Posts by Leslie Flores

What I’ll Be Doing at HM16

Don’t know about you, but I have found SHM’s Key Principles and Characteristics of an Effective Hospital Medicine Group to be a very useful framework for thinking about what it takes for a hospitalist group to be successful. The Key Characteristics seem to have resonated with hospitalists and hospitalist group leaders across the country. They have also gained the interest of hospital administrators and CMOs, and I think that’s a good thing because one of the top take-aways from the Key Characteristics is how crucial it is for HMGs to be adequately resourced and supported. John Nelson and I will, as usual, be serving as course co-directors for the practice management pre-course at the upcoming HM16 meeting in San Diego on March 6th. This year we wanted to take a completely different approach and structure the pre-course in a way that will help attendees really put the Key Characteristics into…

What’s Your Hospitalist Group’s Gross Happiness Index?

Since the 1970s the kingdom of Bhutan’s leaders have believed that the country’s “Gross National Happiness” is more important than its gross national product. They actually started measuring Gross National Happiness in 2010. When I think about factors contributing to sustainability in hospital medicine, I wonder if hospitalist group leaders should be measuring “Gross Group Happiness” and not just gross group product. According to a recent Wall Street Journal article, Bhutan’s 2015 Gross National Happiness Index suggests that increasing economic prosperity isn’t necessarily making Bhutan’s citizens happier. That struck a chord with me. Hospitalists today are earning more money than ever and are cramming their work into fewer annual worked days with more time off. But I have to ask: is that really the recipe for increasing hospitalist “happiness?” I believe that paying deliberate attention to hospitalist personal and professional well-being is a crucial strategy for ensuring that “hospitalist” remains…

Working in an Interruption-Rich Environment

I’ve been writing this darn blog post for four days. Every time I sit down to work on it the phone rings, someone knocks on the door, or I hear that little “ding” that means I have a new email or text. Sometimes it’s my own brain interrupting me, telling me I forgot something or that something else on my list is more urgent. Occasionally it’s just asking me what’s in the fridge. I’m no expert in the field of interruption science, but even I know these interruptions are killing my productivity. When I talk with hospitalists around the country about factors that negatively impact their productivity and professional satisfaction, interruptions – especially low-value ones – are usually high on the list. This won’t be news to anyone, I’m sure, but strategies for reducing or more effectively dealing with interruptions are hard to come by. Studies suggest that workers are…

Will Nurses Be Part of the Answer to HM Sustainability?

by Leslie Flores
In my last post I suggested that in order for hospital medicine to be both financially and professionally sustainable, we need to figure out how hospitalists can see more patients each day while at the same time be more satisfied with their work. One possible approach to achieving this aim is to support physician hospitalists with less costly staff doing work not requiring a physician’s license or expertise. The most common skill mix diversification approach in Hospital Medicine Groups (HMGs) has been to add NPs and/or PAs to the team. SHM’s 2014 State of Hospital Medicine Report indicates that more than 65% of HMGs serving adults have one or more NP/PAs practicing in them. Over the last year or two, though, I’ve increasingly encountered the presence of nurses (usually RNs, though sometimes LPNs) in clinical roles supporting hospitalist practices. A few groups have incorporated nurses for years, but now more…
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs as well as those in other hospital-focused practice specialties since 20104. Ms. Flores began her career as a hospital executive, after receiving a BS degree in biological sciences at the University of California at Irvine and a Master’s in healthcare administration from the University of Minnesota. In addition to her leadership experience in hospital operations, business development, managed care and physician relations, she has provided consulting, training and leadership coaching services for hospitals, physician groups, and other healthcare organizations. Ms. Flores is an active speaker and writer on hospitalist practice management topics and serves on SHM’s Practice Analysis and Annual Meeting Committees. She serves as an informal advisor to SHM on practice management-related issues and helps to coordinate SHM’s bi-annual State of Hospital Medicine Survey.

Making Hospital Medicine a Sustainable Specialty

Despite hospital medicine’s meteoric rise as the fastest-growing specialty in history and the fact that there are almost 50,000 hospitalists in the U.S. today, I’m a little worried about the future of the specialty. There are two conflicting messages I’m hearing increasingly in the work we do with hospitalist practices around the country. Hospital executives are telling us, “Our hospitalist program is too expensive and the cost is simply unsustainable.” But at the same time we are hearing too many hospitalists saying, “This job is way too hard and just not rewarding – I’m not sure how much longer I can do it.” Over the last couple of years I’ve noticed what appears to be a trend of declining hospitalist morale. There are probably a variety of factors at play, including: Rising cost pressures, as hospitals struggle with supporting more physicians across multiple specialties on declining revenue. The widespread adoption of…