The COVID-19 pandemic placed incredible stress on the entire U.S. healthcare system—the need to care for patients hospitalized with a novel infectious disease, displacing elective surgical patients, and keeping “regular” medical patients’ home—creating workforce and capacity mismatches. Limited personal protective equipment at the outset of the pandemic also necessitated changes in how clinicians were deployed. Although hospitalists across the country have long been involved in addressing healthcare systems challenges, COVID-19 suddenly placed them at the fore of a rapidly evolving pandemic response, including being tasked with developing workforce plans involving clinicians both within and outside of hospital medicine. We aim to describe what we learned from engaging with hospitalists nationwide.
Given the persistent strains on the acute care system, we believe the hospitalist operational and clinical skillset is instrumental to the agile and continuous development of hospital workforce plans. We propose a conceptual framework illustrating the relationships among skillset, innovation, and system constraints that should be considered when anticipating needs for workforce planning, deployment, and adaptation.
The Hospital Medicine Reengineering Network (HOMERuN), a collaborative research network of academic hospitalists, quickly mobilized at the outset of the pandemic to focus on dissemination of knowledge and learnings regarding effective pandemic responses. Several workgroups were formed, including groups focused on discharge criteria, physician and advanced practice provider wellness and support, medical education, clinical pathways, and workforce adaptations among others. Our workgroup, composed of 11 hospitalists from eight U.S. academic medical centers, surveyed colleagues nationwide to learn what inpatient workforce adaptations were being implemented and compiled surge plans and training manuals disseminated to non-hospitalist clinicians newly working in the inpatient setting. Follow-up focus groups and surveys also permitted tracking of staffing changes and operational practices as cases surged and receded. Virtual meetings, newsletters, and publications were used to share findings with hospitalists registered with HOMERuN.1
Through this work, we saw some commonalities in responses to the first wave of patients, such as patient cohorting and hospitalist supervision of specialists and advanced care providers who were newly working in an inpatient general medicine clinical setting. Although there were similar workforce adaptations deployed by hospitals across the country, we saw however even greater evidence of the need for unique planning in each health system. Contextual differences in factors including clinical staff availability, regulations around involvement of learners in COVID-19 care, and the physical environment across hospitals limited the wholesale application of uniform effective solutions from one institution to another without significant local adaptation.
Regardless of the adaptations put in place by a given institution, we observed that hospitalists were integral to making operational decisions, serving as leaders of workgroups, and overseeing daily communication and collaboration across complex health system networks. These observations reinforced the importance of hospitalists and their skillsets, balancing dual roles as front-line clinicians and operational leaders. Systems knowledge and systems process improvement have always been central to hospitalist work.2-4 Hospitalists were uniquely positioned to lead the response to COVID-19 due to a deeply embedded understanding of the inpatient clinical context, navigating the inpatient setting to deliver care efficiently and safely to patients, accessing and utilizing system-wide resources, engaging in real-time, rapid process improvement, collaborating across clinical roles, and navigating communication channels.
- Linker A KS, Astik G, Keniston A, et al. Bracing for the wave: A multi-institutional survey analysis of inpatient workforce adaptations in the first phase of COVID-19. J Gen Intern Med. 2021 May 28;1-6. doi: 10.1007/s11606-021-06697-6. Online ahead of print.
- Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335(7):514-517.
- Wachter RM, Goldman L. Zero to 50,000—The 20th anniversary of the Hospitalist. N Engl J Med. 2016;375(11):1009-1011.
- The core competencies in hospital medicine: A framework for curriculum development by the Society of Hospital Medicine. J Hosp Med. 2006;1:2-95.
- Leykum LK, O’Leary K. Annals for hospitalists inpatient notes—Sensemaking: Fostering a shared understanding in clinical teams. Ann Intern Med. 2017;167(4):Ho2-ho3.
COVID-19, Hospital-based Medicine, Leadership, Administration, & Career Planning, Medical Education, Research, SGIM
All authors are members of the Hospital Medicine Reengineering Network (HOMERuN) COVID-19 Collaborative Workforce Planning workgroup—more information is available at https://www.hospitalinnovate.org/covid19/.
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