Optimize patient throughput with these 4 hospital-hospitalist alignment strategies

In many hospitals, hospitalists routinely care for at least 50 percent of inpatients — so when physician alignment falls out of place, the entire hospital feels the effects.

Making sure a hospitalist program runs smoothly is key to maintaining hospital operations. Becker's Hospital Review caught up with Bonnie Barndt-Maglio, RN, PhD, and Barbara Bryan, BSN, managing directors at Prism Healthcare Partners, about common challenges hospitals encounter in hospitalist programs and tips for overcoming them.

1. When hospitalist turnover is high. "Hospitalists are often difficult to recruit and retain, so this can contribute to a lack of commitment as hospitalist personnel turn over," Ms. Bryan says.

Another driver of turnover is misalignment of hospitalists' individual goals and the goals of the organization. "For example, if a hospitalist is compensated on production but the hospital would like to reduce length of stay (LOS), the goal of seeing patients more efficiently is not aligned," Ms. Bryan says. When this happens, hospitalists may not feel as committed to that particular organization, and may be more likely to act in their own interest, such as taking a job at another location.

To reduce turnover rates, hospital administrators should focus on implementing policies and initiatives that consider hospitalists' goals and integrate them into the organization. Dr. Barndt-Maglio and Ms. Bryan recommended several tips to facilitate better hospital-hospitalist alignment.

"Setting up goals that are mutually beneficial to both the hospital and the hospitalists will help align efforts," Ms. Bryan says. This could include basing part of hospitalists' compensation on metrics such as LOS reduction, discharge order timing or certain quality outcomes, like readmission rates.

Hospitals should also consider "budgeting administrative time for chief hospitalists to participate in leadership meetings and teams," Dr. Barndt-Maglio says.

2. When hospitalist misalignment is affecting patient throughput. Because hospitalists typically care for a large portion of hospitalized patients, they're highly influential in patient outcomes as well as overall hospital operations. When hospitalists and administrators have different priorities in day-to-day tasks, patient throughput can suffer.

"It is absolutely necessary to include hospitalists in interdisciplinary rounding, and also to have them round on discharged patients early in the day," Ms. Bryan says. "This is a struggle for hospitalists since they'd often prefer to see their 'sickest' patients prior to those patients who are ready for discharge."

Getting hospitalists to make efficient throughput a No. 1 priority is critical to reducing LOS and maintaining optimal capacity. Hospitals can do this by focusing on barriers to discharge and incentivizing hospitalists to write at least 60 to 70 percent of their discharge orders before noon, Dr. Barndt-Maglio says.

3. When getting hospitalists committed to hospitalwide clinical improvement programs is difficult. Hospitalists who don't feel like part of an organization are less inclined to get onboard with clinical improvement initiatives. However, gaining hospitalists' support is critical to making long-term operational changes.

There are several things hospitals can do to ensure hospitalists are invested in clinical performance improvement. For one, "hospitalists should have an active voice in the work teams that implement performance improvement processes and protocols," Dr. Barndt-Maglio says.

Improving transparency is another way to drive hospitalist engagement. Hospitalists, like most physicians, are highly motivated by data and competition.

"Posting scorecards and dashboards on performance measures that are particular to the hospitalist program can also help drive change," Ms. Bryan says.

4. When a hospital is in an extremely competitive hospitalist market. Given that hospitalist recruitment is challenging in most markets, there are several strategies hospitals can deploy to ensure their clinical team feels supported when hospitalists are in short supply.

Creatively using mid-level providers is a great way to supplement hospitalist programs, Dr. Barndt-Maglio and Ms. Bryan agree. "Hospitals should lean on their nurse practitioners by having them fill roles specific to their patient population and practice," Dr. Barndt-Maglio says. Nurse practitioners can pitch in managing observation patients, admitting and discharging patients or caring for a specific group of patients based on diagnosis or geographic region.

Conclusion

Getting hospitalists and hospital administrators aligned around the same goals is essential to improving patient care and hospital workflow. Financial incentives, reporting tools and performance trackers are key strategies hospitals can employ to facilitate greater hospitalist buy-in when it comes to quality initiatives.

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