May 30, 2023

HOMERuN Collaborative: Wellness Measurement for Hospitalists Focus Groups

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: Krishna Chokshi, Andrew Schram, James Clements, Ruby Marr, Kanapa Kornsawad, Ashwini Niranjan-Azadi, Elizabeth Murphy, Omrana Pasha-Razzak, Pinky Jha, Sara Westergaard, Holly Day, Tiffany Lee   Background: Hospitalist wellness is an increasingly important priority across hospital medicine particularly in the wake of COVID-19. Multiple wellness measurement tools exist and are used variably across the field. Our aim is to examine the use and usefulness of wellness measurement tools specifically from the perspective of hospitalists.

Measures of Well-Being

Current measurement approaches: Overall, current approaches are not working well due to: Wide variability in whether formal measurement is happening Survey fatigue, especially with lengthy surveys, is a major issue and counterproductive to wellness and also contributes to low response rates Measurement tools often don't delve into drivers; qualitative assessment like focus groups may be better at identifying drivers/underlying issues

Recommended measures: Individual impact measures: burnout level, moral injury, emotional exhaustion, psychological safety, joy in work Workload measures: excess work, census, time spent beyond normal workday, administrative burden, documentation, work-life balance, section/department-specific pain points Operational impact measures: turnover, retention, intention to leave, clinical time reduction, recommendation of job to others

Frequency of measurement: Strong opinions on both sides: annual vs more frequently (even up to weekly) Benefit of annual measurement is to align with fiscal year and see how interventions have impacted the group Benefit of more frequent measurement: signals more investment in the issue, able to assess progress and culture shift more rapidly Increased frequency may be easier with targeted surveys (nocturnists) or pulse surveys (push one button a day about a specific issue) Challenge to more frequent surveys is survey fatigue Especially important to measure when there are changes in leadership, roles, size of group, major initiatives

"So many of the measurement tools out there are helping you take the temperature but they''e not actually getting any kind of treatment planning for what needs to be fixed… what's the root cause and how do we move forward to fix those things."

Evaluation Tools and Data Collection

Evaluation tool design: Asking questions specific to hospitalists is essential (clinic questions on some surveys can be a turnoff) Benefit to benchmarking across Hospital Medicine but others raise point that our groups and locations are very heterogenous Might be helpful to have common domains in a survey for hospitalists but be able to ask questions differently and/or add group-specific questions Focus groups may be a better way to gather specific information, and a focus group guide could be useful

How data collected is being used or should be used: Data needs to drive solutions Several groups are using data to improve operational workflow: Staffing ratios, leadership structure, FTE support, case management structure, work hours, service restructuring, bonus programs Act/implement change or people will feel like they aren't being heard; "One thing to measure and another thing to implement change" Measurement tool can tell us "how much the house is on fire" with morale but this needs to be followed by leadership engaging the group in designing solutions Transparency can be difficult

"Everybody has opinions about well-being right? They want to talk about it in the hallway. But getting them to actually put something down on their survey—that was hard."

Key Takeaways: Overall, wellness measurement for hospitalists is an area in need of significant focus, growth, and development. Marked heterogeneity between hospital medicine groups: Qualitative assessment likely necessary to understand wellness drivers within a group. Wellness assessments should assess drivers of burnout to facilitate action. Only survey if intend to act; otherwise risk frustration and alienation of the group. Balance measurement strategies with the risk of survey fatigue. Transparency and feedback to the group is essential.

The goal of this webinar series is to introduce residents and fellows applying for academic hospitalist positions to leaders in the field from around the country, to de-mystify the application and job-search process, and to answer questions that future academic hospitalists have about the field. Registration for the June 6 webinar is open.

HOMERuN-Affiliated Study Seeking Partners

Roflumilast or Azithromycin to Prevent COPD Exacerbations (RELIANCE) Study

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 $2,000 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 June 9, 2023.

Image Attributions: Vector images from 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.