Answering Your Questions About Integrating a Hospitalist and Hospitalist Model

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The OBGYN hospitalist concept provides safer labor and delivery for mothers. By sharing our experience and knowledge we can help advance the field of OBGYN hospitalist care. Thank you for your interest and submitting your questions. We hope our answers provide valuable insight to start a new hospitalist model or improve an existing one.

 

Question: It’s challenging integrating an OBGYN hospitalist into the group, especially in a busy hospital. We’re used to working a certain way. How do we integrate them successfully into our team culture?

The way a team collaborates is a vital part of its performance. Building a smooth and positive team culture takes time, cooperation and effort, and can be adversely impacted if change isn’t planned and communicated effectively. This is particularly true on a labor and delivery unit where effective team work and utilization of standard processes and protocols may be critical in providing the highest quality of maternal care.  Introducing a new team member should be well planned. There are 5 key things you can do to ensure a seamless integration:

  1. Build a receptive team
  2. Have a skilled lead hospitalist
  3. Adopt a consistent message of service
  4. Provide specific opportunities to encourage questions
  5. Create a system to introduce new hospitalists

 

What you do before you introduce a new member to the team has a lasting influence. Build a team that is receptive and open; team members should feel comfortable sharing opinions, receiving feedback and seek further opportunities for professional development. A receptive team keeps the lines of communication open and will help address potential hiccups before they grow into something larger.

 

A good lead hospitalist will inspire the team to be engaged and support change. By leading by example, they help set and maintain the tone and culture. They are also instrumental bringing in new hospitalists by providing training or orientation and introducing them to other team members. In turn, the new hospitalist will feel welcomed, comfortable, and immediately part of the team.

 

The goal of an OBGYN hospitalist program is to provide the safest and highest quality of care for mothers with the focus on service to the patient, the medical staff and the care team.  This includes Perinatologists (MFMs), midwives, Family Practitioners, the emergency department, OBGYN colleagues, and OBGYN or Family Medicine residents. The team should view the OBGYN hospitalist as a supportive provider who should approach their role from a mindset of service and support which promotes collaboration and teamwork.

 

Everyone is busy. Even if practitioners and staff have questions they may not have time to vocalize them. A dedicated time or event to discuss changes especially the introduction of an OBGYN hospitalist model is a constructive way to address concerns. Inviting feedback in a group setting will lead to additional questions. This is good. When we work with hospitals on a new OBGYN hospitalist programs we organize a lunch or dinner with all the doctors before launching the program. It’s a perfect forum to discuss and clarify any common misunderstandings, fears or resistance.

 

Establishing clear processes, standards, effective communication and teamwork leave little room for poor outcomes. This is also true when integrating a new OBGYN hospitalist. Consider creating a system or checklist to introduce new hospitalists. A system ensures everyone is on the same page and takes the guesswork out. Everything that supports a positive start for the new OBGYN hospitalist will be done.

 

Question: How do you promote acceptance of an OBGYN Hospitalist program where nursing and administration are interested, but community OBGYNs are resistant?

Resistance to an OBGYN hospitalist model from community OBGYNs is common; in fact, it has happened in almost every community we’ve worked with. Keep in mind, this is a fairly new speciality and the unknown often raises concerns. It’s important to understand where resistance is coming from.

 

Many OBGYNs who are unfamiliar with the hospitalist model are worried that they will lose their patients and their practice will be negatively impacted; however, if a program is designed correctly, this is not the case. Competition is a non-issue in a well-designed OBGYN hospitalist program. OBGYN hospitalists are not taking patients or deliveries from other OBs.  They support the hospital staff and practitioners by serving any maternal patients that require care where a private OBGYN is not available. A common scenario is when a doctor is on call, and cannot get to the hospital immediately, or perhaps chooses not to because they are busy with their own patients at their own practice.

 

For example, a patient with a substance abuse history and no prenatal care comes in complaining of abdominal pain.  She is a high-risk patient and her care will require a lot of time. Instead of the on call OBGYN leaving their practice and rescheduling patients or coming in from home in the middle of the night, the OBGYN hospitalist cares for this patient.

 

Yes, the private OBGYN may lose these patients; however, caring for them sometimes comes at the expense of losing sleep and canceling scheduled patients in their clinic. Having an OBGYN hospitalist available allows private OBGYNs to focus on the patients they already have in their busy schedule and maximize the rest they need. Most importantly, an OBGYN hospitalist is there to serve, support, and provide peace of mind. Should an emergency arise and the private OBGYN cannot respond right away, the hospitalist is available immediately to support their patient until the private OBGYN arrives. Once the OBGYN arrives, the hospitalist may continue to assist with this patient’s care, especially if it is a complicated or critical situation.  Sometimes minutes are critical, and in those situations it doesn’t matter who tends to a patient as long as it’s timely. These minutes saved may make a critical difference in the outcome of the mother and her baby.

 

In our experience, community OBGYNs  go through stages of acceptance for hospitalist models. Initially with minimal information and experience with an OBGYN hospitalist model, they are skeptical. Once they have more information and opportunity to dispel concerns, there is an acceptance of this change. Finally, in the last stage after 3-6 months working in a fully functional OBGYN hospitalist model, there is an overwhelming feeling of thankfulness. Private OBGYNs become the biggest champions. They cannot believe that they operated without an OBGYN hospitalist model in the first place and are appreciative of the support.

 

If OBGYNs have accurate information and the support of a well designed program, which includes a supportive and collaborative culture, they will be more open to a hospitalist model. If your nurses and administrative staff are interested in starting an OBGYN hospitalist program, but confronted with resistance, let’s talk. By discussing the concerns your doctors have, we will equip you with the knowledge and facts to dispel any unfounded worries or concerns, and guide you in engaging with your physicians. We are experts in the industry. Having worked with many hospitals, we’re familiar with models that worked well and didn’t work so well.  We understand the challenges hospitals and doctors face. Once you are open to the concept, we can set up a video call with the Medical Director, Medical Chair, or Perinatal Director. These exploration, fact-finding calls are free of change.

 

We truly believe OBGYN hospitalist models provide the safest and best quality of care to mothers, which is why we’re passionate and eager to help and welcome any questions. Please reach out. We look forward to speaking with you!

 

Question: When is it better to use an independent consulting group rather than involving an established hospitalist staffing company?

You can design and manage your own custom OBGYN hospitalist program with the help of an expert consultant group or choose a turn-key solution by hiring a hospitalist management company. The approach you choose largely depends on your hospital’s resources, specific needs, and budget. For a detailed comparison read “Before you start an OBGYN hospitalist program”.  Below are the highlights:  

 

It takes time and effort to design a well-planned and successful OBGYN hospitalist model. It’s a collaborative effort which includes medical and administrative staff, physicians and nurses. Take into consideration their time in addition to the level of expertise to plan, develop, implement and maintain a new program. Also take into consideration the support needed from other departments such as informatics, billing, marketing, and human resources.

 

Understand the level of value the hospital has with a home-grown, local program. There are a number of benefits to creating a local model, such as control of hiring, familiarity and trust with existing and local doctors, seamless integration into the team culture, and higher intrinsic motivation from doctors residing in the community. If these qualities are highly important, hiring a consultant group to assist you may be the best approach.

 

Budget plays a key part in deciding how to implement an OBGYN hospitalist program. In the long term, hiring a management company is more costly, but some hospitals prefer the ease of passing all the work to an outside management organization. Alternatively, hiring a consultant group has lower costs, but gives the hospital more control and requires more time from a comprehensive team.

 

At National OBGYN Hospitalist Consulting Group we take an objective evaluation of your unique needs, which may mean working with us or referring you to a hospitalist management company. No matter what you choose, at the National OBGYN Hospitalist Consulting Group, we want hospitals to be successful and for labor and delivery to be safer for women.

 

Our Consulting Group has a combined OBGYN hospitalist experience of 25+ years and are leaders in the industry, actively contributing to improvements and establishing standards towards the OBGYN hospitalist concept and the hospitalist role. If you are interested in starting a new hospitalist model, improve an existing one, or would like to learn more, let’s connect. We are here to help you in your efforts to make maternal care the best quality and safest it can be.  

– Dr. Rob Olson

 

Connect with the National OBGYN Hospitalist Consulting Group on Twitter @ObGHospitalist or LinkedIn

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