Workload Balancing by Ryan Secan, MD

I’d like to take a quick break from our series on physician inertia to discuss one of the more interesting things I’ve learned exhibiting at SHM Leadership Academy taking place right now in Nashville.  At this gathering, hospitalist leaders from around the country get together to learn about the challenges facing hospital medicine, and how they can better respond to these issues.

One of the challenges these hospitalist leaders are facing is patient assignment.  This is a difficult, manual process at most institutions that is resource intense, and yields results that are far from optimal.  As I’ve discussed this with many attendees (one of whom called the assignment process “the bane of my existence”), one aspect that seems to be on everyone’s mind is workload balancing.   Through Assign, we’ve been doing workload balancing beyond just keeping an even head count for all providers and following hard caps.  However, we’re always looking to improve the process, and we’re now beginning to learn from our experience with nurses.

Just as hospitalist leaders need to assign patients to every provider every shift, charge nurses on each nursing station have to assign patients to each nurse – and they have to continue to manage patients coming onto and leaving the unit.  A key piece of this process involves an acuity tool.  Something that measures how much work the patient requires for the nurse to properly care for them.  This goes beyond just how sick they are, but measures workload for the nurse.  Things like incontinence, fall risk, multiple IV medications, delirium, and so forth.  What seems to be on everyone’s mind here at SHM, is how we could potentially do something similar for providers.  Not just how sick patients are (there are plenty of morbidity calculators available for this sort of thing), but how much work the providers must do to manage the patient for the day.  It’s clearly of interest to forward thinking hospitalist leaders, and I’m hopeful that we can make a big impact on hospitalists and patient care by getting a handle on this complicated issue

It’s been great having so many interesting conversations here in Nashville today, and I’m really looking forward to seeing what tomorrow brings.

If you have any ideas you’d like to share about measuring provider workload, email me