Introducing Two Leaders – OBGYN Hospitalist Field

This month I’d like to introduce you to two leaders in the ob.gyn. hospitalist field.
The first is Dr. Wayne Farley of Questcare Obstetrics, based in Dallas. It currently has ob.gyn. hospitalist programs in Texas, but has recently expanded to Colorado.

Questcare’s first program was established 5 years ago, and in 2008, Dr. Farley stated: “I’m sure the face of our ob.gyn. hospitalist programs will look much different in 2012-2013.” That vision has proven to be very true, and he still believes that Questcare’s programs will continue to evolve with time.

Dr. Wayne Farley

Dr. Farley attributes the program success of Questcare to its focus on the development of perinatal service lines that the facility could not otherwise support. In fact, they have successfully created a variety of these programs for the facilities with which they are currently contracted and hope to expand them in their future contracts.
Questcare Obstetrics is currently expanding perinatal service lines to include high-risk obstetric referral centers. Even more specialized is the Advanced Maternal & Newborn Institute and Specialty Obstetrics Referral Center at Medical City Women’s/Medical City Children’s Hospital in Dallas. This program offers patient-focused outpatient and inpatient care of pregnancies complicated by fetal anomalies and/or chromosomal aberrations.
In addition to high-risk referral centers and specialty clinics, Questcare also has facilitated the development and implementation of a successful maternal transport program.

With this evolutionary change in Questcare’s ob.gyn. hospitalist programs in just 5 years, it should be interesting to see what the next 5 years bring. Questcare Obstetrics is focusing on providing quality ob.gyn. hospitalist programs, while helping expand targeted service lines for its contracted hospitals.

The development of these programs may seem out of the realm of what ob.gyn. hospitalist programs normally bring to a facility, but Questcare’s programs have brought a significant value-added contribution to the hospital without adding to the overall costs of healthcare.

The second person I’d like to introduce is the current president of the Society of OB/GYN Hospitalists (SOGH):

Dr. Karenmarie K. Meyer

Dr. Meyer is a great advocate of the ob.gyn. hospitalist model, and her goals for the fledgling society include defining what an ob.gyn. hospitalist actually is, delineating the criteria for hospitalist core competency; championing patient safety for women in the hospital, emergency department, and in the labor and delivery setting specifically; adding simulation training as part of our core skill set; and documenting our results through research and publications. Dr. Meyer has led significant progress in all of these areas and SOGH has been recognized as an organization whose members will take the lead in determining how ob.gyn. hospital care is provided in the future.

Passionate about the broadening understanding of the model, Dr Meyer recently stated: “Ob.gyn. hospitalists are much more than just an ‘in-house’ doctor available for emergencies. As our membership and visibility continue to increase, others are realizing this as well. Our members are up to date on current management protocols, and our availability to private physicians and their patients has been well recognized in hospitals utilizing our practice model. Our knowledge, consistency, and reliability will continue to define us as the ‘state of the art.’ ”

Dr. Meyer and SOGH are continuing to identify hospitalists’ core competency criteria and how these will be assessed and certified. SOGH also has been asked to help define the core criteria for the first fellowship in an ob.gyn. hospitalist discipline, which is being offered by Dr. Anthony Vintzileos at Stony Brook in N.Y.; the fellowship will be established at Winthrop University Hospital, Mineola, N.Y. The second program will be at the Fountain Valley Regional Hospital associated with the University of California, Irvine.

As the ob.gyn. hospitalist model matures and changes, Dr. Farley’s and Dr. Meyer’s contributions are exciting and are helping to define and drive the future of women’s inpatient care across the country today.

Originally posted MAY 21, 2013 on ehospitalistnews.com

Character Traits of an ObGyn Hospitalist

Through my experience as an ob.gyn. hospitalist, it quickly became clear which things work well and which things do not in an ob.gyn. hospitalist program.

Although internal medicine and pediatrics have been using the hospitalist model for quite some time, it is still a model in its infancy for ob.gyn. medicine. With hospitals investing significant amounts of funding to start ob.gyn. hospitalist programs, there is neither time nor money to waste on pursuing the things that don’t work. The expectation is that even though it’s a new program, it should work almost immediately.

Those who have been through the torturous process of establishing, integrating, and/or converting to any new program in any aspect of life know that this is a fairly unrealistic expectation. There are, however, some basic ingredients or attributes that I believe must be present to lessen the pain and increase an ob.gyn. hospitalist program’s chances of success.

The following are some qualities that should be considered when ob.gyn. hospitalist candidates are interviewed:

• A physician who is a seasoned professional. Finding and then hiring the right people are always challenges in any industry, but even more so for ob.gyn. hospitalist recruitment. The best candidates for ob.gyn. hospitalist jobs need to be seasoned board-certified physicians. Not only will they be involved in every true ob.gyn. emergency, but they must also be able to educate and hold their ground against other, sometimes older ob.gyns., family physicians, and midwives who may not be practicing the most up-to-date, evidence-based medicine. This is not a job for a beginner. Physicians with expert clinical skills are essential for a program’s success, as they are the first responders and must be able to deal with or assist in every situation that presents itself.

• A physician who is a team player. The team needs to be flexible and responsible. Smooth handoff rounds, conveying all necessary information, are essential. An outgoing physician needs to introduce the incoming physician to any active patients. Scheduling needs to be fair and allow call dates to be traded to fit everyone’s schedule. Obviously, team members won’t know if they will be compatible until they start working together, but hospitalists must be willing to leave their egos at the door to be “team players.”

• A doctor who is willing to serve. The private practitioner obstetrician needs to keep her own patient happy and safe, whereas ob.gyn. hospitalists need to keep all the patients and all the labor and delivery professionals (and sometimes the gynecology emergency department professionals) safe and happy. Ob.gyn. hospitalists need to go out of their way to ask nurses and physicians the question: Is there anything I can do to help?

One of the great things about being a hospitalist is that the work is so varied, but programs need hospitalists who are willing to help anyone who asks and are comfortable doing so – from the private practitioner who needs a quick ultrasound to determine position, to the OR tech who requires help moving a patient. Some physicians may think these tasks are just scut work, but they are essential to developing a safe, efficient high-reliability organization (HRO) that can avoid catastrophe in a real crisis or emergency.

• A physician who inspires trust. Hospitalists are consistently meeting patients for the first time. They won’t have developed a relationship with patients over the previous months of pregnancy, so ob.gyn. hospitalists need to be able to bond with them and their families quickly. For example, one of the tools I find to be effective when I deal with a mom who has experienced a failed home birth by a lay midwife is this simple phrase: “I know this is not what you planned, but I am so glad that you are here with us so we can take care of you.”

• A doctor who is a good communicator. Hospitalists need to be able to solve problems quickly by using tact, diplomacy, and professionalism at all times. Being involved with emergencies and bad outcomes, they need to be comfortable with debriefing the team and communicating sensitively with patients and families. Highly developed communication skills also extend to documenting the chart and liaising with an absent private practitioner, the nursing team, and the hospital’s administration.

I was one of the original ob.gyn. hospitalists at my community hospital in Bellingham, Wash. Having Dr. Chris Swain’s company, the OB Hospitalist Group, consult helped us to quickly establish a successful new program. Our team of four hospitalists is employed by St. Joseph’s Medical Center. It is a successful program that I’m proud to say encompasses these aforementioned ingredients: We smoothly integrate our scheduling and handoffs; the local obstetricians, family practitioners, and midwives trust us and appreciate our work; and we regularly foster open communication by attending the nurses’ handoff meetings as well as huddling with the anesthesiologist and nurse team leader.

Originally published SEPTEMBER 25, 2012 for ehospitalistnews.com

 

Leadership Role in Quality and Cost Control – Hospitalist Programs

When an ob.gyn. hospitalist program starts at a hospital, there is often a varying degree of distrust, resistance, and uncertainty about how hospitalists fit into the rhythm of the labor and delivery department.

In the initial stages, the ob.gyn. hospitalist may be relegated to the sidelines and just used in a limited capacity – for an emergency or for patients without a physician, for example.

In established programs, it can be the other end of the spectrum, as ob.gyn. hospitalists are looked to for oversight, leadership, and standardization, and provide these skills, often facilitating how the L&D department operates overall. They can evolve into the manager of labor and delivery rather than only providing coverage.

I was recently intrigued by an article in the New Yorker entitled, Big Med by Dr. Atul Gawande, a surgeon, writer, and public health researcher, in which he compares the operation of his local Cheesecake Factory restaurant to hospital medicine. He observes how, unlike in medicine, the Cheesecake Factory has figured out how to “deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality.” Lamenting the current state of hospital care, Dr. Gawande rightly states: “Our costs are soaring, the service is typically mediocre, and the quality is unreliable.”

Dr. Gawande also points out that doctors are paid for services, not results. Unlike a restaurant, historically medicine is not service oriented. Medicine is becoming like a chain restaurant as large corporations transform it into a Southwest Airlines approach to health care – a high-quality, low-cost product.

We need to keep working toward what the Institute for Healthcare Improvement calls the Triple Aim which seeks to improve the patient experience of care (including quality and satisfaction); improve the health of populations; and reduce the per capita cost of health care.

We need to demonstrate our value by continuing to emphasize our commitment to safety and quality outcomes.

It is necessary to demonstrate that our commitment to safety and quality outcomes translates into real improvement as well as real patient satisfaction. This is going to require data collection as well as new skills and competencies on our part. Not only will we have to hone our clinical skills, but we will also have to step up as leaders to work with the other members of the health care team.

How do quality and cost control occur? Is it even possible to deliver high-quality yet low-cost hospital medicine? And who is actually in charge to help make this happen?

Change in the medical world does not happen quickly; however, the adoption of ob.gyn. hospitalists is one way hospitals can immediately start addressing these issues.

Ob.gyn. hospitalists can be used in a leadership role with responsibility for a patient’s overall care, medical costs, and results. The can coordinate who cares for the patient and how, help reduce costs in malpractice by being physically present in L&D to handle emergencies or other challenging situations, oversee collaboration on standardization to deliver consistency and best practice medicine, and ensure good patient outcomes through their presence, clinical skills, and experience.

The military uses the term C4 – command, control, coordination, and communication. Adapting this for the medical environment could look something like this:

 Oversight instead of command. This can be done by facilitating how the department runs, prioritizing and assigning assets, and being the diplomat and intermediary between hospital administration and L&D.

 Leadership instead of control. This is accomplished by instituting standardization, ensuring best practices, and facilitating policy integration to enable collaboration and consensus to achieve the best possible outcomes at the lowest cost.

 Coordination. The ob.gyn. hospitalist can coordinate between patients and their family physician, midwife, or obstetrician; coordinate between the private practitioner and the ob.gyn. hospitalist; and coordinate between nurses and physicians in L&D, and the patient during follow-up.

 Communication. The ob.gyn. hospitalist can work to ensure that everyone from the L&D floor to the hospital administrators knows what is going on all of the time.

It is fascinating to watch this process occur in real time and to be part of this transformation. There are so many different variations of how ob.gyn. hospitalists are used in different programs. However, I think this gradual shift from coverage only toward oversight, leadership, coordination, and communication is inevitable. Because this transformation makes common sense and because it leads to greater patient safety with better outcomes at the same time, it reduces stress and improves working lifestyles for the private ob.gyn. as well as family physicians, midwives, and the labor and delivery nurses.

Originally published OCTOBER 24, 2012 on ehospitalistnews.com and edermatologynews.com