A STEEEP Hill to Climb: A Scoping Review of Assessments of Individual Hospitalist Performance

Abstract

BACKGROUND: Although ensuring high-quality care requires assessment of individual hospitalist performance, current assessment approaches lack consistency and coherence. The Institute of Medicine’s STEEEP framework for quality healthcare conceptualizes quality through domains of “Safe,” “Timely,” “Effective,” “Efficient,” “Equitable,” and “Patient Centered.” This framework may be applicable to assessing individual hospitalists. OBJECTIVE: This scoping review sought to identify studies that describe variation in individual hospitalist performance and to code this data to the domains of the STEEEP framework. METHODS: Via a systematic search of peer-reviewed literature that assessed the performance of individual hospitalists in the Medline database, we identified studies that described measurement of individual hospitalist performance. Forty-two studies were included in the final review and coded into one or more domains of the STEEEP framework. RESULTS: Studies in the Safe domain focused on transitions of care, both at discharge and within the hospital. Many studies were coded to more than one domain, especially Timely, Effective, and Efficient. Examples include adherence to evidence-based guidelines or Choosing Wisely recommendations. The Patient Centered domain was most frequently coded, but approaches were heterogeneous. No included studies addressed the domain Equitable. CONCLUSIONS: Applying the STEEEP framework to the published literature on assessment of individual hospitalist performance revealed strengths and weaknesses. Areas of strength were assessments of transitions of care and application of consensus guidelines. Other areas, such as equity and some components of safe practice, need development. All domains would benefit from more practical approaches. These findings should stimulate future work on feasibility of multidimensional assessment approaches.

Cohort study of hospitalists’ procedural skills: baseline competence and durability after simulation-based training

“…42 These two investigations Open access shed light on the impact of booster training on procedural skills in nonsurgeons but are imperfect as proxies for hospitalists, who are no longer trainees and have accumulated more experience. Insights from studies on monitoring hospitalist performance in non-procedural skills are also germane in concept, as they focus on collecting and reporting objective individual-level 16 and group-level metrics, 13 approaches applicable to procedural competence tracking. Ultimately, our study examines a population that has been overlooked in terms of ensuring competence, while highlighting the practical realities that must be overcome for the scalability of this work for other hospital medicine groups.…”

“…7 8 Additionally, studies showing two decades of declining volume among internists (which included hospitalists and primary care physicians) 9 10 contribute to concerns about their procedural competency. 11 12 In contrast to a growing literature on metrics used to assess hospitalist performance in non-procedural realms, [13][14][15][16] there has been no previous objective skills assessment of hospitalists who are already permitted to perform procedures, an…”

A novel hospitalist peer observation program to improve educational and operational rounding practices

“…Academic hospitalists are tasked with dual educational and operational missions: to effectively teach learners and efficiently care for patients. [1][2][3] Most hospitalists lack formal training in these domains and struggle to balance these competing demands. 4 Peer observationin which one faculty member directly observes and provides structured feedback to another-improves educational outcomes, including learning climate, learner understanding, and retention.…”

“…[8][9][10][11][12] To our knowledge, peer observation programs have not extended to clinical operations or the role of the hospitalist to optimize clinical efficiency, workflow, and hospital throughput, although the track record in educational training suggests promise. 1,13 Given the significance of this domain to hospitalist success, we created a peer observation program equally focused on educational and operational domains.…”

Assessing Individual Hospitalist Performance: Domains and Attribution

“…In this issue of the Journal of Hospital Medicine, Dow and colleagues have advanced our understanding of the current state of individual-rather than group-level hospitalist performance measurement. 2 This scoping review identified 43 studies published over the last 25 years reporting individual adult or pediatric hospitalist performance across one or more of the STEEEP framework domains of performance: Safe, Timely, Effective, Efficient, Equitable, Patient Centered. 3 The most common domain assessed in the studies was Patient Centered (20 studies), and in descending order from there were Safe (16), Efficient (13), Timely (10), Effective (9).…”