September 19, 2022

HOMERuN Collaborative: Shared Leadership for Hospitalist Health and Safety

The Hospital Medicine Reengineering Network (HOMERuN) is a rapidly growing collaborative made up of more than 50 Hospital Medicine groups from academic and non-academic hospitals across the United States.

Moderators: Natalie Schwatka, Marisha Burden, Angela Keniston, Gopi Astik, Anne Linker, and Matthew Sakumoto Background: There is no doubt formal leaders must support workplace safety and health. However, when everyone has influence, policies and programs become more relevant and consistently implemented. Here we summarize the themes that emerged from focus groups on the topic of shared leadership for safety and health among hospitalist teams.

Conceptualizing Workplace Health and Safety

This is an expansive concept which includes physical and mental health, but mental health receives more attention. Physical health is only discussed when something specific becomes an issue, while mental health and well-being is routinely on everyone’s radar. The pandemic has made this especially salient.  Some hospitalists think that that physical health protection is taken care of (ergonomics, personal protective equipment, infectious disease protection, etc.); others do not agree. The most pressing safety and health issue is violence, harassment, and verbal abuse from patients and families. Hospitalists worry about the role they play in the difficult relationship that might ensue. They also worry about the bias that might come into play when making decisions about which patients may become aggressive or violent. This has been tackled by other health care professionals, such as nurses, but there is a sense that physicians do not need as much support (“No one cares about that for doctors”). However, this is changing and more accept that physicians also need resources. Addressing hospitalist safety and health is challenging, as hospitalist jobs are different than others. For example, you might tell someone to go for a walk during lunch, but hospitalists do not get lunch breaks. Other pressing issues were staffing models that influence workload and burnout, active shooters, suicide risk, and relevance of safety and health protocols developed for nursing units that do not apply to hospitalists. Participants also wondered about the interaction between physician and patient safety and health. For example, metal detectors protect physicians from active shooters, but having them may signal to patients that not everyone is welcome or they may make patients feel unsafe. There was a sense that we should get the patient perspective when trying to determine what makes everyone in a hospital feel safe.

"We need to think about our providers as human beings."

Team Management of Workplace Health and Safety

Team members step up to help and share responsibility for each other. For example, they take a team approach to dealing with violent or aggressive patients. Open communication is important. This came up a few ways: Openly share with team that, when possible, there are flexible work policies or that they are using flexible work policies themselves. Group WhatsApp chats to talk about active shooters. Participants wondered whether someone should have a designated leadership role for this. Passion for the work is a must. Relatedly, hospitalists must know who to go to for specific issues that arise and sometimes that is outside of the team, e.g., patient advocacy, office of equity and inclusion, department of public safety, etc. However, these other support teams are not always sufficiently staffed to help.

"You're empowered to take action when you need to."

Leadership for Workplace Health and Safety

All participants felt that they were leaders for safety and health at work. However, they believed that it starts with formal leaders who must be advocates. Opportunities to help hospitalist teams become leaders for safety and health at work: For those who may not see themselves as leaders, they should recognize that they are already leaders in the hospital with those they are interacting with, e.g., care teams and patients. Leaders do not need to be directive when it comes to safety and health, rather they should be supportive and empowering. However, if a safety and health issue arises, they should act. Role modeling is a great first step. Frame wellness, burnout, and safety as a quality improvement project. Communicate limits and boundaries to protect physical and mental health needs. Professional development should be included in the definition of safety and health at work. Help hospitalists identify why safety and health is meaningful to them and the specific ways in which they can contribute to their team’s safety and health. Build leadership from the start of a career. Build safety and health policies and programs into operations (e.g., when designing workloads). It is hard to be a safety and health leader if others around you are not role modeling as well.

"I think we all consider ourselves leaders in in that area, despite not having a dedicated role to that."

Key Takeaways: Safety and health at work is an expansive concept that includes physical as well as mental health, although mental health receives more attention. The most pressing safety and health issue is violence, harassment, and verbal abuse from patients and families. There is a sense that physicians do not need as much support. We need the patient perspective when trying to determine what makes everyone in a hospital feel safe. Hospitalist team members step up to help and share responsibility for each other. A key strategy that hospitalist teams use is communication — communicate boundaries, limits, safety and health problems that arise, etc. All participants felt that they were leaders for safety and health at work. However, they believed that it starts with formal leaders who must be advocates. They also wondered whether there should be someone formally designated into this safety and health leadership role. There are several opportunities to begin sharing responsibility among hospitalist teams, including role modeling, increasing safety and health communication, and building safety and health into professional development as well as operations planning.

The HOMERuN Patient and Family Advisory Council

Do you need the patient and family perspective on your quality improvement, research, or clinical operations project? Do you want to brainstorm ideas with patients and families about a project you are planning?   Anyone who is part of HOMERuN has access to the HOMERuN PFAC. The HOMERuN PFAC includes 11 members from across the country who can work in partnership with you to maximize the patient-centeredness of your work.    For more information about the PFAC, including scheduling time to bring your project to the PFAC, please contact James.Harrison@ucsf.edu or Tiffany.Lee@ucsf.edu

Become a Site for the RELIANCE Study: Roflumilast or Azithromycin to Prevent COPD Exacerbations

Purpose of RELIANCE: Both roflumilast and azithromycin have been shown to reduce the risk of COPD exacerbations compared to placebo. However, there has not been a head-to-head comparison of these two FDA-approved medications. RELIANCE is intended to support hospital efforts to reduce the risk of all-cause hospitalization and premature deaths in individuals with COPD.  RELIANCE is Seeking Community-Based Hospitalists: Hospitalists are critical in the development of post-discharge care plans and medications used by people with COPD. We found from preliminary work that identification of people with COPD while they are hospitalized is an efficient recruitment method for RELIANCE. Benefits and Compensation: $500/year honorarium for being a community partner (paid after registration) plus $200 per patient enrolled. Option to participate in clinical roundtables with COPD thought leaders. Contribute topic ideas for future grant proposals or publications related to hospitalist care. Community Partners will not be investigators / authors, but will be acknowledged in the RELIANCE publication.  Please reach out to Tiffany.Lee@ucsf.edu if you are interested in participating and would like more information about RELIANCE.

Our next meeting will be on October 14, 2022.

Workplace Health and Safety Image Attributions: Cartoon Vectors by Vecteezy @ Vecteezy.com

Check out the HOMERuN website for more information. If you would like to join the HOMERuN Collaborative calls, please reach out to Tiffany.Lee@ucsf.edu.