Posts by Leslie Flores

Next Step in Sustainability: Re-Thinking How Hospitalists Organize Their Work

Do we really need another commentary on the shortcomings of the 7-on/7-off work schedule?  My colleague John Nelson has written and spoken about this extensively, most recently in his January 2016 column in The Hospitalist.  And while I’ve been planning to write this post for a while, Bob Wachter got the jump on me by famously declaring at his HM16 closing presentation in March that “I think one thing we got wrong was a 7-days-on/7-days-off schedule.”  Nevertheless, I can’t resist weighing in. When I first started working with hospitalist groups more than a dozen years ago, hospitalists routinely told me that the 7-on/7-off schedule was one of the main reasons they chose to go into this specialty.  But too often when I visit groups today there are at least a few more experienced doctors who say they are thinking of leaving the field if they can’t find an alternative to…

A Link between Hospitalist Morale and Retention?

Many observers of our specialty tend to think of hospitalists as itinerant shift workers, many of whom have little emotional commitment to the organization that employs them and will quickly decide to leave for another job where the grass is greener.  Even my colleague John Nelson often describes hospitalists as preferring to “date” rather than “marry” their practice.  And more than one hospital executive has told me, “They’re just going to leave in a couple years anyway, so why should we invest a lot in their development and morale?”   But there’s at least one organization where hospitalist group leaders see things differently, and are working hard to understand the determinants of hospitalist wellbeing and the relationship between wellbeing and retention.  I recently spoke with Dr. Shalini Chandra at Johns Hopkins Bayview Medical Center (JHBMC), lead author of an article recently posted online by the Journal of Hospital Medicine about…

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…