Just to give you my background, I manage a large hospitalist program for a busy downtown community hospital that is part of a large health system consisting of a total of 29 acute care hospitals in the same geographical area.

One of the reasons why our team was hired recently to manage this hospitalist program was to change the existing work culture, which had resulted in poor team performance, low physician engagement and patient satisfaction, lack of communication and coordination as well as patient safety issues.

Before we took over the program, we asked for a few team-related statistics. And to our surprise, they were completely unaware of those. In present times, where we can’t imagine working without data, this was an eye-opener to us. We knew that we are in deep trouble if we step in without extreme preparation.

After multiple discussions with the management and physician group, we focused on a few significant issues which were big contributors to team dysfunction.

1. Lack of trust among physicians. Also, there was no trust in leadership.
2. Artificial harmony. Physicians thought it was a complete waste of time to raise any issues and worked silently.
3. No accountability among team members.
4. Every team member has an individual goal. In fact, they were never made aware of any expectations except taking care of a patient.

We were given four weeks to take over and start our hospitalist program. Expectations were really high, and we knew that challenging the status quo was the only way to go forward.

But before that, we had another big problem to solve.

Hospital management requested to hire a few doctors from the previous physician group since they were part of the hospital for many years. This was a gamble. We could get a lot of vital information — but at the same time, it might backfire if they are not able to make changes as expected of them. We had no choice other than to hire them as the administration was on our back to make it happen.

We had to move very quickly and fortunately were able to hire the remaining physicians in a record time of three weeks. Before starting the program, it was important to get the team together. We decided to do a group orientation.

1. Orientation and training

We planned to invite the entire team together for orientation and training. Our organization is one of the largest hospitalist service providers in the country and has a robust onboarding training program. The orientation and training went on for two days. Besides training, we also focused on setting expectations and getting their feedback about programs. We invited our leaders to speak to the team to give them an idea of who we are and what we do.

After starting our program, we planned to address some of the team issues and started with …

2. Trust building among the team and with leadership

We knew that the previous physician group was burdened with high patient volume and poor physician support staff. We made sure that we hire all full-time physicians and support staff to let our team function smoothly. We promised to keep our individual physicians census below 18 patients (previously each physician was assigned avg. 25 patients/day). Also, we created a system where our physicians were allowed to leave early if they are able to finish their work, which indirectly helped to improve their work-life balance. These measures worked miraculously well. In fact, we decreased our dependence on locum providers to almost none, and team members felt happy to cover for each other.

3. Encouraging open discussion and welcoming feedback

The “open-door policy” allowed us to get more honest feedback.

Rounding on our team members and helping them on busy days helped us to gather more information and also send an indirect message to our team that leadership values what they do on a day to day basis. We leveraged technology to do frequent surveys on issues that we thought were bothersome for the team and redesigned our approach after receiving inputs.

4. Culture of respect and fairness

We worked to develop a culture where everyone is respected and treated fairly. We encouraged our team members to be part of hospital committees to show our presence in decision making, and in turn, helped in creating a sense of ownership and autonomy within our group. We also made sure that everyone shares equal work, including leadership during clinical shifts.

5. Change in compensation model and encouraged value-based incentive

We changed the compensation model from RVU based on a fixed salary structure. To be competitive, we used MGMA salary data. There was a significant impact on the way our team worked with the change in the compensation model. There was no incentive for our physicians to keep patients in hospital longer, and that helped us with some of the major metrics we were targeting. Apart from that, we added incentives for quality of care and safety provided to the patient.

6. Goal setting (mission, vision, purpose)

This is one of the most difficult stages. Though we have done significantly well, we still have a long way to go. We have had zero attrition since we started this program. We have outperformed every key performance indicator. We have brought down the cost of care and providing quality patient care more efficiently than ever. Our team has been growing as a unit and is more aligned with our organization guiding principle.

I believe there is no better time than now for our hospitalist leaders to rise up and be courageous; otherwise, as a new branch of medicine, we will never be relevant to an extent where healthcare organizations will take us seriously.

Rahulkumar Singh is a hospitalist.

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