CLINICAL EXCELLENCE IN HOSPITAL MEDICINE: A QUALITATIVE STUDY

Background: In 2016, there were more than 50,000 hospitalists working in the United States. The Society of Hospital Medicine (SHM) published ‘The Core Competencies in Hospital Medicine’ as a blueprint to standardize expectations of practicing hospitalists and to inform continuing medical education (CME) programs. We conducted a qualitative study to discover elements judged to be most pertinent to excellence in clinical care delivered by hospitalists. 

Methods: The Chiefs of Hospital Medicine Divisions at five different hospitals were asked to identify their “clinically excellent” hospitalists. One author scheduled a time to meet with each hospitalist physician to conduct a semi-structured interview. A qualitative study design was selected to allow themes to emerge that researchers did not anticipate. An interview guide was developed based on review of the existing literature on clinical excellence. All interviews were audio-recorded and transcribed verbatim. Coding, using an ‘editing analysis style’ that resulted in a coding template, was conducted by 2 authors. When coding decisions were discrepant, a third author was enlisted to facilitate consensus. After 18 interviews, the data were yielding confirmatory themes rather than novel ones (thematic saturation), yet other interviews were conducted. The final list of themes was sent to all informants and they unanimously agreed that the themes were representative of their perspectives about clinical excellence in hospital medicine (triangulation).

Results: A total of 26 hospitalists were interviewed. The interviews lasted 26 to 54 minutes – varying based on length of responses to probes. The mean age of the physicians was 38 years, 50% were female, and 62% were non-Caucasian. The table shows the seven themes that emerged that relate to clinical excellence in hospital medicine, the number of times each theme was mentioned, and the percentage of informants referring to the themes.

Conclusions: While competencies should be thought of as the threshold above which all must cross, this study’s result can inform the definition of clinical excellence in hospital medicine to which all should aspire. Establishing excellence as the definitive target, rather than competence, has significant implications for the professional developmental learning plans of hospitalists. Further, the commitment to clinical excellence may fundamentally influence how hospital medicine will be viewed by our colleagues in other specialties.

Table. Major themes related to clinical excellence in hospital medicine that emerged from interviews with the 26 hospitalist physician informants^* 

* Respondents were not queried specifically about these themes, and these counts represent spontaneous and unsolicited responses in each subcategory.