Background: Healthcare systems face challenges to meet the needs of a complex aging patient population, and simultaneously at risk of clinician burnout and loss of talent. Advancements in technology for clinical use have extended the reach of clinicians into patient homes, improving operational efficiency of Acute Care at Home programs, as well as patient and clinician experience. The HealthPartners Hospital@Home (H@H) team has cared for more than 650 patients in private homes, utilizing hospitalists as the primary clinicians. We present qualitative findings from a survey of hospitalists engaged in the H@H program suggesting increased job satisfaction, engagement and renewed meaning in work.
Purpose: 1. Introduce the idea of a creating mobile acute care team who can partner with hospitalists to carry out safe, effective method for acute care delivery in patient homes.2. Share key reflections in fostering a cohesive team, with patient and provider experience at its core3. Illustrate that implementation of the Acute Care at Home model (Hospital@Home) can improve job satisfaction and engagement of clinicians.
Description: The HealthPartners H@H team cares for acutely ill patients across the Twin Cities metro area of Minnesota. The team consists of a mobile care team with lab, imaging and RPM capabilities, partnering with a team of hospitalists for medical decision making. The program evolved rapidly since 2020, following the CMS Acute Hospital Care at Home waiver, and is now a hybrid clinical model for hospitalists, who carry a census of patients both in and out of the hospital. The program has provided an increase in hospital capacity of more than 2000 bed days and the development of a unique partnership between the Hospital Medicine and EMS teams.The simmering issue of clinician burnout also came to a boil during these years, with a dramatic decrease in satisfaction with work life integration in US physicians between 2020 and 2021. Engagement in the H@H model by hospitalists appears to have contributed to resiliency in this space. A qualitative survey of the HealthPartners hospital medicine group shows a stark difference in self-reported job satisfaction, engagement, and finding meaning in work with H@H program. Efforts in fostering healthy team dynamics, improving interdisciplinary communication, transparency and dedicated efforts in improving provider experience may be contributory to these findings. Additionally, there is an alchemy in seeing patients in their homes with a shifted power differential. These encounters can have unexpected richness and offer revealing – often humbling – glimpses into patient’s lives. This exposure provides insight into patients’ unique challenges, deepening the clinician/patient connection and renewed commitment to the mission. Given the association of physician burnout with quality of care, turnover, and reductions in work effort, these findings have profound implications for the health care system.Finding a blueprint to diversify the job description of hospital-based clinicians is key to sustainability of the team. Leveraging telemedicine to maximize efficiency to care for acutely ill patients outside of hospital walls, which in turn can improve job satisfaction, is a promising tactic.
Conclusions: Incorporating hospitalists into Acute Care at Home models of care not only helps to increase hospital capacity but may be a key to improving job satisfaction and engagement. It provides needed diversification of clinical work and help maximize strained healthcare systems.