Organizers and Facilitators: Sarah Apgar, Brad Monash, Ed Vasilevskis, Nila Radhakrishnan, Marisha Burden, Andrew Auerbach

Announcing the Clinical Operations Work Group

We are excited to launch the Clinical Operations Working Group, a new initiative aimed at supporting leaders of academic hospital medicine groups. This effort builds on extensive input from participants across the HOMERuN network, who joined recent breakout sessions to share ideas, identify pressing operational challenges, and suggest ways this group can add value.

Why This Group?

Clinical operation leaders in hospital medicine groups have multiple responsibilities related to the clinical care provided on primary medicine, co-management, and consultative services. They must partner with health system leadership to achieve institutional goals and priorities, and to develop and implement clinical workflows. Further responsibilities include developing and leading clinical rotations, establishing and implementing clinical policies, and supporting and growing clinicians.

To do this work effectively, clinical leaders consistently report the need for:

• Shared benchmarks to support data-driven staffing and resource requests to health system leadership.
• A platform to share clinical service models and the advantages and drawbacks of various approaches.
• Shared approaches to common divisional challenges that impact clinician experience and retention.
• A forum to brainstorm and innovate solutions to common problems faced across institutions such as census, capacity and flow challenges, caring for patients with medical and social complexity, and development of clinical protocols (i.e., caring for patients with disordered eating).
• Mechanisms to study operational models and their impact on outcomes.

Common Themes Across Groups

Workload and Staffing Benchmarks

"We're constantly being asked to do more with less, but we have no shared standard to say how many patients is too many. It would be amazing to have benchmarks to take to leadership and say, 'This is what's reasonable.'"

Service Model Variation

"Should cardiology have its own hospitalist service or should we co-manage? What about trauma, or hem/onc? We need to know what's sustainable and what other places have learned the hard way."

Clinician Experience and Retention



"How do we keep junior faculty from burning out in year two? We need guidance on flexible scheduling, lactation policies, and just showing people they're not alone."

Operational Complexity in Growing Systems



"Our hospital just merged. Now we're juggling patients across campuses with different specialties and EMRs. Who owns the patient when they move? It's chaos."

Capacity Flow and Management



"We're all dealing with throughput nightmares — whether it's delays to discharge, managed Medicare, or no SNF beds. We need to talk about real solutions, not just vent."

Services the Group Might Provide

• A shared repository of operational policies, service models, and implementation tools
• Benchmarks and metrics for staffing, workload, and care complexity
• Consensus briefs or guidance documents on common challenges (e.g., backup systems, lactation accommodations, scope of APP roles)
• A platform for peer comparison and data-sharing to support negotiations with health systems
• Support for multi-site studies on the impact of operational models on outcomes (e.g., throughput, burnout, retention)

Areas of Uncertainty

• How this group will coordinate with SHM SIGs or other HOMERuN groups
• Whether the primary function will be research-focused, practice-based, or a hybrid
• The optimal format for output—real-time consultation, asynchronous briefs, or scheduled reports
• How to ensure non-duplicative, inclusive participation across diverse sites

Next Steps:

1. Define the governance and scope of work group and discuss what topics will be included within the context of clinical operations.
2. Develop structure to define and compare benchmarks across HOMERuN sites.
3. Form work groups to draft initial resource documents (e.g., night coverage models, backup shift structures, specialty co-management).
4. Stay tuned for opportunities to join, contribute, or bring your own clinical ops questions to this group.

To get involved, email Tiffany.Lee@ucsf.edu.

Our next HOMERuN meeting will be on May 9, 2025.

Image Attributions: Vector images from https://www.flaticon.com