Where: Spectrum Health Medical Center, which has 2 main campuses with 1,102 beds in the Grand Rapids, Mich., area.
The issue: Improving the onboarding process for new hospitalists.
Before 2015, the process of joining the 71-hospitalist acute care division at Spectrum Health was fragmented, human resources surveys showed. New hospitalists described orientation as front-loaded, inconsistent, and lacking peer assistance, said Muhammad Nabeel, MD, FACP, a senior hospitalist in the division and clinical assistant professor at the Michigan State University College of Medicine in Grand Rapids.
“There was a variable shadowing process. Providers were educated on the process by our practice manager and site lead, and that varied with the new hires' previous experience,” he said.
To tackle these issues, Dr. Nabeel implemented and coordinated a structured peer mentorship program for new hires.
How it works
The program acclimates new physicians by pairing each with a senior hospitalist colleague for a total of 4 working weeks. For their first 3 days, new hospitalists only shadow their respective mentors, walking into patients' rooms and learning the various unit dynamics. “That is the most crucial phase,” Dr. Nabeel said. During this time, the mentors carry half the average daily census (about 6 to 8 patients) and teach a standardized protocol for introductions, communicating with nurses, and discussing plans of care with patients, he said.
Using a comprehensive checklist, the mentor also communicates expectations regarding documentation, handoffs, roles of different shifts, and other duties. “That checklist is quite rigorous and time intensive, with a certain degree of iterations to make sure that we are explaining the process as clearly as possible,” Dr. Nabeel said.
From day 4 to day 7 (the hospitalists have a 7-on/7-off schedule), new hires average 10 to 12 patients per day until working up to the average 15-patient daily census, while the mentor carries 2 fewer patients than average. “The purpose is to make sure there is collaboration if the new hire needs any assistance, [that] the mentor is available to answer questions or walk through any challenging processes,” Dr. Nabeel said. The formal peer mentorship continues for 4 weeks of work, with the mentor and mentee meeting to discuss progress and review any questions at the end of the second week and again at the end of the fourth week. But the relationship doesn't end.
“The first thing I hear from my mentee is that if she has any questions, she will connect and ask me. It has been a rewarding experience for both of us as we learn new things every day,” Dr. Nabeel said.
From June to December 2015, 11 hospitalists were trained under the new program. To get feedback, Dr. Nabeel conducted an online survey of all new hospitalists that asked questions pertaining to work efficiency and job satisfaction. Overall, 95% of the answers were either very positive or positive, he reported. “In fact, some of the feedback helped us further tweak the program to provide exposure to admitting shifts,” he said. The estimated cost of the program, based on the reduced number of patients seen, was about $2,400 to $3,600 per hire. “Given the feedback that we have received, the fact that our new hires were so satisfied and the transition was smooth, [the cost] is very absorbable with the return on investment in the form of higher provider satisfaction, morale, and overall benefiting the culture of the division,” Dr. Nabeel said.
Variation in the speed of credentialing was a challenge at first. “Sometimes we had to change the schedule because we could not get an accurate start date” and had to pair the new hire with a different mentor, Dr. Nabeel explained. To address this, he said, the program held off on pairing hospitalists until receiving a confirmed start date. Although the group has residents and does some teaching, it is not an academic hospitalist program, he noted. “The culture of mentorship or coaching does not come naturally to most service-oriented hospitalist groups,” Dr. Nabeel said.
About 6 new hires are set to join the group this fall, and they'll go through the same onboarding process, which has become a permanent fixture for all new hires in the division, Dr. Nabeel said. The group has also expanded the program, tailoring a variation for its locum tenens clinicians, he said. “Given the success of this in regard to work ethic and workflow, we want all hospitalists working at both campuses to represent a homogenous standard,” he said.
Words of wisdom
“This program gives us an opportunity where we can get to know each other as a team and build a culture and camaraderie within our division....It is a tangible way of saying that we care,” Dr. Nabeel said. “Their future is our future, and our future is their future.”