated electronic medical record facilitates communication between hospitalists and primary care physicians, with instant messaging for updating the PCPs on the patient’s hospital stay.

The Denver VA hospitalists value their collegial culture, Dr. Anderson said. “We are invested in our group and in one another and in life-long learning. I often ask my group for their feedback. It’s one of the singular joys of my career to lead such a wonderful group, which has been built up person by person. I hired every single member. As much as their clinical skills and the achievements on their curriculum vitae were important, I also paid attention to their interpersonal communication skills.”

Members of the Denver hospitalist group also share an academic focus and commitment to scholarship and research. Dr. Anderson’s academic emphasis is on how to promote teaching and faculty development through organized bedside rounding and how to orient students to teaching as a potential career path. He is associate program director for medicine residencies at the University of Colorado and leads its Clinician/Educator Pathway.

The VA hospital’s interdisciplinary bedside rounding initiative involves the medicine team – students, residents, attending – and pharmacist, plus the patient’s bedside nurse and nurse care coordinator. “We have worked on fostering an interdisciplinary culture, and we’re very proud of the rounding model we developed here. We all round together at the bedside, and typically that might include 7 or 8 people,” Dr. Anderson explained.

“In planning this program, we used a Rapid Performance Improvement Project team with a nurse, pharmacist, and physical therapist helping us envision how to redesign rounds to overcome the time constraints,” he said. “We altered nurses’ work flow to permit them to join the rounding for their patients, and we moved morning medication administration to 7 a.m., so it wouldn’t get in the way of the rounding. We now audit rates of physician-to-nurse communication on rounds and how often we successfully achieve the nurse’s participation.”¹ This approach has also cut rates of phone pages from nurses to house staff, and substantially increased job satisfaction.
 

What’s different in the VA?

The work of hospitalists in the VA is mostly similar to other hospital settings, but perhaps with more intensity, Dr. Anderson said. There are comorbidities such as higher rates of PTSD, alcohol use disorder, substance abuse, and mental health issues – all of which have an effect over time on patients. But veterans also have different attitudes about, for example, pain.

“When patients are asked to rate their pain on a scale of 0 to 10, for a veteran of a foreign war, 2 out of 10 is not the same as someone else’s 2 out of 10. How do we compensate for that difference?” he said. “And while awareness of PTSD and efforts to mitigate its impact have made incredible gains over the past 15 years, we still see a lot of these issues and their manifestations in social challenges such as homelessness. We are fortunate to have VA outpatient services and homeless veteran programs to help with these issues.”

There is a different paradigm for care at the VA, Dr. Anderson said. “We are a not-for-profit institution with the welfare of veterans as our primary aim. Beyond their health and wellness, that means supporting them in other ways and reaching out into the community. As doctors and nurses we feel a kinship around that mission, although we also have to be stewards of taxpayer dollars. We recognize that the VA is a large and complicated, somewhat inertia-laden organization in which making changes can be very challenging. But there are also opportunities as a national organization to effect changes on a national scale.”

Dr. Anderson chairs the VA’s Hospitalist Field Advisory Committee (HFAC), a group of about eight hospitalists empaneled to advise the system’s Office of Specialty Care Services on clinical policy and program development. They serve 3-year terms and meet monthly by phone and annually in Washington. The HFAC’s last annual meeting occurred in mid-September 2018 in Washington with a focus on developing a hospital medicine annual survey and needs assessment, revisiting strategic goals, and convening multilateral meetings with the chiefs of medicine and emergency medicine FACs.

“Our biggest emphasis is clinical – this includes clinical pathways, best practices for managing PTSD or acute coronary syndrome, and the like. We also share management issues, such as how to configure medical records or arrange night coverage. This is a national conversation to share what some sites have already experienced and learned,” Dr. Anderson said.

“We also have a VA Academic Hospitalist Subcommittee, working together on multisite research studies and on resident education protocols. Because we’re a large system, we’re able to connect with one another and leverage what we’ve learned. I get emails almost every day about research topics from colleagues across the country,” he said. A collaborative website and email distribution list allows doctors to post questions to their peers nationwide.
 

A calling for hospital medicine

Before moving to Denver, Dr. Anderson served as a major in the Air Force Medical Corps and was based at the David Grant US Air Force Medical Center on Travis Air Force Base in California – which is where he did his residency. In the course of a “traditionalist” internal medical training, including 4-month stints on hospital wards in addition to outpatient services, he realized he had a calling for hospital medicine.

In a job at the Providence (R.I.) VA Medical Center, he exclusively practiced outpatient care, but he found that he missed key aspects of inpatient work, such as the intensity of the clinical issues and teaching encounters. “I cold-called the hospital’s chief of medicine and volunteered to start mentoring inpatient residents,” Dr. Anderson said. “That was 17 years ago.”

Another abiding interest derived from Dr. Anderson’s military service is travel medicine. While a physician in the Air Force, he was deployed to Haiti in 1995 and to Nicaragua in 2000, where he treated thousands of patients – both U.S. service personnel and local populations.

“In Haiti, our primary mission was for U.S. troops who were still based there following the 1994 Operation Uphold Democracy intervention, but there were a lot fewer of them, so we mostly kept busy providing care to Haitian nationals,” he said. “That work was eye opening, to say the least,” and led to a professional interest in tropical illnesses. “Since then, I’ve been a visiting professor for the University of Colorado posted to the University of Zimbabwe in Harare in 2012 and 2016.”

What gives Dr. Anderson such joy and enthusiasm for his VA work? “I am a curious lifelong learner. Every day, there are 10 new things I need to learn, whether clinically or operationally in a big hospital system or just the day-to-day realities of leading a group of physicians. I never feel like I’m treading water,” he said. He is also energized by teaching – seeing “the light bulb go on” for the students he is instructing – and by serving as a role model for doctors in training.

“As I contemplate all the simultaneous balls I have in the air, including our recent move into a new hospital building, sometimes I think it is kind of crazy to be doing as much as I do,” he said. “But I also take time away, balancing work versus nonwork.” He spends quality time with his wife of 21 years, 17-year-old daughter, other relatives, and friends, as well as on physical activity, reading books about philosophy, and his hobby of rebuilding motorcycles, which he says offers a kind of meditative calm.

“I also feel a deep sense of service – to patients, colleagues, students, and to the mission of the VA,” Dr. Anderson said. “There is truly something special about caring for the veteran. It’s hard to articulate, but it really keeps us coming back for more. I’ve had vets sing to me, tell jokes, do magic tricks, share their war stories. I’ve had patients open up to me in ways that were both profound and humbling.”
 

References

1. Young E et al. Impact of altered medication administration time on interdisciplinary bedside rounds on academic medical ward. J Nurs Care Qual. 2017 Jul/Sep;32(3):218-225.

The National Association of Inpatient Physicians (NAIP) “opened its doors” in the spring of 1998, welcoming the first 300 hospitalists. The term “hospitalist” was first coined in Bob Wachter’s 1996 New England Journal of Medicine article,1 although hospitalists were relatively few at that time, and the term not infrequently evoked controversy.

Having full-time hospital-based physicians was highly disruptive to the traditional culture of medicine, where hospital rounds were an integral part of a primary care physicians’ practice, professional identity, and referral patterns. Additionally, many hospital-based specialists were beginning to fill the hospitalist role. 

The decision to include “inpatient physician” rather than “hospitalist” in the name was carefully considered and was intended to be inclusive, without alienating potential allies. Virtually any doctor working in a hospital could identify themselves as an inpatient physician, and all who wanted to participate were welcomed. It also was evident early on that this young specialty was going to comprise many different disciplines, including internal medicine, family practice, and pediatrics to name a few, and reaching out to all potential stakeholders was an urgent priority.

During its’ first 5 years, the field of hospital medicine grew rapidly, with NAIP membership nearing 2,000 members. The bimonthly newsletter The Hospitalist provided a vehicle to reach out to members and other stakeholders, and the annual meeting gave hospitalists a forum to gather, learn from each other, and enjoy camaraderie. Early research efforts focused on patient safety and, just as importantly, in 2002, the publication of the first Productivity and Compensation Survey (which is now known as SHM’s State of Hospital Medicine Report) and the initial development of The Hospitalist Core Competencies (first published in 2006, and now in its’ 2017 revision) all helped define the young specialty and gain acceptance.^2,3

 
The term hospitalist became mainstream and accepted, and the name of our field, hospital medicine, has now become widely recognized. 

Though the term “inpatient physician” had focused on physicians as a primary constituency, the successful growth of hospital medicine now increasingly depended upon other important constituencies and their understanding of the hospital medicine specialty and the role of hospitalists. These stakeholders included virtually all health care professionals and administrators, government officials at the federal, state, and local levels, patients, and the American public.

As NAIP leadership, it was our belief and intent that having a name that accurately portrayed hospitalists and hospital medicine would define our “brand” in an understandable way. This was especially important given the breadth and depth of the responsibilities that NAIP and its’ members were increasingly taking on in a rapidly changing health care system. Additionally, it was a top priority to find a name that would inspire confidence and passion among our members, stir a sense of loyalty and pride, and continue to be inclusive.

With this in mind, the NAIP board undertook a process to search for a new name in the spring of 2002. As NAIP President-Elect, stewarding the name change process was my responsibility.
In approaching this challenge, we initially evaluated the components of other professional organizations’ names, including academy, college, and society among others, and whether the specialist name or professional field was included. We then held focus groups among regional hospitalists, invited feedback from all NAIP members, and solicited leadership feedback from other professional organizations. All of these data were taken into our fall 2002 board meeting in St. Louis. 

Prior to the meeting, it was agreed that making a name change would require a supermajority of two-thirds of the 11 voting board members (though only 10 ultimately attended the meeting). Also participating in the discussion were the nonvoting four ex-officio board members and the NAIP CEO. The initial discussion included presentations arguing for Hospital Medicine versus Hospitalist as part of the name. We then discussed and voted on the primary professional component of the name, with “Society” finally being chosen. After further discussion and a series of ballots, we arrived at the name “Society of Hospital Medicine.” In the final ballot, 7 out of 10 cast their votes in favor of this finalist, and our organization became The Society of Hospital Medicine. Our abbreviation SHM was to become our logo, which was developed in advance of our 2003 annual meeting. 

In the 15 years since, the Society of Hospital Medicine has become well known to our constituents and stakeholders. SHM is recognized for its staunch advocacy, particularly at the federal level, with recent establishment of a Medicare specialty code designation for hospitalists, and support for endeavors such as Project Boost, which focused on patient transitions from hospital discharge to home.^4,5,6 Hospitalists throughout the United States routinely manage hospitalized patients, and now have their specialty expertise recognized via Focused Practice in Hospital Medicine (Internal Medicine and Family Practice), and future specialty training and certification for pediatric hospitalists.^7,8,9 

The Journal of Hospital Medicine now highlights accomplishments in hospital medicine research and knowledge.¹⁰ Hospitalist leaders frequently are developed through the SHM Leadership Academy,¹¹ and hospitalists increasingly fill diverse health care responsibilities in education, research, informatics, palliative care, performance improvement, administration, among many others. Of note, SHM membership currently exceeds 17,000 members, and now offers membership that includes nurse practitioners, physician assistants, fellows, residents, students, and practice administrators, among others.¹² 

These achievements and many more have been driven by the efforts of past and present Society of Hospital Medicine members and staff, and like-minded, invested professionals and organizations. The name Society of Hospital Medicine (SHM) is highly familiar and well regarded by virtually all our stakeholders and is recognized for its proven leadership in continuing to define our brand, hospital medicine.

Dr. Dichter is an intensivist and associate professor of medicine at the University of Minnesota Medical Center, Minneapolis.

References

1. Wachter RM et al. The emerging role of “hospitalists” in the American health care system. N Eng J Med. 1996 Aug 15;335(7):514-7.
2. SHM’s State of Hospital Medicine Report 2018. Fall 2018. 
3. Satyen N et al. Core competencies in hospital medicine 2017 Revision. J Hosp Med. 2017 Apr;12:S1.
4. Society of Hospital Medicine website, Policy & Advocacy homepage (accessed July 26, 2018).  
5. CMS manual system, Oct. 28, 2016 (accessed July 26, 2018). 
6. Society of Hospital Medicine website, Clinical Topics: Advancing successful care transitions to improve outcomes (accessed July 26, 2018). 
7. American Board of Internal Medicine website, MOC requirements: Focused practice in hospital medicine (accessed July 26, 2018). 
8. American Board of Family Medicine website, Designation of practice in hospital medicine (accessed July 26, 2018). 
9. The American Board of Pediatrics website, Pediatric hospital medicine certification (accessed July 26, 2018). 
10. Journal of Hospital Medicine official website (accessed July 26, 2018). 
11. SHM Leadership Academy website (accessed July 26, 2018). 
12. Society of Hospital Medicine website, About SHM membership (accessed July 26, 2018).

The National Association of Inpatient Physicians (NAIP) “opened its doors” in the spring of 1998, welcoming the first 300 hospitalists. The term “hospitalist” was first coined in Bob Wachter’s 1996 New England Journal of Medicine article,1 although hospitalists were relatively few at that time, and the term not infrequently evoked controversy.

Having full-time hospital-based physicians was highly disruptive to the traditional culture of medicine, where hospital rounds were an integral part of a primary care physicians’ practice, professional identity, and referral patterns. Additionally, many hospital-based specialists were beginning to fill the hospitalist role. 

The decision to include “inpatient physician” rather than “hospitalist” in the name was carefully considered and was intended to be inclusive, without alienating potential allies. Virtually any doctor working in a hospital could identify themselves as an inpatient physician, and all who wanted to participate were welcomed. It also was evident early on that this young specialty was going to comprise many different disciplines, including internal medicine, family practice, and pediatrics to name a few, and reaching out to all potential stakeholders was an urgent priority.

During its’ first 5 years, the field of hospital medicine grew rapidly, with NAIP membership nearing 2,000 members. The bimonthly newsletter The Hospitalist provided a vehicle to reach out to members and other stakeholders, and the annual meeting gave hospitalists a forum to gather, learn from each other, and enjoy camaraderie. Early research efforts focused on patient safety and, just as importantly, in 2002, the publication of the first Productivity and Compensation Survey (which is now known as SHM’s State of Hospital Medicine Report) and the initial development of The Hospitalist Core Competencies (first published in 2006, and now in its’ 2017 revision) all helped define the young specialty and gain acceptance.^2,3

 
The term hospitalist became mainstream and accepted, and the name of our field, hospital medicine, has now become widely recognized. 

Though the term “inpatient physician” had focused on physicians as a primary constituency, the successful growth of hospital medicine now increasingly depended upon other important constituencies and their understanding of the hospital medicine specialty and the role of hospitalists. These stakeholders included virtually all health care professionals and administrators, government officials at the federal, state, and local levels, patients, and the American public.

As NAIP leadership, it was our belief and intent that having a name that accurately portrayed hospitalists and hospital medicine would define our “brand” in an understandable way. This was especially important given the breadth and depth of the responsibilities that NAIP and its’ members were increasingly taking on in a rapidly changing health care system. Additionally, it was a top priority to find a name that would inspire confidence and passion among our members, stir a sense of loyalty and pride, and continue to be inclusive.

With this in mind, the NAIP board undertook a process to search for a new name in the spring of 2002. As NAIP President-Elect, stewarding the name change process was my responsibility.
In approaching this challenge, we initially evaluated the components of other professional organizations’ names, including academy, college, and society among others, and whether the specialist name or professional field was included. We then held focus groups among regional hospitalists, invited feedback from all NAIP members, and solicited leadership feedback from other professional organizations. All of these data were taken into our fall 2002 board meeting in St. Louis. 

Prior to the meeting, it was agreed that making a name change would require a supermajority of two-thirds of the 11 voting board members (though only 10 ultimately attended the meeting). Also participating in the discussion were the nonvoting four ex-officio board members and the NAIP CEO. The initial discussion included presentations arguing for Hospital Medicine versus Hospitalist as part of the name. We then discussed and voted on the primary professional component of the name, with “Society” finally being chosen. After further discussion and a series of ballots, we arrived at the name “Society of Hospital Medicine.” In the final ballot, 7 out of 10 cast their votes in favor of this finalist, and our organization became The Society of Hospital Medicine. Our abbreviation SHM was to become our logo, which was developed in advance of our 2003 annual meeting. 

In the 15 years since, the Society of Hospital Medicine has become well known to our constituents and stakeholders. SHM is recognized for its staunch advocacy, particularly at the federal level, with recent establishment of a Medicare specialty code designation for hospitalists, and support for endeavors such as Project Boost, which focused on patient transitions from hospital discharge to home.^4,5,6 Hospitalists throughout the United States routinely manage hospitalized patients, and now have their specialty expertise recognized via Focused Practice in Hospital Medicine (Internal Medicine and Family Practice), and future specialty training and certification for pediatric hospitalists.^7,8,9 

The Journal of Hospital Medicine now highlights accomplishments in hospital medicine research and knowledge.¹⁰ Hospitalist leaders frequently are developed through the SHM Leadership Academy,¹¹ and hospitalists increasingly fill diverse health care responsibilities in education, research, informatics, palliative care, performance improvement, administration, among many others. Of note, SHM membership currently exceeds 17,000 members, and now offers membership that includes nurse practitioners, physician assistants, fellows, residents, students, and practice administrators, among others.¹² 

These achievements and many more have been driven by the efforts of past and present Society of Hospital Medicine members and staff, and like-minded, invested professionals and organizations. The name Society of Hospital Medicine (SHM) is highly familiar and well regarded by virtually all our stakeholders and is recognized for its proven leadership in continuing to define our brand, hospital medicine.

Dr. Dichter is an intensivist and associate professor of medicine at the University of Minnesota Medical Center, Minneapolis.

References

1. Wachter RM et al. The emerging role of “hospitalists” in the American health care system. N Eng J Med. 1996 Aug 15;335(7):514-7.
2. SHM’s State of Hospital Medicine Report 2018. Fall 2018. 
3. Satyen N et al. Core competencies in hospital medicine 2017 Revision. J Hosp Med. 2017 Apr;12:S1.
4. Society of Hospital Medicine website, Policy & Advocacy homepage (accessed July 26, 2018).  
5. CMS manual system, Oct. 28, 2016 (accessed July 26, 2018). 
6. Society of Hospital Medicine website, Clinical Topics: Advancing successful care transitions to improve outcomes (accessed July 26, 2018). 
7. American Board of Internal Medicine website, MOC requirements: Focused practice in hospital medicine (accessed July 26, 2018). 
8. American Board of Family Medicine website, Designation of practice in hospital medicine (accessed July 26, 2018). 
9. The American Board of Pediatrics website, Pediatric hospital medicine certification (accessed July 26, 2018). 
10. Journal of Hospital Medicine official website (accessed July 26, 2018). 
11. SHM Leadership Academy website (accessed July 26, 2018). 
12. Society of Hospital Medicine website, About SHM membership (accessed July 26, 2018).

The National Association of Inpatient Physicians (NAIP) “opened its doors” in the spring of 1998, welcoming the first 300 hospitalists. The term “hospitalist” was first coined in Bob Wachter’s 1996 New England Journal of Medicine article,1 although hospitalists were relatively few at that time, and the term not infrequently evoked controversy.

Having full-time hospital-based physicians was highly disruptive to the traditional culture of medicine, where hospital rounds were an integral part of a primary care physicians’ practice, professional identity, and referral patterns. Additionally, many hospital-based specialists were beginning to fill the hospitalist role. 

The decision to include “inpatient physician” rather than “hospitalist” in the name was carefully considered and was intended to be inclusive, without alienating potential allies. Virtually any doctor working in a hospital could identify themselves as an inpatient physician, and all who wanted to participate were welcomed. It also was evident early on that this young specialty was going to comprise many different disciplines, including internal medicine, family practice, and pediatrics to name a few, and reaching out to all potential stakeholders was an urgent priority.

During its’ first 5 years, the field of hospital medicine grew rapidly, with NAIP membership nearing 2,000 members. The bimonthly newsletter The Hospitalist provided a vehicle to reach out to members and other stakeholders, and the annual meeting gave hospitalists a forum to gather, learn from each other, and enjoy camaraderie. Early research efforts focused on patient safety and, just as importantly, in 2002, the publication of the first Productivity and Compensation Survey (which is now known as SHM’s State of Hospital Medicine Report) and the initial development of The Hospitalist Core Competencies (first published in 2006, and now in its’ 2017 revision) all helped define the young specialty and gain acceptance.^2,3

 
The term hospitalist became mainstream and accepted, and the name of our field, hospital medicine, has now become widely recognized. 

Though the term “inpatient physician” had focused on physicians as a primary constituency, the successful growth of hospital medicine now increasingly depended upon other important constituencies and their understanding of the hospital medicine specialty and the role of hospitalists. These stakeholders included virtually all health care professionals and administrators, government officials at the federal, state, and local levels, patients, and the American public.

As NAIP leadership, it was our belief and intent that having a name that accurately portrayed hospitalists and hospital medicine would define our “brand” in an understandable way. This was especially important given the breadth and depth of the responsibilities that NAIP and its’ members were increasingly taking on in a rapidly changing health care system. Additionally, it was a top priority to find a name that would inspire confidence and passion among our members, stir a sense of loyalty and pride, and continue to be inclusive.

With this in mind, the NAIP board undertook a process to search for a new name in the spring of 2002. As NAIP President-Elect, stewarding the name change process was my responsibility.
In approaching this challenge, we initially evaluated the components of other professional organizations’ names, including academy, college, and society among others, and whether the specialist name or professional field was included. We then held focus groups among regional hospitalists, invited feedback from all NAIP members, and solicited leadership feedback from other professional organizations. All of these data were taken into our fall 2002 board meeting in St. Louis. 

Prior to the meeting, it was agreed that making a name change would require a supermajority of two-thirds of the 11 voting board members (though only 10 ultimately attended the meeting). Also participating in the discussion were the nonvoting four ex-officio board members and the NAIP CEO. The initial discussion included presentations arguing for Hospital Medicine versus Hospitalist as part of the name. We then discussed and voted on the primary professional component of the name, with “Society” finally being chosen. After further discussion and a series of ballots, we arrived at the name “Society of Hospital Medicine.” In the final ballot, 7 out of 10 cast their votes in favor of this finalist, and our organization became The Society of Hospital Medicine. Our abbreviation SHM was to become our logo, which was developed in advance of our 2003 annual meeting. 

In the 15 years since, the Society of Hospital Medicine has become well known to our constituents and stakeholders. SHM is recognized for its staunch advocacy, particularly at the federal level, with recent establishment of a Medicare specialty code designation for hospitalists, and support for endeavors such as Project Boost, which focused on patient transitions from hospital discharge to home.^4,5,6 Hospitalists throughout the United States routinely manage hospitalized patients, and now have their specialty expertise recognized via Focused Practice in Hospital Medicine (Internal Medicine and Family Practice), and future specialty training and certification for pediatric hospitalists.^7,8,9 

The Journal of Hospital Medicine now highlights accomplishments in hospital medicine research and knowledge.¹⁰ Hospitalist leaders frequently are developed through the SHM Leadership Academy,¹¹ and hospitalists increasingly fill diverse health care responsibilities in education, research, informatics, palliative care, performance improvement, administration, among many others. Of note, SHM membership currently exceeds 17,000 members, and now offers membership that includes nurse practitioners, physician assistants, fellows, residents, students, and practice administrators, among others.¹² 

These achievements and many more have been driven by the efforts of past and present Society of Hospital Medicine members and staff, and like-minded, invested professionals and organizations. The name Society of Hospital Medicine (SHM) is highly familiar and well regarded by virtually all our stakeholders and is recognized for its proven leadership in continuing to define our brand, hospital medicine.

Dr. Dichter is an intensivist and associate professor of medicine at the University of Minnesota Medical Center, Minneapolis.

References

1. Wachter RM et al. The emerging role of “hospitalists” in the American health care system. N Eng J Med. 1996 Aug 15;335(7):514-7.
2. SHM’s State of Hospital Medicine Report 2018. Fall 2018. 
3. Satyen N et al. Core competencies in hospital medicine 2017 Revision. J Hosp Med. 2017 Apr;12:S1.
4. Society of Hospital Medicine website, Policy & Advocacy homepage (accessed July 26, 2018).  
5. CMS manual system, Oct. 28, 2016 (accessed July 26, 2018). 
6. Society of Hospital Medicine website, Clinical Topics: Advancing successful care transitions to improve outcomes (accessed July 26, 2018). 
7. American Board of Internal Medicine website, MOC requirements: Focused practice in hospital medicine (accessed July 26, 2018). 
8. American Board of Family Medicine website, Designation of practice in hospital medicine (accessed July 26, 2018). 
9. The American Board of Pediatrics website, Pediatric hospital medicine certification (accessed July 26, 2018). 
10. Journal of Hospital Medicine official website (accessed July 26, 2018). 
11. SHM Leadership Academy website (accessed July 26, 2018). 
12. Society of Hospital Medicine website, About SHM membership (accessed July 26, 2018).

On behalf of SHM’s Practice Analysis Committee, I’m thrilled to introduce the 2018 State of Hospital Medicine Report (SoHM) and the resumption of this monthly Survey Insights column written by committee members.

It’s a bit like giving birth. A 9-month–long process that started last January with the excitement of launching the survey and encouraging hospital medicine groups (HMGs) to participate. Then the long, drawn-out process of validating and analyzing data, and organizing it into tables and charts, watching our baby grow and take shape before our eyes, with a few small hiccups along the way. Then graphic design and the agonizing process of copy editing – over and over until our eyes crossed – and printing.

Like all expectant parents, by August we were saying, “Enough already; when will this ever end?”

But we finally have a baby, and what proud parents we are! Here are a couple of key things you should know about the 2018 SoHM:

• The total number of HMGs participating in this year’s survey was marginally lower than in 2016 (569 this year vs. 595 in 2016), but the respondent groups are much more diverse. While more than half of respondent HMGs (52%) are employed by hospitals or health systems, multistate management companies employ 25%, and universities or their affiliates employ 12%. More pediatric hospitalist groups (38) and HMGs that serve both adults and children (31) participated this year, compared with 2016, and almost twice as many academic HMGs participated as in the previous survey (96 this year vs. 59 in 2016).
• The survey content is more wide-ranging than ever. As usual, SHM licensed hospitalist compensation and productivity data from the Medical Group Management Association for inclusion in this report, and the SoHM also covers just about every other aspect of hospitalist group structure and operations imaginable. In addition to traditional questions regarding scope of services, staffing and scheduling models, leadership configuration, and financial support, this year’s report includes new information on:

• Hospitalist comanagement roles with surgical and medical subspecialties.

• Information about unfilled positions and how they are covered (including locum tenens use).
• Utilization of dedicated daytime admitters.
• Prevalence of geographic or unit-based assignment models.
• Responsibility for CPT code selection.
• Amount of financial support per wRVU.

The report has retained its colorful, easy-to-read report layout and the user-friendly interface of the digital version. And because we have more diversity this year with regard to HMG employment models, we have been able to reintroduce findings by employment model.

The 2018 SoHM report is now available for purchase at www.hospitalmedicine.org/sohm. I encourage you to obtain the SoHM report for yourself; you’ll almost certainly find more than one interesting and useful tidbit of information. Use the report to assess how your practice compares to your peers, but always keep in mind that surveys don’t tell you what should be – they tell you only what currently is.

New best practices not reflected in survey data are emerging all the time, and the ways others do things won’t always be right for your group’s unique situation and needs. Whether you are partners or employees, you and your colleagues “own” the success of your practice and are the best judges of what is right for you.
 

Leslie Flores, MHA, SFHM, is a partner with Nelson Flores Hospital Medicine Consultants, and a member of the SHM Practice Analysis Committee.

On behalf of SHM’s Practice Analysis Committee, I’m thrilled to introduce the 2018 State of Hospital Medicine Report (SoHM) and the resumption of this monthly Survey Insights column written by committee members.

It’s a bit like giving birth. A 9-month–long process that started last January with the excitement of launching the survey and encouraging hospital medicine groups (HMGs) to participate. Then the long, drawn-out process of validating and analyzing data, and organizing it into tables and charts, watching our baby grow and take shape before our eyes, with a few small hiccups along the way. Then graphic design and the agonizing process of copy editing – over and over until our eyes crossed – and printing.

Like all expectant parents, by August we were saying, “Enough already; when will this ever end?”

But we finally have a baby, and what proud parents we are! Here are a couple of key things you should know about the 2018 SoHM:

• The total number of HMGs participating in this year’s survey was marginally lower than in 2016 (569 this year vs. 595 in 2016), but the respondent groups are much more diverse. While more than half of respondent HMGs (52%) are employed by hospitals or health systems, multistate management companies employ 25%, and universities or their affiliates employ 12%. More pediatric hospitalist groups (38) and HMGs that serve both adults and children (31) participated this year, compared with 2016, and almost twice as many academic HMGs participated as in the previous survey (96 this year vs. 59 in 2016).
• The survey content is more wide-ranging than ever. As usual, SHM licensed hospitalist compensation and productivity data from the Medical Group Management Association for inclusion in this report, and the SoHM also covers just about every other aspect of hospitalist group structure and operations imaginable. In addition to traditional questions regarding scope of services, staffing and scheduling models, leadership configuration, and financial support, this year’s report includes new information on:

• Hospitalist comanagement roles with surgical and medical subspecialties.

• Information about unfilled positions and how they are covered (including locum tenens use).
• Utilization of dedicated daytime admitters.
• Prevalence of geographic or unit-based assignment models.
• Responsibility for CPT code selection.
• Amount of financial support per wRVU.

The report has retained its colorful, easy-to-read report layout and the user-friendly interface of the digital version. And because we have more diversity this year with regard to HMG employment models, we have been able to reintroduce findings by employment model.

The 2018 SoHM report is now available for purchase at www.hospitalmedicine.org/sohm. I encourage you to obtain the SoHM report for yourself; you’ll almost certainly find more than one interesting and useful tidbit of information. Use the report to assess how your practice compares to your peers, but always keep in mind that surveys don’t tell you what should be – they tell you only what currently is.

New best practices not reflected in survey data are emerging all the time, and the ways others do things won’t always be right for your group’s unique situation and needs. Whether you are partners or employees, you and your colleagues “own” the success of your practice and are the best judges of what is right for you.
 

Leslie Flores, MHA, SFHM, is a partner with Nelson Flores Hospital Medicine Consultants, and a member of the SHM Practice Analysis Committee.

On behalf of SHM’s Practice Analysis Committee, I’m thrilled to introduce the 2018 State of Hospital Medicine Report (SoHM) and the resumption of this monthly Survey Insights column written by committee members.

It’s a bit like giving birth. A 9-month–long process that started last January with the excitement of launching the survey and encouraging hospital medicine groups (HMGs) to participate. Then the long, drawn-out process of validating and analyzing data, and organizing it into tables and charts, watching our baby grow and take shape before our eyes, with a few small hiccups along the way. Then graphic design and the agonizing process of copy editing – over and over until our eyes crossed – and printing.

Like all expectant parents, by August we were saying, “Enough already; when will this ever end?”

But we finally have a baby, and what proud parents we are! Here are a couple of key things you should know about the 2018 SoHM:

• The total number of HMGs participating in this year’s survey was marginally lower than in 2016 (569 this year vs. 595 in 2016), but the respondent groups are much more diverse. While more than half of respondent HMGs (52%) are employed by hospitals or health systems, multistate management companies employ 25%, and universities or their affiliates employ 12%. More pediatric hospitalist groups (38) and HMGs that serve both adults and children (31) participated this year, compared with 2016, and almost twice as many academic HMGs participated as in the previous survey (96 this year vs. 59 in 2016).
• The survey content is more wide-ranging than ever. As usual, SHM licensed hospitalist compensation and productivity data from the Medical Group Management Association for inclusion in this report, and the SoHM also covers just about every other aspect of hospitalist group structure and operations imaginable. In addition to traditional questions regarding scope of services, staffing and scheduling models, leadership configuration, and financial support, this year’s report includes new information on:

• Hospitalist comanagement roles with surgical and medical subspecialties.

• Information about unfilled positions and how they are covered (including locum tenens use).
• Utilization of dedicated daytime admitters.
• Prevalence of geographic or unit-based assignment models.
• Responsibility for CPT code selection.
• Amount of financial support per wRVU.

The report has retained its colorful, easy-to-read report layout and the user-friendly interface of the digital version. And because we have more diversity this year with regard to HMG employment models, we have been able to reintroduce findings by employment model.

The 2018 SoHM report is now available for purchase at www.hospitalmedicine.org/sohm. I encourage you to obtain the SoHM report for yourself; you’ll almost certainly find more than one interesting and useful tidbit of information. Use the report to assess how your practice compares to your peers, but always keep in mind that surveys don’t tell you what should be – they tell you only what currently is.

New best practices not reflected in survey data are emerging all the time, and the ways others do things won’t always be right for your group’s unique situation and needs. Whether you are partners or employees, you and your colleagues “own” the success of your practice and are the best judges of what is right for you.
 

Leslie Flores, MHA, SFHM, is a partner with Nelson Flores Hospital Medicine Consultants, and a member of the SHM Practice Analysis Committee.

Editor’s note: SHM occasionally puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org for more information on how you can lend your expertise to help improve the care of hospitalized patients.

This month, The Hospitalist spotlights Atashi Mandal, MD , a Med-Peds hospitalist in Huntington Beach, Calif. Dr. Mandal has been a member of SHM since for more than a decade, has served on the Public Policy Committee, and is currently serving on the Patient Experience Committee.

How did you initially hear about SHM, and why did you become a member?

I was a newly minted hospitalist and eagerly searching for a way to use my CME allowance, when I discovered SHM’s annual conference, which happened to be nearby in San Diego that year. I also was intrigued by, and excited to learn more about, an organization that dedicated itself only to hospital medicine. After attending the conference, I was hooked!
 

As a member of more than a decade, what aspects of your membership have you found to be most valuable?

I’ve always been very impressed by the quality and variety of the educational offerings. As a Med-Peds hospitalist, I can happily attest to greater inclusion of pediatric-specific content and a more robust presence of pediatric hospitalists over the years. Moreover, I am very appreciative of SHM’s progressive attitude as demonstrated by incorporating topics such as gender disparities, LGBTQ health, and the opioid crisis into our curriculum. I also have greatly enjoyed the networking opportunities with fellow hospitalists, some of whom I am happy to say have also become good friends over the years. More recently over the past few years, I’ve participated on committees, which has been an illuminating and gratifying way to help shape SHM’s current and future directives.
 

Describe your role on the Public Policy Committee. What did the committee accomplish during your term?

I was very honored to serve as a member of this committee for three terms. The staff is truly superhuman and amazing, considering how well they stay abreast of the swiftly changing administrative and legislative currents in health care. Just during my tenure as an SHM member, we’ve witnessed paramount shifts in our practice and culture, from the passage of MACRA, [the Medicare Access and CHIP Reauthorization Act] to the opioid epidemic. The Public Policy Committee identifies issues that affect our practice as hospitalists and advocates on our behalf through various means, from submitting comments and letters as well as personally meeting with our regulatory agencies such as CMS [Centers for Medicare & Medicaid Services], and our federal legislators. Some major victories were the acquisition of our specialty billing code and approval of an advanced care billing code. Additionally, the committee has been tirelessly advocating for reform with observation status. We have submitted comments to legislative committees regarding the opioid crisis and continue to work with MACRA as it affects our membership. While I served, I took a special interest in mental health and pediatric issues, including CHIP [Children’s Health Insurance Program] reauthorization and the 21st Century Cures Act.
 

What is Hill Day, and what can Hospital Medicine 2019 attendees expect to gain from participating?

Hill Day is a truly educational, exciting – and most important – fun opportunity to hone our advocacy skills and gain some real-world experience interacting with legislators and their staffs. On the last day of the annual conference attendees can travel to D.C., where we will spend about a half-day meeting with our respective state’s legislators or their staff. We typically discuss two or three preselected bills that can directly impact our practice as hospitalists. The legislators and their staffers generally are not aware of how certain legislative items can greatly benefit or adversely affect our patients, and they therefore rely on front-line clinicians like us to provide this narrative, much to their gratitude. I learn a lot and have even more fun each time I go to Capitol Hill, so I strongly encourage everyone to participate in this unique opportunity.
 

Do you have any advice for early-career hospitalists looking to gain experience and get involved with SHM?

I would encourage you to find your voice and participate! Whether by joining a committee or a Special Interest Group or just chatting on one of the many stimulating forums, we each have something to bring to the table, irrespective of our tenure as hospitalists. The new perspectives mingling with those that are well established is what keeps our organization relevant, so I look forward to new ideas and fresh faces!

Ms. Steele is a marketing communications specialist at the Society of Hospital Medicine.

Editor’s note: SHM occasionally puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org for more information on how you can lend your expertise to help improve the care of hospitalized patients.

This month, The Hospitalist spotlights Atashi Mandal, MD , a Med-Peds hospitalist in Huntington Beach, Calif. Dr. Mandal has been a member of SHM since for more than a decade, has served on the Public Policy Committee, and is currently serving on the Patient Experience Committee.

How did you initially hear about SHM, and why did you become a member?

I was a newly minted hospitalist and eagerly searching for a way to use my CME allowance, when I discovered SHM’s annual conference, which happened to be nearby in San Diego that year. I also was intrigued by, and excited to learn more about, an organization that dedicated itself only to hospital medicine. After attending the conference, I was hooked!
 

As a member of more than a decade, what aspects of your membership have you found to be most valuable?

I’ve always been very impressed by the quality and variety of the educational offerings. As a Med-Peds hospitalist, I can happily attest to greater inclusion of pediatric-specific content and a more robust presence of pediatric hospitalists over the years. Moreover, I am very appreciative of SHM’s progressive attitude as demonstrated by incorporating topics such as gender disparities, LGBTQ health, and the opioid crisis into our curriculum. I also have greatly enjoyed the networking opportunities with fellow hospitalists, some of whom I am happy to say have also become good friends over the years. More recently over the past few years, I’ve participated on committees, which has been an illuminating and gratifying way to help shape SHM’s current and future directives.
 

Describe your role on the Public Policy Committee. What did the committee accomplish during your term?

I was very honored to serve as a member of this committee for three terms. The staff is truly superhuman and amazing, considering how well they stay abreast of the swiftly changing administrative and legislative currents in health care. Just during my tenure as an SHM member, we’ve witnessed paramount shifts in our practice and culture, from the passage of MACRA, [the Medicare Access and CHIP Reauthorization Act] to the opioid epidemic. The Public Policy Committee identifies issues that affect our practice as hospitalists and advocates on our behalf through various means, from submitting comments and letters as well as personally meeting with our regulatory agencies such as CMS [Centers for Medicare & Medicaid Services], and our federal legislators. Some major victories were the acquisition of our specialty billing code and approval of an advanced care billing code. Additionally, the committee has been tirelessly advocating for reform with observation status. We have submitted comments to legislative committees regarding the opioid crisis and continue to work with MACRA as it affects our membership. While I served, I took a special interest in mental health and pediatric issues, including CHIP [Children’s Health Insurance Program] reauthorization and the 21st Century Cures Act.
 

What is Hill Day, and what can Hospital Medicine 2019 attendees expect to gain from participating?

Hill Day is a truly educational, exciting – and most important – fun opportunity to hone our advocacy skills and gain some real-world experience interacting with legislators and their staffs. On the last day of the annual conference attendees can travel to D.C., where we will spend about a half-day meeting with our respective state’s legislators or their staff. We typically discuss two or three preselected bills that can directly impact our practice as hospitalists. The legislators and their staffers generally are not aware of how certain legislative items can greatly benefit or adversely affect our patients, and they therefore rely on front-line clinicians like us to provide this narrative, much to their gratitude. I learn a lot and have even more fun each time I go to Capitol Hill, so I strongly encourage everyone to participate in this unique opportunity.
 

Do you have any advice for early-career hospitalists looking to gain experience and get involved with SHM?

I would encourage you to find your voice and participate! Whether by joining a committee or a Special Interest Group or just chatting on one of the many stimulating forums, we each have something to bring to the table, irrespective of our tenure as hospitalists. The new perspectives mingling with those that are well established is what keeps our organization relevant, so I look forward to new ideas and fresh faces!

Ms. Steele is a marketing communications specialist at the Society of Hospital Medicine.

Editor’s note: SHM occasionally puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Visit www.hospitalmedicine.org for more information on how you can lend your expertise to help improve the care of hospitalized patients.

This month, The Hospitalist spotlights Atashi Mandal, MD , a Med-Peds hospitalist in Huntington Beach, Calif. Dr. Mandal has been a member of SHM since for more than a decade, has served on the Public Policy Committee, and is currently serving on the Patient Experience Committee.

How did you initially hear about SHM, and why did you become a member?

I was a newly minted hospitalist and eagerly searching for a way to use my CME allowance, when I discovered SHM’s annual conference, which happened to be nearby in San Diego that year. I also was intrigued by, and excited to learn more about, an organization that dedicated itself only to hospital medicine. After attending the conference, I was hooked!
 

As a member of more than a decade, what aspects of your membership have you found to be most valuable?

I’ve always been very impressed by the quality and variety of the educational offerings. As a Med-Peds hospitalist, I can happily attest to greater inclusion of pediatric-specific content and a more robust presence of pediatric hospitalists over the years. Moreover, I am very appreciative of SHM’s progressive attitude as demonstrated by incorporating topics such as gender disparities, LGBTQ health, and the opioid crisis into our curriculum. I also have greatly enjoyed the networking opportunities with fellow hospitalists, some of whom I am happy to say have also become good friends over the years. More recently over the past few years, I’ve participated on committees, which has been an illuminating and gratifying way to help shape SHM’s current and future directives.
 

Describe your role on the Public Policy Committee. What did the committee accomplish during your term?

I was very honored to serve as a member of this committee for three terms. The staff is truly superhuman and amazing, considering how well they stay abreast of the swiftly changing administrative and legislative currents in health care. Just during my tenure as an SHM member, we’ve witnessed paramount shifts in our practice and culture, from the passage of MACRA, [the Medicare Access and CHIP Reauthorization Act] to the opioid epidemic. The Public Policy Committee identifies issues that affect our practice as hospitalists and advocates on our behalf through various means, from submitting comments and letters as well as personally meeting with our regulatory agencies such as CMS [Centers for Medicare & Medicaid Services], and our federal legislators. Some major victories were the acquisition of our specialty billing code and approval of an advanced care billing code. Additionally, the committee has been tirelessly advocating for reform with observation status. We have submitted comments to legislative committees regarding the opioid crisis and continue to work with MACRA as it affects our membership. While I served, I took a special interest in mental health and pediatric issues, including CHIP [Children’s Health Insurance Program] reauthorization and the 21st Century Cures Act.
 

What is Hill Day, and what can Hospital Medicine 2019 attendees expect to gain from participating?

Hill Day is a truly educational, exciting – and most important – fun opportunity to hone our advocacy skills and gain some real-world experience interacting with legislators and their staffs. On the last day of the annual conference attendees can travel to D.C., where we will spend about a half-day meeting with our respective state’s legislators or their staff. We typically discuss two or three preselected bills that can directly impact our practice as hospitalists. The legislators and their staffers generally are not aware of how certain legislative items can greatly benefit or adversely affect our patients, and they therefore rely on front-line clinicians like us to provide this narrative, much to their gratitude. I learn a lot and have even more fun each time I go to Capitol Hill, so I strongly encourage everyone to participate in this unique opportunity.
 

Do you have any advice for early-career hospitalists looking to gain experience and get involved with SHM?

I would encourage you to find your voice and participate! Whether by joining a committee or a Special Interest Group or just chatting on one of the many stimulating forums, we each have something to bring to the table, irrespective of our tenure as hospitalists. The new perspectives mingling with those that are well established is what keeps our organization relevant, so I look forward to new ideas and fresh faces!

Ms. Steele is a marketing communications specialist at the Society of Hospital Medicine.