Survey says….

When Advanced Inpatient Medicine started at our Wilkes-Barre site in October of 2013, I saw a very dysfunctional facility that was essentially run by specialists and the primary care docs that consulted them frequently. There was no thought to the changing landscape from a fee for service mentality to a pay for performance one. Right before we started there, I met with the CEO & warned that if we did our job right, he would have many consultants beating down his door to complain about us. In fact, that is exactly what happened. We didn’t consult a pulmonologist for every simple pneumonia or cardiologist for every chest pain, so, as our service grew, some specialists got upset and considered us a threat to their livelihood. One went so far as to try to get us thrown out with literally fabricated stories about our performance. On the 2014 physician satisfaction survey, my fellow medical staff, especially the medical specialists, crucified us. They were very critical and talked about a lack of communication and expressed concerns about clinical quality of care. After all, as one cardiologist put it, “You can’t possibly take care of CHF without a cardiologist.” Yes, it was that bad. We had to work with the CMO & other staff to create a dashboard to show that our quality was better than the general primary care doctors, with a markedly lower length of stay with no corresponding increase in admission rates.
Fast forward a year later to the newly released annual physician satisfaction survey this week. Our group has had a tremendously large increase in our scores across the board. No longer does the medical staff seem suspicious that everything we do is part of some conspiracy to affect their livelihood. (Yes, there is always one who just won’t give up that idea!) We received much higher marks in the perception of quality of care, communication, etc. The bottom line is that we have now generally become accepted as a part of the medical staff that provides a quality role at that hospital. That is a very gratifying survey to read because it means that things are progressing right on schedule. Taking care of hospitalized patients is the easy part, and not a whole lot different from place to place. Changing a culture requires patience & the ability to communicate openly & realize that this is a gradual process. Bad habits have been allowed to fester for a generation. Yet, we are slowly putting in system & process improvements that are starting to create fundamental change. The resistant few are beginning to realize that pay for performance is coming whether they like it or not. Those that refuse to embrace it will be left without a hospital to work at. Truthfully, that’s fine with me because I believe that our hospitalist team will be able to provide excellent care of those patients.
AIM continues to grow by hiring staff that embrace the two pronged challenge of patient care and improving the system. Are you one of those looking to truly make a difference? We have added several more sites and are looking for some talented providers that have that same mindset. Time to jump on board!

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