The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers

Abstract

Background Hospital capacity strain impacts quality of care and hospital throughput and may also impact the well being of clinical staff and teams as well as their ability to do their job. Institutions have implemented a wide array of tactics to help manage hospital capacity strain with variable success. Objective Through qualitative interviews, our study explored interventions used to address hospital capacity strain and the perceived impact of these interventions, as well as how hospital capacity strain impacts patients, the workforce, and other institutional priorities. Design, Setting, and Participants Qualitative study utilizing semi-structured interviews at 13 large urban academic medical centers across the USA from June 21, 2019, to August 22, 2019 (pre-COVID-19). Interviews were recorded, professionally transcribed verbatim, coded, and then analyzed using a mixed inductive and deductive method at the semantic level. Main Outcome Measures Themes and subthemes of semi-structured interviews were identified. Results Twenty-nine hospitalist leaders and hospital leaders were interviewed. Across the 13 sites, a multitude of provider, care team, and institutional tactics were implemented with perceived variable success. While there was some agreement between hospitalist leaders and hospital leaders, there was also some disagreement about the perceived successes of the various tactics deployed. We found three main themes: (1) hospital capacity strain is complex and difficult to predict, (2) the interventions that were perceived to have worked the best when facing strain were to ensure appropriate resources; however, less costly solutions were often deployed and this may lead to unanticipated negative consequences, and (3) hospital capacity strain and the tactics deployed may negatively impact the workforce and can lead to conflict. Conclusions While institutions have employed many different tactics to manage hospital capacity strain and see this as a priority, tactics seen as having the highest yield are often not the first employed. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07106-8.

Measuring and driving hospitalist value: Expanding beyond wRVUs

“…A reflexive approach for hospitals to improve costs and efficiency may be to “squeeze more juice out of the lemon” (i.e., encourage hospitalists to see more patients more quickly). Preliminary studies suggest, however, that increasing clinical workloads negatively impact hospitalist well‐being, mental health, and hospitalist job performance, 2,3,5 while simultaneously negatively impacting hospital operational and financial outcomes 5,6 …”

“…Increasing workloads affect hospitalist job performance, such as perceived quality of care and operational outcomes (e.g., length of stay). Studies have shown that 40% of physicians stated that their typical patient load in the inpatient setting exceeded safe levels at least monthly 10 and that resources often lag behind the ever‐increasing workloads 3 . Another study by Elliott et al 5 highlighted that when physicians saw more than 15 patients in a shift, patient length of stay increased exponentially and costs increased (i.e., hospital charges).…”

“…Integrating the job demands‐resources model of burnout 12 and the conceptual model for integrated approaches to the protection and promotion of worker health and safety, 13 we propose a framework to use as a guiding principle for future studies on hospitalist work—taking into account workforce, patient, and institutional goals (Figure 1). We begin by connecting the concepts of hospitalist workload to hospitalist outcomes and job performance—as job demands and resources affect hospitalist well‐being, 2,3 perceptions of their work environment, and their ability to do their job (e.g., efficiency and throughput and high‐quality patient care). Importantly, research has also shown a dose–response relationship between task load and burnout 14 .…”

“…As hospitalists have faced unprecedented work conditions and unpredictable work demands, research is emerging that stress, anxiety, overwork, and burnout are high 1,2 . The stressors faced by hospitalists, further magnified during the pandemic, unfortunately, are not new 3 …”

“…1,2 The stressors faced by hospitalists, further magnified during the pandemic, unfortunately, are not new. 3 As hospitalists increase their footprint in the healthcare ecosystem and have experienced unprecedented growth (with at least 75% of US hospitals utilizing hospitalists and over 50,000 practicing hospitalists 4 ), it is tempting to focus attention on the direct costs of hospitalist care models. The literature, however, suggests that this attention may be misdirected and that there exists a trade-off where the request to "see more patients" actually increases waste and decreases quality.…”