Former New York Gov. Eliot Spitzer proposed a new loan-forgiveness program that would entice new doctors to rural communities, and his newly sworn-in successor, Gov. David Paterson, has expressed support for the initiative. But many in the medical community say it isn't enough, because the program doesn't address the overarching problems such as exorbitant malpractice insurance premiums, flat Medicare reimbursement rates, and a lagging rural economy.
Many of the same market forces that have made recruitment more difficult and a higher priority recently--physician shortages, demographic changes, and generational attitude differences--have also increased many facilities' focus on physician retention.
Retaining physicians begins with a concerted effort to address retention issues within the organization on an ongoing basis, says Kevin Donovan, FACHE, FACMPE, vice president of physician and ambulatory services at Elliot Health System in Manchester, NH.
Groups that have formalized retention initiatives tend to have lower turnover rates than groups without them. Although any retention-targeted initiatives are a step in the right direction, Donovan recommends outlining a dedicated retention plan that involves senior leadership and is based on routine reporting, analysis, discussion, and accountability.
The plan should also address cultural-fit issues, which are frequently identified as the top cause of voluntary turnover, and establish a plan to identify at-risk physicians and intervene before turnover becomes a probability.
"The plan doesn't have to be a 20-page document, but it has to be a set of actions you agree to and actually implement," Donovan says.
Focus on the first three years Physicians are at the highest risk of leaving during their first three years at a new practice. In fact, roughly 46% of newly hired recruits will "fail" within 18 months, Donovan says, adding that "communication is key" to keeping newly hired physicians content and engaged. Provide physicians with answers to the following questions upon hiring and throughout the first few months:
Where is the organization going?
How do you expect me to contribute?
How am I doing?
How do I improve my skills?
"Communication starts with mentorship or mentors, but it goes all the way up to the highest level of the organization and meeting at set intervals," Donovan says.
This story was adapted from one that first appeared in the March edition of Physician Compensation & Recruitment, a monthly publication by HealthLeaders Media.
The quality and patient satisfaction ratings of local hospitals were all over the pages of newspapers earlier this week, after CMS released the long-awaited results of its Hospital Consumer Assessment of Healthcare Providers and Systems survey. The story made The New York Times and other high profile news outlets, spurring consumer interest in how their local hospitals fared in the survey. For consumers, it's new, it's fresh, and they're interested.
But for most quality directors, the numbers posted on the Hospital Compare site are old news. That's what Derrick Suehs, chief quality officer for Syracuse, NY's Crouse Hospital told me earlier this week. The data posted on the Hospital Compare site was taken from surveys completed between October 2006 and June 2007. That's a lot of time for a lot of changes to take place at a hospital--and Suehs says Crouse has already addressed the areas where Hospital Compare's results say it is lacking.
Internally, Suehs says his challenge is to make sure that hospital employees don't get caught up in the newly-posted numbers, but instead, continue to work at providing safe and quality care for all patients. But with newspapers and other media outlets talking about HCAHPS and the Hospital Compare site, how do you keep potential patients from getting caught up in the numbers posted there?
"It is important that the hospital explain to the public how the information and data is collected and reported--and in this case, through HCAHPS--without being defensive," says Suehs.
The best way to do this is to be transparent. Use your hospital's Web site to take ownership of your data and present the most current statistics with an explanation of where the numbers came from. Like many hospitals, Crouse partners with a survey vendor that gives them more immediate results of patient satisfaction data--long before it is posted on the Hospital Compare site. By using data that is days--instead of months--old, Crouse has been able to address areas where it is lacking and make improvements, but on Hospital Compare patients won't see that for several months--until the next HCAHPS results are posted.
"We emphasize what our current results are and what we're doing to continuously improve. We back our claims with simple, but statistically valid numbers and visuals that the general public can understand," Suehs says.
If you can see the current data, let your patients see it as well. Share with them the progress you're making and provide the information they're looking for when choosing a hospital. Give them a short explanation of why the data is different and the work your organization has been doing to make the numbers stronger.
CMS has brought patient satisfaction information into the public eye, and now, as quality directors, we need to take charge of how our hospital is seen by the public and do our best to make sure that our hospital does its best to communicate information to those inside and outside the hospital. If your hospital isn't yet "owning" its information and how it is presented, the time is now.
California's Sonoma Valley Hospital is fighting infections with the use of telemedicine. The hospital is partnering with UC Davis Medical Center to allow staff at Sonoma Valley to get expert opinion on infection cases using the state of the art technology. Using new technology and an Internet hookup, Sonoma Valley staff can instantly contact a physician at UC Davis, who then can use a camera and monitor to see the problem and offer advice in real time.
California health investigators have found no health violations in an inspection of Fresno-based Saint Agnes Medical Center following an infection outbreak in the hospital's cardiac surgery unit. At least 12 Saint Agnes patients contracted life-threatening bacterial infections between January 2007 and September 2007. Hospital officials said the infection rate returned to normal since then, and current patients are not at risk for infections.
A Rhode Island bill requiring hospitals to report all hospital-borne infections within 72 hours is moving swiftly through the General Assembly. The bill's sponsor, Hanna M. Gallo, said she was inundated with e-mails and phone calls from Rhode Islanders with stories about friends and loved ones who acquired devastating infections or complications as the result of hospital stays. There are those who question the bill's effectiveness, however, saying it could divert resources away from battling infections in the hospitals themselves.
During a recent visit to Boston, U.S. Secretary of Health and Human Services Michael O. Leavitt said the increasing number of incentives to provide more and more procedures is the largest contributor to rising health costs. To help streamline costs, Leavitt said the country needs a central billing system monetary quality incentives.
Lisa McGiffert, an analyst for Consumers Union is criticizing Iowa's idea of letting a private group cofounded by the Iowa Hospital Association handle patient safety data instead of having government officials do it. The proposal would require hospitals to report patient-safety and pricing information to a group called the Iowa Healthcare Collaborative. The Collaborative was founded by the Iowa Hospital Association and the Iowa Medical Society, and McGiffert says she is concerned the data may be biased as a result.
Regence BlueCross BlueShield of Utah is asking patients to anonymously rate their doctors' bedside manner and things like ease of parking and check-in efficiency on a scale of 1 to 5. Those scores have been available online, and soon customers will be able to post comments about their experiences at the insurer's Web site.
A Wall Street Journal Online/Harris Interactive Health-Care Poll shows most adults favor the use of patient satisfaction surveys to determine healthcare quality above all other quality measures. Of those surveyed, more than half said it is also fair to measure healthcare quality based on the use of electronic medical records.
