Measuring and driving hospitalist value: Expanding beyond wRVUs

Burden, Marisha; Patel, Moksha; Kissler, Mark J.; Harry, Elizabeth; Keniston, Angela

doi:10.1002/jhm.12849

Cited by 14 publications

(26 citation statements)

References 21 publications

(37 reference statements)

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“…Recent work has suggested focusing on evidence-based staffing practices as one solution, linking workloads to hospitalist, patient, and organizational outcomes. 10 Participants also expressed caution about the rapidly expanding clinical domains of hospitalists. Additional roles for hospitalists have been created at many institutions, in part due to increased clinical volumes and hospitalist expertise.…”

Section: Discussionmentioning

confidence: 99%

“…37 As payment models shift and budget threats loom, hospitals and hospitalists will have to move beyond the direct math of what a hospitalist costs and develop better ways to measure value-value that hospitalists bring by ensuring that hospitals are staffed no matter the situation and the value that is brought through high-quality care and improved throughput. 10,38,39 This work highlights the importance of a focus on the hospitalist workforce and ensuring that key components of work (i.e., workload, sustainability) are directly addressed.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, understanding and implementing the optimal clinical care models is paramount. Recent work has suggested focusing on evidence‐based staffing practices as one solution, linking workloads to hospitalist, patient, and organizational outcomes 10 …”

Section: Discussionmentioning

confidence: 99%

“…8,9 Further, hospitalist financial models may worsen burnout and patient quality and safety issues by increasing patient census per hospitalist as a means to reduce the financial stress on hospitals. 10 To date, little attention has been paid to the perspective of frontline hospitalists, particularly in relation to understanding the future challenges that the hospitalist workforce will face. We utilized rapid qualitative methods to understand current and future workforce challenges that will assist in developing strategies to cultivate a thriving hospitalist workforce, particularly in the setting of challenges faced by the field during and after the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…The literature shows that there is a high level of burnout in hospital medicine, which is now exacerbated by the unpredictability and variability of clinical environments during the pandemic 8,9 . Further, hospitalist financial models may worsen burnout and patient quality and safety issues by increasing patient census per hospitalist as a means to reduce the financial stress on hospitals 10 …”

Section: Introductionmentioning

confidence: 99%

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Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field

Kulkarni

Keniston

Linker

et al. 2023

Journal of Hospital Medicine

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Background: The hospitalist workforce has been at the forefront of the pandemic and has been stretched in both clinical and nonclinical domains. We aimed to understand current and future workforce concerns, as well as strategies to cultivate a thriving hospital medicine workforce.Design, Setting, and Participants: We conducted qualitative, semistructured focus groups with practicing hospitalists via video conferencing (Zoom). Utilizing components from the Brainwriting Premortem Approach, attendees were split into small focus groups and listed their thoughts about workforce issues that hospitalists may encounter in the next 3 years, identifying the highest priority workforce issues for the hospital medicine community. Each small group discussed the most pressing workforce issues. These ideas were then shared across the entire group and ranked.We used rapid qualitative analysis to guide a structured exploration of themes and subthemes.Results: Five focus groups were held with 18 participants from 13 academic institutions. We identified five key areas: (1) support for workforce wellness; (2) staffing and pipeline development to maintain an adequate workforce to match clinical growth; (3) scope of work, including how hospitalist work is defined and whether the clinical skillset should be expanded; (4) commitment to the academic mission in the setting of rapid and unpredictable clinical growth; and (5) alignment between the duties of hospitalists and resources of hospitals. Hospitalists voiced numerous concerns about the future of our workforce. Several domains were identified as high-priority areas of focus to address current and future challenges.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field

Kulkarni

Keniston

Linker

et al. 2023

Journal of Hospital Medicine

Self Cite

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Salient Measures of Hospitalist Workload

2023

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ImportanceThe ideal hospitalist workload and optimal way to measure it are not well understood.ObjectiveTo obtain expert consensus on the salient measures of hospitalist workload.Design, Setting, and ParticipantsThis qualitative study used a 3-round Delphi technique between April 5 and July 13, 2022, involving national experts within and external to the field. Experts included hospitalist clinicians, leaders, and administrators, as well as researchers with expertise in human factors engineering and cognitive load theory.Main Outcomes and MeasuresThree rounds of surveys were conducted, during which participants provided input on the salient measures of hospitalist workload across various domains. In the first round, free-text data collected from the surveys were analyzed using a directed qualitative content approach. In the second and third rounds, participants rated each measure’s relevance on a Likert scale, and consensus was evaluated using the IQR. Percentage agreement was also calculated.ResultsSeventeen individuals from 14 organizations, encompassing clinicians, leaders, administrators, and researchers, participated in 3 rounds of surveys. In round 1, participants provided 135 unique qualitative comments across 10 domains, with 192 unique measures identified. Of the 192 measures presented in the second round, 6 (3%) were considered highly relevant, and 25 (13%) were considered moderately relevant. In round 3, 161 measures not meeting consensus were evaluated, with 25 (16%) considered highly relevant and 95 (59%) considered moderately relevant. Examples of measures considered highly relevant included a patient complexity score and outcome measures such as savings from hospital days avoided and clinician turnover.Conclusions and RelevanceIn this qualitative study measuring hospitalist workload, multiple measures, including those quantifying work demands and the association of those demands with outcomes, were considered relevant for measuring and understanding workloads. The findings suggest that relying on traditional measures, such as productivity-related measures and financial measures, may offer an incomplete understanding of workloads and their association with key outcomes. By embracing a broader range of measures, organizations may be able to better capture the complexity and nuances of hospitalist work demands and their outcomes on clinicians, patients, and organizations.

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