Six Essentials for Directors of New Hospitalist Programs

By Nagendra Gupta, MD
December 12, 2018

Implementing a program can be challenging for even experienced leaders. Having a detailed strategy can foster a successful outcome.

Implementing a hospitalist program can be a daunting task, even for seasoned medical directors. It involves not just lots of hard work and planning, but also meticulous attention to detail.

Much of the initial stress can be alleviated if a strategic plan is created and followed.

The biggest factor for determining the success and longevity of a program is camaraderie among the physicians.

Depending upon the program, numerous things can play important roles in getting a good start. But knowing these six crucial things when starting with a program can make a huge difference to the outcome — and can have a direct impact on how your next 12 to 18 months will be spent.

Know your team. The biggest factor for determining the success and longevity of a program is camaraderie among the physicians. As a director, it’s your responsibility to develop a sense of friendliness and mutual trust among colleagues. This increases team morale and, in turn, helps shape the culture of the program into one of excellence.

Legendary automobile industrialist Henry Ford once said, “Coming together is the beginning. Keeping together is progress. Working together is success.” No other saying exemplifies the importance of team-building better than this.

Know your goals. The fact that a new program is being brought in means that an existing program or a team is being replaced. Usually, the reasons for such a change have nothing to do with the clinical part of the work. So, what is it the hospital wants? What exactly are you expected to accomplish that the previous team was not able to do?

A candid discussion with your leaders about the metrics that matter the most to them is vital. For most hospitals, these usually center around length of stay, core measures and patient satisfaction scores in some form. It is important to know where the hospital stands on each of these metrics; this will help determine where you intend to go — and how quickly.

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Know your EMR. A good electronic medical record can be a hospitalist’s best friend, especially when mastered and used well. (Those of us who have switched from any other EMR to Epic can vouch for this.) As a director, it is even more important for you to master the EMR for reasons beyond good documentation and ease of order entry.

For example, creating a simplified manner of assigning patients in the morning that not only adheres to a unit-based protocol but also divides them equally would be nice. Getting this smoothly done by 7 a.m. would be even better. And being able to delegate this task to a nonphysician support staff would be icing on the cake. This can help you preserve those precious morning minutes for more important tasks.

Know your people. This includes everyone in the hospital with whom you will be working, such as nursing leaders, department heads, patient advocates and social workers. With a new program, you likely will experience issues you need help with, and contacting the right person can solve the problem without getting rerouted through multiple channels. 

Know your hospital. Most of us would not take this idea seriously. However, knowing the facility’s layout is not just about navigating the labyrinth of corridors or discovering the restroom locations. It is about understanding the way units are laid out, so unit-based rounding can be implemented — especially in larger programs. This simple strategy saves time for hospitalists and contributes to vastly improved patient and nursing satisfaction. 

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Know your patients. It is important to have a good understanding of demographics. This includes cultural differences and the payer mix, which can help directors gain a better understanding of the patient population. That, in turn, helps directors understand the barriers they might encounter to timely discharges.


Every hospital is different. Likewise, every hospitalist program is different. Starting a program is not a one-size-fits-all scenario, but a framework applicable to most programs can be created using these six suggestions.

This helps create the potential to convert an average program into a successful program. Consider these building blocks that can be used to lay a strong foundation. Create the culture you wish to imbibe, right from day one. 

Nagendra Gupta, MD, is medical director of the hospitalist program at Texas Health Arlington Memorial Hospital, a full-time practicing hospitalist and board-certified in internal medicine.

Topics: Management

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