Communication

The Inmates Are Running the Asylum

OK; that might be a bit of an exaggeration. But if you left your clinical shift asking why you feel so depleted and frustrated and why you had that negative interaction with that patient, you should do yourself a favor and read the recent review in the Journal of Hospital Medicine entitled "When Personality Is the Problem: Managing Patients with Difficult Personalities on the Acute Care Unit". In this article, it notes that about 4-15% of the population is affected by at least one personality disorder and that this prevalence is thought to be much higher in those seeking healthcare services – perhaps as high as 25% of the population. This is thought to be due to in part to lifestyle factors, such as drinking and drug use, as well as the fact that individuals who possess these dysfunctional personality structures may have difficulty accessing and utilizing care adequately. These…

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…

Equal Time for Hospital Execs

Last month, I wrote a letter to hospital executives, urging them to deliberately invest their own personal time and effort in fostering hospitalist wellbeing. I suggested several actions that leaders can take to enhance hospitalist job satisfaction and reduce the risk of burnout and turnover. Following publication of that post, I heard from several hospital executives and was pleasantly surprised that they all responded positively to my message. Several execs told me that they gained valuable new insights about their hospitalists’ challenges and needs or that they planned to take action on one or more of my suggestions that had never occurred to them before.  Especially useful to them was the idea of a hospitalist “hierarchy of needs,” in which basics such as well-designed work (including adequate staffing), belonging, and esteem must be addressed before expecting hospitalists to undertake “self-actualizing” work, such as engagement in organizational performance improvement initiatives. Their…

Creating Value through Crowdsourcing & Finding “Value” in the New Year

Earlier this month, I took a day trip to the University of Michigan Frankel Cardiovascular Center for their inaugural value challenge. Little did I know that when I arrived, I would be part of an all-star judging team that would be giving away $100,000 (a.k.a. real money) complete with a “big check”, a la Publisher’s Clearing House, to the best idea to improve value! Given that I do not see patients on our cardiology service, I was starting to wonder if I was in over my head. The good news is that value was defined quite broadly by different stakeholders; I was able to follow along, even though I wasn’t up to date with the latest in intra-aortic balloon pumps. We heard from 5 finalists. Interestingly, 3 of the ideas centered on specialized teams to improve care coordination for specific conditions such as atrial fibrillation, pulmonary embolism, or cardiogenic shock. While…

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)
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