What We Do and don't do...

We perform evaluations of existing programs that may be struggling due to political and/or operational challenges, or that simply wish to assess how their performance compares to external benchmarks and current best practices. We find that the primary challenges encountered by hospitalist programs usually relate to the rapidly evolving nature of hospital medicine – and the healthcare system in general – and the resulting changes in organizational expectations and operational complexity. In addition, many programs are still organized in ways that worked well when they were small physician practices operating in a simpler environment, but are no longer effective for a much larger and more complex practice that is not only caring for patients but are also charged with leading organizational change and quality improvement in a rapidly changing and resource-constrained environment.

Many of our clients find that our detailed reports provide all the needed guidance and detail for them to implement our recommendations on their own. Other clients seek our help with technical aspects of implementation for specific recommendations, such as the design of a new compensation plan, creation of a new staffing model or schedule, or development of other specific operating systems or processes.

We can provide implementation assistance that is customized to your specific needs. This may include on-site support by a member of our team on a one-time or regularly scheduled basis, remote support via email, phone, and/or web conference, or a combination of on-site and remote support. In some cases implementation assistance may involve an interim management arrangement in which a member of our team works regularly with you for a period of time to serve as project manager for a significant scope of work.

When appropriate, we assist our clients in the selection of a local medical group or national hospitalist management company to provide hospitalist services, including:

• preparing volume, payor mix and other relevant program projections
• drafting a request for proposal document
• identifying potential hospitalist program vendors
• issuing the RFP and managing the proposal submission process
• reviewing and evaluating submitted proposals
• supporting the vendor selection process
• assisting with contract design and negotiation

We work with hospitals and physician groups to assess the feasibility of developing a new program, and help them design their programs by creating a comprehensive business and implementation plan. Steps include:

• Assessing stakeholder needs and goals
• Evaluating the current environment, and identifying drivers and barriers affecting potential program development
• Examining internal resources and capabilities compared to those needed to support successful program development

We project hospitalist program volume and workload, staffing requirements and probable program revenues and costs. Based on this assessment, we make recommendations regarding feasibility. We then create a comprehensive plan, including:

• Proposing a workable organizational structure (e.g., employment of hospitalists vs. contracting with an independent group or management company)
• Proposing a scope of services and appropriate coverage model
• Defining staffing, scheduling and other operational criteria
• Projecting program revenues, expenses and financial support requirements
• Identifying contract negotiation considerations
• Suggesting performance standards and monitoring processes
• We also provide technical assistance with implementation upon request

We assist clients in understanding the staffing levels needed for their current and anticipated workload, and in designing staffing models that efficiently address coverage needs. What sometimes appears to be a staffing problem (e.g., not the right number of hospitalists) is often really a scheduling problem. We advise clients with regard to alternative scheduling methodologies, and assist them in developing schedules with attention to continuity of care between hospitalist and patient, physician lifestyle considerations, and distributing manpower effectively to handle variations in workload.

We believe the preference of the doctors themselves is one of the most critical components in determining how to structure a schedule, and want to make sure the hospitalists understand the pros and cons of their choices so they can decide whether there are better options.

We assist hospital medicine groups in the design and modeling of new hospitalist compensation plans. Our goal is to align incentives so that the compensation plan supports the goals of the practice, and we have worked with many practices to build production, quality and other performance incentives into the compensation model.

Fundamental to our compensation philosophy is the idea that the compensation plan should help connect individual hospitalists both to the work they do and to the well-being of the practice, helping to foster a sense of practice ownership. The compensation model also needs to align hospitalists’ interests with those of the institution in which they practice. Our compensation work includes detailed data analysis and modeling to anticipate the likely impact of proposed compensation changes on both individual hospitalist incomes and on the total program budget. We also advise clients on implementation and transition considerations.

Hospitalist groups sometimes benefit from on-site interim management services. Reasons may include departure of a prior leader, an underperforming program needing significant change to get back on track, a transition to an employed hospitalist program after a period of outsourcing, a looming crisis such as the threatened resignation of multiple providers, or other similar concerns.

Our interim management services are provided by an experienced non-physician leader who has worked with hospitalist groups in a variety of settings. Some organizations find this appealing since it doesn’t involve the cost and long-term commitment that would be required to engage a hospitalist management company.

We assume management responsibility for the hospitalist program for a period of time sufficient to make the changes required for the program to successfully stand on its own, typically a few months to a year or more. Interim management usually includes a combination of regularly scheduled on-site time (weekly or bi-weekly) and remote support by the interim manager. Interim program management generally includes the following services:

• A rapid assessment of hospitalist program operations, identifying shortcomings and opportunities as well as options to address them.
• Program redesign covering applicable aspects of the program, such as staffing and coverage models, work flow, compensation plan, operational processes, charge capture, etc.
• We then develop a mutually agreed-upon implementation plan and work with your team to implement it.
• Regular performance tracking and reporting.

Active change management for the provider team is incorporated into our implementation planning and execution. And throughout our engagement, we work with designated people to successfully transition ongoing management of the program to in-house staff at the end of our engagement.

We work with both new and mature hospitalist practices to engage them in developing a strategic plan for the evolution and growth of the practice, including:

• facilitating strategic planning retreats
• providing supporting data collection and analysis
• drafting strategic plan documents

One of the most common challenges that hospitalist groups face is sub-optimal physician leadership. The hospitalist group leader is often a valued clinician who has been promoted into a leadership role by virtue of her/his clinical excellence but who has limited experience leading, managing, and/or motivating others. The new leader may not have received training or coaching to succeed in a role that requires a very different skill set from that of their clinical role. In other cases an experienced and capable physician leader may struggle with a specific leadership competency such as holding staff accountable, managing change, or dealing with conflict. Some clients tell us that they recognize “rising stars” on their teams, and want to invest in these high-potential emerging leaders to help them maximize their own performance and the performance of the team overall.

Through our collaboration with James McKenna, MBA, we are pleased to offer our clients the services of an experienced leadership trainer and coach who has worked nationally with numerous hospitalist and other physician leaders to help them achieve their individual, team, and organizational goals. Please contact us to learn more about how Mr. McKenna can customize a program specific to your hospitalist team’s needs.

Through our collaboration with James McKenna, MBA, we are pleased to offer our clients a proven program of patient experience training and coaching. Mr. McKenna has developed an engaging, impactful patient experience improvement program customized for hospitalists and their teams. This program not only help clinicians build empathy and learn important patient interaction skills, it also “hard-wires” key patient experience improvement processes into hospitalist group operations and work flows so that performance improvements are sustained long after the training work has been completed. Please contact us to learn more about how Mr. McKenna can customize a program specific to your hospitalist team’s needs.

We are available to attend and facilitate meetings on-site to help address and resolve issues that may arise among the hospitalists or between the hospitalists and other interested parties, ranging from hospital administrators to surgeons or medical sub-specialists. We have helped resolve issues such as:

• the hospitalists’ role in the ICU and their relationship with intensivists
• differing expectations regarding the hospitalists’ role in the emergency department
• coverage of code blues and other emergency situations
• hospitalist involvement in the care of surgical or medical sub-specialty patients
• hospitalist participation in the development and implementation of clinical guidelines and protocols

We assist hospitals and medical groups with the design and negotiation of Professional Services Agreements for hospitalist services, including:

• Projecting the financial support likely to be required for effective operation of the practice
• Recommending appropriate financial support payment methodologies that effectively align interests and protect both parties
• Proposing other contract terms and conditions that will be valuable for successful management of the hospital – group relationship
• We see ourselves as ‘marriage counselors’ whose job is to facilitate negotiation of a fair and equitable agreement that sets the stage for a lasting, mutually satisfying relationship.