Driving Innovation: Partnering with hospitalists to make Canadian Healthcare better
Over the past few years, “Innovation” has become the latest buzzword in the debates around our healthcare systems. Whether it is the federal government’s Advisory Panel on Healthcare Innovation, or the Health Care Innovation Working Group of the Premiers’ Council of the Federation, all levels of government are looking to identify and promote innovative solutions for our healthcare challenges. With the widespread adoption of the hospitalist model of care over the past two decades, hospitalists have become a major player in the delivery of acute care services to Canadians (hospitalists are generalist physicians who spend the majority of their time looking after general medical patients in hospitals). Given that so much of our healthcare dollars are spent on the acute care sector, it would be worthwhile to ask how our policy makers and health system administrators can work with this emerging group of physician providers to stimulate and drive innovation in acute care facilities? Here are a few ideas to stimulate debate about the role of hospitalists in healthcare innovation in Canada:
1- The hospitalist model as key enabler of innovation
The hospitalist model is now well ingrained in North America. However hospitalists in Canada continue to face challenges in being accepted as permanent residents of the healthcare landscape. Indeed, efforts to “revert” the inpatient delivery system to one where community-based general practitioners (GPs) provide the majority of Most Responsible Provider (MRP) care continue to be popular with policy makers. The recent primary care strategy outlined by the Ministry of Health in BC outlines efforts to explore alternative models to current hospitalist programs, following previous initiatives announced in 2013 to attract GPs back to providing inpatient care. While it is unclear if such efforts have been successful, research has shown a strong trend towards GPs focusing primarily on ambulatory care and reducing involvement in hospital-based care. It is unlikely that simple financial incentives will be sufficient to attract community-based practitioners back to providing large-scale inpatient services.
Accepting that hospitalists are “here to stay”, at least for a large percentage of acute care institutions (medium to large community hospitals, large academic centres), could prove to be a liberating experience for many health system policy makers, managers and physicians! Instead of trying to reverse the development of more hospital medicine programs, healthcare leaders can instead focus their efforts on partnering with hospitalists (and others who dedicate a significant portion of their time to acute medicine) to find novel ways of delivering services to an increasingly complex patient population. The current fragmented model of care (with ambulatory and acute care teams largely operating in silos) is rife with improvement opportunities. Hospitalists are well positioned to work with community-based physicians, system managers and other allied health professionals in developing integrated teams that can wrap services around the needs of complex, multimorbid patients by leveraging technologies for better care coordination across transition points, thus allowing each team to do what they are good at while ensuring patients do not fall through the cracks.
2- Foster leadership training for hospitalists
Hospitalists “live” in their acute care organizations, spending the majority of their clinical time in such settings. It is therefore not surprising that they are great candidates to take on leadership roles in various aspects of running the healthcare system. Hospitalists are particularly well suited to take on leadership roles in improving quality of care and patient safety (QI/PS). For example, a large number of individuals who participated in a network of physicians interested in QI/PS in Ontario were hospitalists. Institutions are well served when they support their hospitalits to take leadership development courses. Hospitalists should have strong representation in the leadership structures of their hospitals or health authorities, such as the Medical Advisory Councils and venues where decisions are made about the delivery of care to patients at local levels. By involving them in the decision making process, institutions are much more likely to engage physicians in system redesign efforts.
3- Engage hospitalists in the decision making process, early, often!
Hospitalists spend a large component of their time communicating with other health professionals and helping patients navigate the health system. As front-line providers who effectively interact with a large number of physician and other provider groups, hospitalists can provide a unique perspective to inform discussions on the future of our healthcare system, and the quest to find solutions to current challenges in delivering high value care for Canadians. Engaging them early in any system redesign process can not only help increase physician participation in such initiatives, but it can also ensure that the new care processes take into account the realities on the ground. Physician engagement is an often talked about concern for many healthcare policy makers and managers. Hospitalists are a readily available group of physicians who can be relied on to engage with the hospital leadership, as long as they are invited to participate in the process early on and in a meaningful way.
More than ever, our healthcare systems in Canada need innovative solutions for higher quality care at an acceptable cost. This is even more pressing in the acute care sector. Partnering with a group of individuals who are major contributors to service delivery in hospitals and have a vested interest in wanting to see the system work more efficiently and deliver better care makes sense, and given our fiscal climate, should be a priority for all healthcare leaders.