Background: Hospitalist groups must be able to respond to unexpected staff absences due to sick calls, personal emergencies, and unanticipated leave, all of which have substantially increased since the 2020 coronavirus pandemic. They also need to be able to respond to ongoing fluctuations in census related to seasonal respiratory viral surges, as well as institutional and regional capacity constraints. As hospitalist groups grow and add new services lines that require specialization–for example, Hospital at Home or procedural hospitalists—responding to these challenges can be time-consuming and difficult for group members to navigate through written policies and expectations alone. While most groups have medical directors, being on call daily for these types of issues can be burdensome and unsustainable.
Purpose: Our intent was to establish a single point of contact with the authority to render staffing and policy decisions in real time, removing this responsibility from the hospitalists currently on service, who may not have the operational knowledge nor bandwidth to address. Our academic hospitalist group developed the Leader on Call (LOC) role to troubleshoot unexpected staffing, capacity, and logistical issues.
Description: The LOC was implemented in January 2023. Eight members of our Division agreed to serve in the role on a rotating basis and a written standard work document was developed to orient people to the role. Our group has a robust online policy manual that was also available to guide decision making. In an effort to avoid bothering hospitalists not on service, the LOC creates a daily chat in Microsoft Teams as a means of providing standardized communication regarding census and staffing and as a point of escalation for urgent issues that arise throughout the day. The LOC schedule is aligned with individuals’ clinical schedules to minimize impact on time spent outside of work. In our annual Wellness Survey, 83% of faculty members answered “Agree” or “Strongly Agree” that the LOC reduces their stress around high census and scheduling issues. Survey responses also confirmed that it increased hospitalist perception that leadership is supportive of group concerns and potential sources of burnout. While some leadership team members have dedicated administrative FTE, other hospitalists volunteer to serve in this role due to the positive impact on the group.
Conclusions: Implementation of a Leader on Call role can help hospitalist groups respond to staffing and capacity challenges in real time. Having a designated LOC can have a positive impact on hospitalist wellness by reducing the stress providers feel related to these challenges, and sharing this role among a number of individuals minimizes the burden on a single medical director. Lastly, developing written standard work allows rapid onboarding for new LOCs.