Background: All hospitals strive for service excellence. In 2014, there were more than 40,000 hospitalists delivering the lion’s share of inpatient care in our nation’s hospitals. No empiric research has characterized hospitalist comportment and communication patterns as they care for patients so as to establish norms and expectations. We set out to establish a metric that would comprehensively assess hospitalist providers’ comportment and communication; one that could be used to assess performance in this realm for any patient encounter. We hypothesized that the resultant tool should be correlated with patient satisfaction measures such as Press-Ganey (PG).
Methods: The Chiefs of Hospital Medicine Divisions at five hospitals were asked to identify their best hospitalists. These hospitalists were observed during routine clinical care of patients. An observation tool was developed that focused on elements believed to be associated with excellent comportment and communication. One observer watched the physicians, taking detailed field notes and recording distinct behaviors. After several elements were removed because there was no variability, namely that behaviors were performed by all or no hospitalists, the final comportment & communication score (CCS) represented a composite of 23 observable behaviors. The CCS was calculated for each hospitalist for every patient encounter. The mean CCS of each provider was compared to their PG scores to evaluate the correlation between the two scores. The observer also rated the overall quality of care delivered at the end of each encounter.
Results: A total of 26 hospitalists were observed as they took care of patients. The mean age of the physicians was 38 years, 13 (50%) were female, and 16 (62%) were of non-white race. Each provider was observed with an average of 7 patients. The mean CCS was 61 (SD: 10.6), and these ranged from 37 to 80 across the providers. CCS and PG were moderately correlated (Pearson adjusted correlation 0.45, p-value 0.047). CCS was also substantially correlated with subjective overall quality score (Pearson adjusted correlation 0.71, p value 0.001).
Conclusions: This study represents a first step in trying to characterize comportment and communication in Hospital Medicine. Because hospitalists spend only a small proportion of their clinical time in direct patient care, it is imperative that excellent comportment and communication be established as a goal for every encounter.