“Hospitals with these programs are more likely to be large and located in urban areas,” says Dr. Houff. “I think smaller, community facilities find themselves at a crossroads where they need to decide whether they are going to commit to be a fully-functioning acute care facility or if they want to be a ‘stabilize and transfer’ facility. We see a trend today that big hospitals are getting bigger and small hospitals are getting smaller. One way community facilities can buck that trend is by fully committing to establish a high-performing hospitalist program that will help the hospital retain patients and build market share.”
Dr. Houff offers the following three best practices for hospital leaders, including those of community hospitals, for successful hospitalist programs.
1. Determine your service plan upfront. Successful hospitalist programs should determine the service plan and scope of the program, as well as its desired outcomes, before the program services patients. If a hospital plans to call on the services of a hospitalist group, the service plan increases the likelihood that the hospital selects a good group partner to meets its individual needs, says Dr. Houff.
“Begin with the end in mind,” says Dr. Houff. “It is very important to develop a service plan upfront that is unique to the facility and identifies goals, key deliverables and endpoints that the program is expected to achieve.”
Service plans also clearly define the responsibilities of the physicians within the program, which can increase their job satisfaction and reduce turnover.
“Hospitalists will be unsatisfied if their hospital comes back every 30 days with a new set of responsibilities,” says Dr. Houff. “There is this feeling of lack of control when this happens.”
Dr. Houff says that service plans allow the hospital to consider the scope of practices and services that they want a hospitalist program to provide. Hospital leaders should not automatically assume any hospitalist or hospitalist group is able to provide services that include procedures.
“Due largely to the 80-hour restrictions on medical resident training, fewer hospitalists are now trained to do common hospital-based procedures, such as placing lines and managing patient airways. Many of them just aren’t comfortable with these procedures and managing patient emergencies,” says Dr. Houff. “A hospital that is looking for a hospitalist program to offer these services needs to find a hospitalist group that trains physicians on these procedures or seek alternative arrangements.”
After the service plan is completed and agreed to by physicians, it should be continually referred to by the physicians and program leaders. Dr. Houff recommends reviewing the success of the program, and its physicians’ performance, through quarterly reviews against the service plan.
2. Focus on physician recruitment. In order to attract the best candidates for a hospitalist program, hospitals must present their facility and community in a favorable light, says Dr. Houff.
“Recruiting hospitalists and aligning the incentives that are related to attracting and retaining these physicians is one of the most difficult parts of maintaining a successful hospitalist program,” says Dr. Houff. “Hospitals may have to expend significant resources internally to do this, which is another reason why hospitals seek hospitalist group partners to manage their programs.”
Most hospitalists field multiple job offers, so hospitals must focus on portraying their community and facility as a great place to work, says Dr. Houff. “Hospital leadership should be prepared to highlight the best aspects of their facility — whether it’s the medical staff, a strong nursing program or great technology — and attempt to show these candidates that the hospital offers an environment of care that will keep the candidate there for the long term,” he says.
3. Manage turnover. Turnover is the “Achilles’ heel” of the hospitalist specialty, according to Dr. Houff. Thus, it is important that hospitals actively work retain physicians.
“One of the risks that I believe is underappreciated by many hospitals, especially those seeking to establish an “in-house” program, is the element of physician turnover,” says Dr. Houff. “Some facilities may experience 25-35 percent turnover per year, and losses that high undermine local physician buy-in and program traction.”
The hospitalist specialty is one of the fastest growing specialties in medicine and as a result, physicians are heavily recruited. Programs that use hospitalist groups who employ an equity model achieve a lower turnover rate and better outcomes because they are more likely to attract and retain quality physicians, says Dr. Houff.
Learn more about Hospitalists Management Group.
