Hospital Medicine's Evolution: Literature Search and Interview Study with Practices

Introduction: Hospital medicine is a young specialty that is still evolving. In its early years, research focused on clinical outcomes, efficiency, and cost effectiveness. As the specialty matures, increasing attention is being given to the patient and hospitalist experience with the hospitalist model of care. Methods: In 2008, we conducted a literature search to identify patients' and hospitalists' satisfaction concerns and potential strategies for their resolution. We used our findings to develop a semistructured interview guide as a basis for a wide-ranging discussion with Kaiser Permanente (KP) hospitalists and physician leaders and KP and non-KP subject-matter experts on their priorities, concerns, and successful practices. Results: Respondents identified sustainability and communications in coordinating care as their high-priority concerns with sustainability as the top priority. Within these broad concerns, they identified contributing factors and their interrelationships. Factors influencing sustainability of the hospitalist model include hospitalist scheduling, workload, comanagement responsibilities, and recruitment and retention. Regarding communications in coordinating care, respondents viewed themselves as being in the center of a web involving communication with patients, physicians in other services, nurses, and other hospitalists. Conclusion: Promising approaches have been developed to address sustainability concerns and for communicating with patients, physicians in other services, nurses, and other hospitalists. However, getting reliable feedback on patient satisfaction surveys for individual hospitalists is a continuing challenge. Despite the use of brochures and business cards to introduce themselves to patients and explain their role, there are difficulties in establishing a hospitalist-patient bond.