In a fee-for-service or value-based healthcare environment, effective hospitalist programs have become essential to improving patient satisfaction, reducing length of stay and readmissions, and achieving population health goals. Additionally, referring physician engagement and satisfaction are key performance drivers and indicators of success. Yet, high turnover among hospitalists is typical for many programs and constitutes a million-dollar-plus problem when the costs of recruitment and lost revenue are considered.
Siloed operations, broken communication channels, unclear accountabilities, unfulfilled expectations and lack of a partnership culture are among the many, inter-related causes of dissatisfaction and turnover. Turnover impacts the quality of relationships among physicians, hospital staff, and even patients and families.
Once the cycle of turnover begins, “warm body syndrome” to meet volumes ensues, and it becomes nearly impossible to effectively recruit and retain the best providers. Locum tenens provide temporary relief. But by nature, they do not establish the long-term, trusted relationships necessary to impact long-term engagement and performance.
Challenges common to many organizations contribute to turnover:
- Partnerships established at the corporate level need clarity and buy-in among all the local stakeholders who will implement the program.
- Without proper context and opportunities for building trusted relationships among referring physicians, a culture that is insular, resistant to change and even mistrustful or disrespectful of colleagues can arise.
- Lack of understanding around the motivations and workstyles of different generations can create conflict.
- Expectations set during recruitment and the realities of practice are often misaligned, especially around volumes and scheduling.
- Onboarding lacks rigor, the necessary exposure to the C-Suite, colleagues and community, and sufficient duration to ensure engagement and retention.
The Regional Chief Medical Officer of CHRISTUS St. Michael Health System was faced with the challenge of high turnover among hospitalists and the negative downstream effect of the “revolving door.” He and the Associate Chief Medical Officer of Sound Physicians, their hospitalist program partner, understood that issues affecting their performance were not unique to hospitalists or to their own organizations. However, they recognized that the solution would need to be highly relevant to their needs and immediately impactful.
It became clear that transformation – both structural and cultural – was needed to:
- Address the recruitment and retention of quality hospitalists
- Increase the satisfaction of patients and referring physicians with the program
- Drive improved operational performance.
The Regional CMO engaged Tiller-Hewitt HealthCare Strategies, a trusted advisor, to initiate a program assessment, with the support of the Associate Chief Medical Officer. The objective was to engage the stakeholders, and then develop and activate solutions to reach their primary objective:
“Create an environment that enhances our partnership and our ability to recruit, onboard, integrate and retain the industry’s premier providers.”
Tiller-Hewitt’s comprehensive assessment engaged over 50 stakeholders from CHRISTUS St. Michaels and Sound Physicians. They represented the key clinical and administrative roles that influence the patient experience along the entire continuum from the emergency department through discharge. Based on the assessment, the priority they identified was to develop and launch a formalized hospitalist onboarding, navigation and mentorship program.
The program positioned the hospitalists to gain engagement and respect from referring and specialist physicians at the hospital and in the community. That sparked a dramatic turnaround and improvement in recruitment, retention and value-based operational performance (see table below).
- At the very outset of the assessment, the clarity of the leaders’ commitment and value of the engagement resulted in two full-time hospitalists immediately rescinding their resignations, which represented retention of 23% of the hospitalist staff at the time.
- The improved quality of candidates and fully vetted interviews drove higher recruiting and staffing percentages.
- The organization reduced turnover by transforming into a culture of retention versus “warm body recruitment.”
- Key hires have resulted from newly structured leadership engagement in candidate interviews and follow-up, as well as from orchestrating involvement of their candidates’ spouses in the hospital and community introductions.
- CHRISTUS St. Michael Health System earned recognition as one of the nation’s 100 Top Hospitals by IBM Watson Health™ and is one of only 15 hospitals in the nation to also earn the Everest Award, simultaneously setting the national benchmark for balanced excellence in a single year as well as for greatest improvement over five consecutive years.
“Being skeptical at first, we immediately saw the high degree of engagement of our stakeholders and value of the ‘slam dunk’ results following close behind.”
“Value stream mapping of current and ideal states produced solutions that are prioritized, manageable, visible. We broke the cycle of ‘hot topic moments’ with sustainable solutions and accountability.”
Regional Chief Medical Office
“This was one of the best collaborations I have been a part of! You were a tremendous facilitator and went far beyond a traditional SWOT analysis process to create and execute action steps that had immediate impact.”
Associate Chief Medical Officer
“Because of your work, the group has really ramped up recruitment. Our hospitalists team has become a unified force and are gaining respect from the specialists.”
Physician Relations Manager