Mark Williams Advocates Change Through Hospitalists

Watch a video of the seminar here.

They’ve infiltrated hospitals – more than 68 percent have them – and they’ve infiltrated popular culture: TV physician Dr. Oz. recommends that hospital patients “get to know you’re hospitalist” as part of his patient checklist.

But what exactly are hospitalists?

They – along with engineers – may be a key factor in healthcare reform, said Mark Williams, professor and chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine, who spoke to faculty and students on May 3 as part of McCormick’s Dean’s Seminar Series.

“I’d like to think of hospitalists as innovators in changing care delivery,” he said. “(And) engineers can help deliver better care to patients.”

Hospitalists are filling a need that began to evolve nearly 50 years ago, with the creation of government-funded healthcare. When President Lyndon Johnson signed Medicare into law in 1964, it was as simple as checking a box on a social security card. For the first decade, expenses remained relatively flat – the average annual cost of healthcare per U.S. resident in 1970 was $356.

But soon that cost began to rise exponentially: today we spend about $8,000 per resident on healthcare – more than double what countries with a similar life expectancy pay. The budget for Medicare and Medicaid has eclipsed the national defense budget.

Healthcare reform has begun to address these issues: hospitals will soon have their payments cut by 1 percent if they don’t meet quality of care standards and if they have excessive readmission rates (one study showed that one in five Medicare patients are rehospitalized with 30 days).

But hospitals don’t often have enough incentive to reduce admission rates. Children’s Hospital of Boston, for example, created an asthma prevention program that gave each patient a vacuum cleaner with a HEPA filter to trap dust and allergens. That helped reduced emergency room visits by 62 percent and saved families $1,300 per child – but that savings was not passed onto the hospital.

“The hospital lost money,” Williams said. “(Doctors) have been getting paid to do things to patients.”

So what’s the answer? One possibility are hospitalists; physicians who work only in hospitals and act as transition coordinators and case managers for patients. Hospitalists are not the patient’s doctor; rather, they coordinate quality and safety, bed management, hospital residents, and patient transitions.

Williams established the first hospitalist program at a public hospital in 1998 and leads one of the largest academic hospitalist programs in the United States. As part of the program, he helped implement better communication among doctors and nurses with “structured interdisciplinary rounds” that created teams of staff on each floor. The teams used checklists for each patient, which ultimately resulted in a 50 percent decrease in adverse events.

“It resulted in better patient outcomes,” Williams said. “We love this teamwork approach.”

Williams, who worked in a gas station for nine years, said he has always been struck by inefficiencies in hospitals.

“That frustration has driven me to try to effect changes,” he said. In addition to the hospitalist program, he has worked with Sanjay Mehrotra, professor of industrial engineering and management sciences, to study how to more efficiently manage hospital resources.

“Engineers can bring a fresh pair of eyes” to make the process more efficient, Williams said, and hospitalists can help effect that change.

“Hospitalists tend to reduce length of stay and overall costs,” he said. “They begin to understand the system…and become experts at delivering care.”