By  |  October 18, 2010 | 

Or, as the saying goes: “In the history of the world nobody ever took a rental car through the car wash.”

By Mike Radzienda

Last week I attended the Midwest HM Conference in Chicago. There was an amazing turnout and the caliber of speakers was outstanding. Kudos to Mark Williams and his team for putting on a great event.

A recurring theme in many talks (including mine) focussed on teamwork; in particular, how teamwork, effectiveness and outcomes are enhanced through UNIT BASED INTERDISCIPLINARY ROUNDS. This begs the question, if your hospital is not doing unit based interdisciplinary rounds, how can you as a hospitalist leader make them happen?

Let’s back up a moment and recount how we arrived at the current model of inpatient care delivery. Prior to hospitalists (i.e.: the dark ages) a med unit with 25 beds might host up to 25 different providers on any given day. The traditionalist would show up either very early, or very late to round on their small inpatient census (a model anathema to building trusting relationships with nurses).

This fragmentation and dispersion of providers was conducive to creating a culture of unit ownership which naturally fell into the hands of nursing. And so , if you notice at any given hospital, nursing leadership not only controls unit operations, but also manages bed assignments, quality assurance,  and patient relations (among other departments).

We blew it. Nursing never had a viable partner with whom they could OWN THE UNIT.

Fast forward to the hospitalist era (i.e.: the enlightenment) and many hospitals have not modified this construct.  Yet, in a facility where hospitalists have assumed the inpatient load, the provider:unit ratio would be expected to have dropped significantly -right?

Recently, while rounding on a telemetry unit in a hospital where over 80% of the house was covered by hospitalists, I was shocked to find  23 patients covered by 14 different providers.

How can this be?

14 years after Wachter’s article, why aren’t hospitalists assigned to units where they may preside over interdisciplinary rounds, build relationships with their nursing co-workers, and participate in the governance of their own unit?

Remember, HCAHPS can be deconstructed to one question:

During your recent hospitalization did your healthcare team have their act together?

A. Yes

B.  No

C.  Team?! What the hell is a healthcare team?

If you were building a new primary care practice, would you put your exam rooms on 6 different floors managed by 6 different staff?

The med unit is effectively the hospitalist’s office. And, it is up to us to OWN THE UNIT. Once your practice has implemented unit based rounds and geographic placement, your hospital will realize the benefits of an ownership culture. Until then, you are only renting.

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  1. Mark Williams October 20, 2010 at 7:20 pm - Reply

    Thanks for your kind words. Speakers like you are why the conference was a success!

    • Mike Radzienda October 20, 2010 at 11:03 pm - Reply

      Thanks Mark!

  2. David Friar November 4, 2010 at 10:03 am - Reply

    We’re under considerable pressure to adopt a Unit Based Staffing model.
    Our fears, real or imagined, are:
    – Assigning a provider to a unit will introduce inefficiency. Inefficiency isn’t always bad, time spent working with the care team or “being available” doesn’t generate receipts, making it expensive time that needs to be compensated. Hospitals don’t like that part of the discussion.
    – Unit based staffing complicates our flexible schedule system. It’s difficult to match up a provider going off schedule with one coming on.
    – The hospital frequently transfers patients from unit to unit to balance census and free up telemetry beds, disrupting the continuity of care of patient if the provider doesn’t follow the patient and disrupting unit based staffing model if the provider does follow the patient.

    I’d appreciate any thoughts or insight you, or others have on these concerns.

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