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Nelson RE, Farkhondehpour A, Hall AM, Martin SK, Kwan BK, Ricotta DN. Reframing hospital medicine as a destination career for trainees. J Hosp Med 2024; 19:333-336. [PMID: 37572073 DOI: 10.1002/jhm.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Ryan E Nelson
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ali Farkhondehpour
- San Diego School of Medicine, University of California, La Jolla, California, USA
| | - Alan M Hall
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Shannon K Martin
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Brian K Kwan
- San Diego School of Medicine, University of California, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Daniel N Ricotta
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts, USA
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Washburn C, Kantsiper ME, Esteve R, Gupta I, Memon G, Michtalik HJ. Comparison of hospitalist morale in a COVID-19 alternate care site (ACS) to hospitalist morale in conventional hospitals in Maryland. PLoS One 2023; 18:e0288981. [PMID: 37531371 PMCID: PMC10395830 DOI: 10.1371/journal.pone.0288981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 07/08/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Morale and burnout were concerns for hospitalists prior to the COVID-19 pandemic; these concerns were amplified as COVID-19 spread and hospitals experienced unprecedented stress. In contrast to prior literature, our study assesses both satisfaction and the importance of various factors. This study examines morale of hospitalists early in the COVID-19 pandemic in two settings: conventional hospitals and a COVID-19 Alternate Care site (ACS) in the same geographic region in Maryland. Multiple studies published early in the pandemic show low morale in COVID-19 hospitals. METHODS In a cross-sectional survey study, we analyze data from the Hospitalist Morale Index (HMI) administered between September 2020 and March 2021 to determine the pandemic's impact on hospitalist morale. RESULTS Surprisingly, our study found morale in the ACS was better than morale at the conventional hospitals. ACS hospitalists and conventional hospitalists were demographically similar. Our results show that a significantly higher proportion of conventional hospitalists reported burnout compared to the ACS hospitalists. General quality of life was rated significantly higher in the ACS group than the conventional group. Significantly more ACS hospitalists were invested in making their group outstanding. Five main HMI domains were examined with questions on a 5-point rating scale: Clinical Factors, Workload, Material Rewards, Leadership, and Appreciation/Acknowledgement. ACS hospitalists rated most measures higher than conventional hospitalists; largest differences were observed in Clinical Factors and Appreciation/Acknowledgement domains. Narrative comments from ACS hospitalists revealed strong identification with the mission of the ACS and pride in contributing during a crisis. One key difference between the two groups explains these findings: provider autonomy. The ACS staff chose the position and the assignment, while conventional hospitalists caring for COVID-19 patients could not readily opt out of this work. CONCLUSION Our data suggest that autonomy in assignments with risk has implications for morale and burnout.
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Affiliation(s)
- Catherine Washburn
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Melinda E Kantsiper
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, Maryland, United States of America
- Baltimore Convention Center Field Hospital, Baltimore, Maryland, United States of America
| | - Rogette Esteve
- Baltimore Convention Center Field Hospital, Baltimore, Maryland, United States of America
| | - Ishaan Gupta
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, Maryland, United States of America
- Baltimore Convention Center Field Hospital, Baltimore, Maryland, United States of America
| | - Gulzeb Memon
- Baltimore Convention Center Field Hospital, Baltimore, Maryland, United States of America
| | - Henry J Michtalik
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, Maryland, United States of America
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Singh A, Panek T, Tackett S, Paranji S, Gundareddy V, Kauffman R, Wright S, Bowling G, Torok H, Patel H, Alhadeff I, Nogi M, McIlraith T, Robertson T, Kisuule F. Elements Influencing Recruitment and Retention of Millennial Hospitalists Born in or after 1982: a Survey-Based Study. J Gen Intern Med 2022; 37:3925-3930. [PMID: 35657465 PMCID: PMC9165541 DOI: 10.1007/s11606-022-07680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospitalist turnover is exceedingly high, placing financial burdens on hospital medicine groups (HMGs). Following training, many begin their employment in medicine as early-career hospitalists, the majority being millennials. OBJECTIVE To understand what elements influence millennial hospitalists' recruitment and retention. DESIGN We developed a survey that asked participants to rate the level of importance of 18 elements (4-point Likert scale) in their decision to choose or remain at an HMG. PARTICIPANTS The survey was electronically distributed to hospitalists born in or after 1982 across 7 HMGs in the USA. MAIN MEASURES Elements were grouped into four major categories: culture of practice, work-life balance, financial considerations, and career advancement. We calculated the means for all 18 elements reported as important across the sample. We then calculated means by averaging elements within each category. We used unpaired t-tests to compare differences in means for categories for choosing vs. remaining at an HMG. KEY RESULTS One hundred forty-four of 235 hospitalists (61%) responded to the survey. 49.6% were females. Culture of practice category was the most frequently rated as important for choosing (mean 96%, SD 12%) and remaining (mean 96%, SD 13%) at an HMG. The category least frequently rated as important for both choosing (mean 69%, SD 35%) and remaining (mean 76%, SD 32%) at an HMG was career advancement. There were no significant differences between respondent gender, race, or parental status and ratings of elements for choosing or remaining with HMGs. CONCLUSION Culture of practice at an HMG may be highly important in influencing millennial hospitalists' decision to choose and stay at an HMG. HMGs can implement strategies to create a millennial-friendly culture which may help improve recruitment and retention.
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Affiliation(s)
- Amteshwar Singh
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA.
| | - Tiffani Panek
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Suchitra Paranji
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Venkat Gundareddy
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Regina Kauffman
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Scott Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregory Bowling
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Haruka Torok
- Division of General Internal Medicine, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Hemali Patel
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Ilan Alhadeff
- Hospitalist Services, Team Health, Hollywood, FL, USA
| | - Masayuki Nogi
- Division of Hospital Medicine, The Queen's Medical Center, Honolulu, HI, USA
| | - Thomas McIlraith
- Department of Hospital Medicine, Mercy Medical Group, Sacramento, CA, USA
| | - Thomas Robertson
- Division of Academic Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Flora Kisuule
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
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Robinson D, Masters C, Ansari A. The 5Rs of Cultural Humility: A Conceptual Model for Healthcare Leaders. Am J Med 2020; 134:S0002-9343(20)30914-1. [PMID: 34756854 DOI: 10.1016/j.amjmed.2020.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Dea Robinson
- Metropolitan State University, Department of Health Professions, Denver, CO
| | - Christie Masters
- University of California - Los Angeles, Department of Medicine, Westwood, California
| | - Aziz Ansari
- Loyola University Medical Center, Division of Hospital Medicine, Maywood, IL.
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Sabitova A, Hickling LM, Priebe S. Job morale: a scoping review of how the concept developed and is used in healthcare research. BMC Public Health 2020; 20:1166. [PMID: 32711485 PMCID: PMC7382865 DOI: 10.1186/s12889-020-09256-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background The job morale of healthcare staff is widely seen as an important factor for the quality of care. Yet, there are different understandings of what constitutes job morale, which hinders systematic research and comparisons. We therefore conducted a scoping review of how the concept of job morale has developed over time and how it is used in healthcare research. Methods A scoping review was conducted to identify relevant literature. Data were gathered on study design and context, objectives, definitions of morale, outcome measures and key findings. Data was synthesised using a descriptive analytical framework. Results Ninety-three unique studies met eligibility criteria for the present review. The literature outlines four main periods of the evolution of the concept of job morale: The First World War and the interwar years; Second World War; Aftermath of the Second World War; and Contemporary period. The concept of job morale originated in a military context and was later applied to and specified in the healthcare literature. The concept has been applied to individuals and groups. The understandings used in healthcare vary, but overlap. Methods for assessing job morale in healthcare include quantitative scales, indirect measurements of consequences and predictors of morale, and qualitative approaches. Existing studies have mainly focused on the job morale of general practitioners, nurses and mental health professionals in high-income countries. Conclusions Although the understandings of job morale in healthcare are heterogeneous and inconsistent, the concept appears to have been useful over longer periods of time and in different contexts. Which precise understanding of job morale is useful, depends on the given research purpose, and studies should make explicit which exact understanding they apply. Systematic research on job morale is required to facilitate measures to improve and maintain high levels of morale across different professional groups, including professionals in low- and middle-income countries.
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Affiliation(s)
- Alina Sabitova
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Development, Queen Mary University of London, London, E13 8SP, UK.
| | - Lauren M Hickling
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Development, Queen Mary University of London, London, E13 8SP, UK.,East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Development, Queen Mary University of London, London, E13 8SP, UK
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Sabitova A, McGranahan R, Altamore F, Jovanovic N, Windle E, Priebe S. Indicators Associated With Job Morale Among Physicians and Dentists in Low-Income and Middle-Income Countries: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e1913202. [PMID: 31922555 PMCID: PMC6991249 DOI: 10.1001/jamanetworkopen.2019.13202] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear. OBJECTIVE To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale. DATA SOURCES A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed. STUDY SELECTION Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis. DATA EXTRACTION AND SYNTHESIS Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias. MAIN OUTCOMES AND MEASURES Levels of job burnout, job satisfaction, and job motivation as indicators of job morale. RESULTS Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation. CONCLUSIONS AND RELEVANCE The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.
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Affiliation(s)
- Alina Sabitova
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
- Department of Public Health, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Rose McGranahan
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
| | - Francesco Altamore
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
- Department of Biomedical, Metabolic, and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
| | - Emma Windle
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Development, Queen Mary University of London, London, United Kingdom
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House S, Frintner MP, Leyenaar JK. Factors Influencing Career Longevity in Pediatric Hospital Medicine. Hosp Pediatr 2019; 9:983-988. [PMID: 31722959 DOI: 10.1542/hpeds.2019-0151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric hospital medicine (PHM) is a growing field recently approved by the American Board of Pediatrics as a subspecialty. Understanding factors associated with hospitalist retention is important for workforce planning. Our objective for this study was to examine the proportion of pediatric hospitalists who remained in PHM over a 5-year period and identify factors associated with retention. METHODS We used 2012 and 2016 data from the American Academy of Pediatrics' Pediatrician Life and Career Experience Study. Retention was defined as being a self-reported hospitalist on both surveys. χ2 tests were used to examine relationships between retention and variables within 3 categories: demographics, position-related factors, and factors related to stress and satisfaction. A multivariable logistic regression was used to further assess relationships between select factors and retention. RESULTS In 2012, 206 of 1804 survey respondents were hospitalists (11%); 180 of these 206 individuals responded again in 2016, and 122 (68%) remained hospitalists. In the multivariable analysis, individuals earning ≥$175 000 were more likely than those earning less (adjusted odds ratio [aOR] = 3.93; 95% confidence interval [CI]: 1.26-12.25) and those more satisfied with their job were more likely than those less satisfied (aOR = 3.28; 95% CI: 1.22-8.80) to remain hospitalists. Respondents with more concern about educational debt were less likely than those less concerned to remain hospitalists over 5 years (aOR = 0.42; 95% CI: 0.20-0.90). CONCLUSIONS Two-thirds of early- to mid-career hospitalists remained in PHM 5 years later. Financial factors and job satisfaction appear to play an important role in retention; consideration should be given to the impact of these factors on the PHM workforce.
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Affiliation(s)
- Samantha House
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; .,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
| | - Mary Pat Frintner
- Department of Research, American Academy of Pediatrics, Itasca, Illinois
| | - JoAnna K Leyenaar
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
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Wang JY, Zhuang HL, Chiou JY, Wang CW, Wang CY, Liu LF. Exploring factors influencing the work-related morale for certified nursing assistants in hospice care: A structural equation modeling study. PLoS One 2018; 13:e0206281. [PMID: 30365527 PMCID: PMC6203351 DOI: 10.1371/journal.pone.0206281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 10/10/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Certified nursing assistants (CNAs) in palliative care units often encounter the death of patients and undergo emotional burdens because of their altruistic practices. However, the influences of altruism and perceptions of death on the work morale of CNAs remain unclear. The fact that morale can be improved by modifying related factors justifies the necessity of a theoretical model of morale for CNAs. However, such a model is currently absent. Based on relevant literature, factors including altruism, social support, perceptions of death, and job satisfaction are related to morale through the mediation of job stress. AIM This study was aimed toward determining the influencing factors and developing a structural model of morale with regard to CNAs working in palliative care units. DESIGN The hypothesized model was tested in a cross-sectional design with structural equation modeling using AMOS 23. SETTING/PARTICIPANTS A total of 413 CNAs from five hospice units in Taiwan participated in the survey. RESULTS Goodness-of-fit indexes, including χ2/DF = 2.187, PGFI = 0.461, and PNFI = 0.462, among others, confirmed the modified model fit the data well. Altruism, social support, perceptions of death, and job satisfaction were negatively related to job stress (-0.238, -0.196, -0.204, and -0.131, respectively). Altruism and social support positively affected job satisfaction (0.635 and 0.553). Factors directly affecting morale included altruism, social support, job stress, and job satisfaction (0.837, 0.711, -0.244, and 0.540, respectively). The relationship between altruism and morale was the strongest among all the direct paths toward morale. Job stress was the major mediator in these relationships. CONCLUSION Altruism is imperative for morale. The confirmed model is called the Five Constructs to Morale (5CM) model. These findings indicate the need to assess the levels of altruism and perceptions of death during the recruitment of CNAs. From the perspective of human resource management and organizational behavior, CNAs with a high level of altruism and a positive attitude toward death assure the well-being of end of life patients because of work involvement and commitment to the challenging work of hospice care. The cultivation of a supportive environment and coping strategies are suggested for the management of CNAs facing patient death. Hospice care decision makers should carefully assess morale levels among health professionals by applying the 5CM model. Identifying modifiable factors that can improve morale among nursing staff in hospice care to ensure work fulfillment and quality care merits emphasis in clinical practice. The establishment of effective strategies to facilitate the work morale of nursing staff is suggested for palliative care units. Morale improvement related task should be a global public health priority.
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Affiliation(s)
- Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Hui-Lin Zhuang
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Jeng-Yuan Chiou
- Department of Health Policy and Management, Chung Shan Medical University, Changhua, Taiwan
| | - Chia-Woei Wang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Yu Wang
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Fan Liu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kara A, Johnson CS, Hui SL, Kashiwagi D. Hospital-Based Clinicians' Perceptions of Geographic Cohorting: Identifying Opportunities for Improvement. Am J Med Qual 2017; 33:303-312. [PMID: 29241347 DOI: 10.1177/1062860617745123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Members of the Society of Hospital Medicine were surveyed about geographic cohorting (GCh); 369 responses were analyzed, two thirds of which were from GCh participants. Improved collaboration with the bedside nurse, increased nonclinical interactions, decreased paging interruptions, and improved efficiency were perceived by >50%. Narrowed clinical expertise, increased fragmentation, increased face-to-face interruptions, and an adverse impact on camaraderie within the hospitalist group were reported by 25% to 50%. Academic practices were associated with positive perceptions while higher patient loads were associated with negative perceptions. Comments on GCh benefits invoked improvements in (1) interprofessional collaboration, (2) efficiency, (3) patient-centeredness, (4) nursing satisfaction, and (5) GCh mediated facilitation of other interventions. GCh downsides included (1) professional and personal dissatisfaction, (2) concerns about providing suboptimal care, and (3) implementation barriers. GCh is receiving attention. Although it facilitates important benefits, it is perceived to mediate unintended consequences, which should be addressed in redesign efforts.
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Affiliation(s)
- Areeba Kara
- 1 ASPIRE scholar, Department of General Internal Medicine, IU School of Medicine, Inpatient Medicine Indiana University Health Methodist Hospital, Indianapolis, IN
| | - Cynthia S Johnson
- 2 Department of Biostatistics, IU School of Medicine, Indianapolis, IN
| | - Siu L Hui
- 3 Regenstrief Institute, Indianapolis, IN
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