Society of Hospital Medicine Creates Self-Assessment Tool for Hospitalist Groups

The Hospitalist. 2014 March;2014(03):

March 1, 2014 | The Hospitalist

In the final framework, 47 key characteristics were defined and organized under 10 principles (see Figure 1).

The authors and SHM’s board of directors view this document as an aspirational approach to improvement. We feel it helps to “raise the bar” for the specialty of hospital medicine by laying out a roadmap of potential improvement. These principles and characteristics provide a framework for HMGs seeking to conduct self-assessments, outlining a pathway for improvement, and better defining the central role of hospitalists in coordinating team-based, patient-centered care in the acute care setting.

In enhancing quality, the approach of a gap analysis is a very effective tool. These principles provide an excellent approach to begin that review.

So how do you get started? Hopefully, your HMG has a regular meeting. Take a principle and have a conversation. For example, what do we have? What don’t we have?

Other groups may want to tackle the entire document in a daylong strategy review. Some may want an outside facilitator. Bottom line: It doesn’t matter how you do it; just start with a conversation.

Dr. Cawley is CEO of Medical University of South Carolina Medical Center in Charleston. He is past president of SHM.

Reference

Cawley P, Deitelzweig S, Flores L, et al. The key principles and characteristics of an effective hospital medicine group: An assessment guide for hospitals and hospitalists. J Hosp Med. 2014;9(2):123-128.

Figure 1. The 10 Key Principles and 47 Key Characteristics of an Effective Hospital Medicine Group¹

Principle 1: The HMG has effective leadership

Characteristic 1.1: The HMG has one or more designated hospitalist practice leaders with appropriate dedicated administrative time.

1.2: The HMG has an active leadership development plan that is supported with appropriate budget, time, and other resources.

1.3: The HMG’s hospitalist practice leader has an important role within the hospital and medical staff leadership.

Principle 2: The HMG has engaged hospitalists

2.1: The HMG conducts regularly scheduled meetings to address key issues for the practice, and the hospitalists actively participate in such meetings.

2.2: The HMG’s hospitalists receive regular, meaningful feedback about their individual performances and contributions to the HMG and the hospital/health system.

2.3: The HMG’s vision, mission, and values are clearly articulated and understood by all members of the HMG team.

2.4: Hospitalists in the HMG know the performance status of both the group and the hospital.

Principle 3: The HMG has adequate resources

3.1: The HMG has defined its needs for non-clinician administrative management and clerical support and is adequately staffed to meet these needs.

3.2: All HMG team members (including physicians, nurse practitioners, physician assistants, and ancillary staff) have clearly defined, meaningful roles.

3.3: The HMG has followed an objective approach to determine its staffing needs.

Principle 4: The HMG has an effective planning and management infrastructure

4.1: The HMG prepares an annual budget with adequate financial and administrative oversight.

4.2: The HMG generates periodic reports that characterize its performance for review by HMG members and other stakeholders.

4.3: The HMG has a current set of written policies and procedures that are readily accessible by all members of the HMG team.

4.4: The HMG has a documentation and coding compliance plan.

4.5: The HMG is supported by appropriate practice management information technology, clinical information technology, and data analytics.

4.6: The HMG has a strategic or business plan that is reviewed and updated at least every three years.

Principal 5: The HMG is aligned with the hospital and/or health system

5.1: The HMG develops annual goals that align with the goals of the hospital(s) it serves and the goals of the hospitalists’ employer (if different).

5.2: The HMG’s compensation model aligns hospitalist incentives with the goals of the hospital and the goals of the hospitalists’ employer (if different).

5.3: The HMG collaborates with hospital patient relations and/or risk management staff to implement practices that reduce errors and improve the patient’s perception of the hospital.

5.4: The HMG periodically solicits satisfaction feedback from key stakeholder groups, which is shared with all hospitalists and used to develop and implement improvement plans.

Principle 6: The HMG supports care coordination across care settings

6.1: The HMG has systems in place to ensure effective and reliable communication with the patient’s primary care provider and/or other provider(s) involved in the patient’s care in the non-acute-care setting.

6.2: The HMG contributes in meaningful ways to the hospital’s efforts to improve care transitions.

Principle 7: The HMG plays a leadership role in addressing key clinical issues in the hospital and/or health system: teaching, quality, safety, efficiency, and the patient/family experience

7.1: The HMG’s hospitalists are committed to teaching other members of the clinical team.

7.2: The HMG actively seeks to maximize effectiveness of care by consistently implementing evidence-based practices and reducing unwarranted variation in care.

7.3: The HMG’s hospitalists champion and model behaviors intended to promote patient safety.

7.4: The HMG contributes in meaningful ways to hospital efficiency by optimizing length of stay and improving patient flow.

7.5: The HMG contributes in meaningful ways to improving the patient and family experience.

7.6: The HMG contributes in meaningful ways to optimizing clinical resource utilization and cost per stay.

7.7: The HMG’s hospitalists demonstrate a commitment to continuous quality improvement (CQI) and actively participate in initiatives directed at measurably improving quality and patient safety.

Principle 8: The HMG takes a thoughtful and rational approach to its scope of clinical activities

8.1: The HMG has a well-defined plan for evolving the scope of hospitalist clinical activities to meet the changing needs of the institution.

8.2: The respective roles of the hospitalists and physicians in other specialties in treating patients, including patients that are co-managed, are clearly defined with a mechanism to resolve issues with regard to scope and responsibilities.

8.3: The HMG uses appropriate references to define the clinical responsibilities of hospitalists.

Principle 9: The HMG has implemented a practice model that is patient- and family-centered, team-based, and emphasizes effective communication and care coordination

9.1: The HMG’s hospitalists provide care that respects and responds to patient and family preferences, needs, and values.

9.2: The HMG’s hospitalists have access to and regularly use patient/family education resources.

9.3: The HMG actively participates in interprofessional, team-based decision-making with members of the clinical care team.

9.4: The HMG has effective and efficient internal hand-off processes for both change of shift and change of responsible provider.

9.5: When serving as attending physicians, the HMG’s hospitalists (in coordination with other clinicians as appropriate) assure that a coordinated plan of care is implemented.

Principle 10: The HMG recruits and retains qualified clinicians

10.1: Hospitalist compensation is market competitive.

10.2: The HMG’s hospitalists all have valid and comprehensive employment or independent contractor agreements.

10.3: The HMG’s hospitalists are actively engaged in sourcing and recruiting new members.

10.4: The HMG has a comprehensive orientation process for new clinicians.

10.5: The HMG provides its hospitalists with resources for professional growth and enhancement, including access to continuing medical education (CME).

10.6: The HMG measures, monitors, and fosters its hospitalists’ job satisfaction, well being, and professional development.

10.7: The medical staff has a clear mechanism to credential and privilege hospitalists, and the hospitalists hold unrestricted staff privileges in the applicable medical staff department.

10.8: The HMG has a documented method for monitoring clinical competency and professionalism for all clinical staff and addressing deficiencies when identified.

10.9: A significant portion of full-time hospitalists in the HMG demonstrate a commitment to a career in hospital medicine.

10.10: The HMG’s full-time and regular part-time hospitalists are board certified or board eligible in an applicable medical specialty or subspecialty.

Society of Hospital Medicine Creates Self-Assessment Tool for Hospitalist Groups

Reference

Figure 1. The 10 Key Principles and 47 Key Characteristics of an Effective Hospital Medicine Group1

Figure 1. The 10 Key Principles and 47 Key Characteristics of an Effective Hospital Medicine Group¹