The Domains of Hospitalist Satisfaction
In the article, Job characteristics, satisfaction, and burnout across hospitalist practice models by Hinami, et. al., there is a discussion of the "domains" of physician/employee satisfaction, which conveys the multi-dimensional nature of the concept. The domains identified in the article are as follows:
Engagement vs. Satisfaction Among Hospital Teams (Rick Blizzard, D.B.A.; Health and Healthcare Editor, Gallup Healthcare). This article discusses the difference between employee/clinician satisfaction and engagement. "Gallup research shows that both employee engagement and employee satisfaction relate to meaningful outcomes. However, satisfaction is a broad, attitudinal outcome, like organizational loyalty or pride. It is hard to act on... Engaged employees are psychologically committed to their work, go above and beyond their basic job expectations, and want to play a key role in fulfilling the mission of their organizations... only 28% of U.S. employees are engaged in their jobs, while 17% are actively disengaged..."
Hospitalist Satisfaction/Engagement - Intervening for Improvement
A key issue for hospital medicine group (HMG) leaders seeking to intervene and improve the satisfaction and/or engagement of their hospitalists is recognizing which issues are at the group/practice level and which issues are at the larger organizational level. There are limits to what an HMG leader can improve if the sources of dissatisfaction/disengagement relate to higher level issues that can only be solved by the larger organization (i.e., the hospital, the health system, the management company, etc.)
A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction, December 2006
This monograph prepared by an SHM task force outlines the issues related to hospitalist satisfaction and a survey tool for assessing "job fit" for hospitalists. A framework is described consisting of four "pillars" 1) rewards and recognition; 2) workload and schedule; 3) autonomy and control; and 4) community and environment.
A Roadmap for Trust: Enhancing Physician Engagement This white paper written by Amer Kaissi for the Regina Qu'Appelle Health Region (RQHR) in Canada "summarizes the evidence on physician engagement, drawing on peer reviewed articles and reports from the grey literature, and suggests an integrative framework to help healthcare managers better understand and improve physician engagement.
There are a wide range of measurement tools and vendors addressing physician satisfaction and engagement. Below is a representative list identified through a web search. It is not an exhaustive list. The list appears in alphabetical order.
In addition, SHM’s Practice Management Committee has established a 2014 goal to create a "public domain" questionnaire using existing survey tools and scientific literature that Hospital Medicine Groups can use to measure Hospitalist Engagement.
The Advisory Board has developed a program called the Physician Engagement Initiative which "pairs a rigorous and action-oriented survey platform with a suite of change management resources to engage physicians in improving organizational performance and advancing strategic goals."
American Medical Group Association (AMGA) Provider Satisfaction Benchmarking Program "provides the opportunity to assess just how satisfied your providers are, using a multidimensional survey that reflects the complexity of their work lives. Built using core principles of survey design and of psychometrics, and tested among medical groups throughout the country, the survey instrument is easy to administer and consistently produces high response rates."
Avatar Physician Surveys "Avatar is the American Hospital Association's exclusively-endorsed provider for Employee / Exit Surveys and Physician Engagement / Satisfaction Surveys to their 5,000 hospitals and healthcare systems."
HealthStream Physician Insights Survey "Knowing how physicians think and feel about your organization is critical to your success. Use our industry leading tools to maximize physician engagement and satisfaction with all of the resources and survey data that you need to build better relationships and increase physician alignment."
INTEGRATED Healthcare Strategies physician surveys "have been developed to measure the opinions of different physician groups associated with an organization including employed physicians, the volunteer medical staff, and referring physicians who rarely visit the hospital."
PRC Physician Readiness Study "will allow you to measure: 1) Medical home certification; 2) How best to assist physicians with transformation; 3) Utilization of EMR systems, clinical integration, patient portals and care coordination; and 4) Physician engagement"
Press Ganey Physician Voice Survey "Strong physician engagement and alignment can lead to better patient experiences and quality of patient care. Conversely, when physicians leave, become disengaged or are not aligned with the organization’s mission, vision, and values, the impact can be felt throughout the care delivery process. Organizations that meaningfully engage and collaborate with physicians and physician leadership are on the most direct path to deliver exceptional patient experiences and outcomes."
U.S. physician satisfaction: a systematic review (Citation: J Hosp Med. 2009 Nov;4(9):560-8. doi: 10.1002/jhm.496.) From the abstract: "The purpose of this article is to systematically review the literature on US physician satisfaction... After exclusions by 2 independent reviewers, 97 articles were included... Physician satisfaction was relatively stable, with small decreases primarily among primary care physicians (PCPs). The major pertinent mediating factors of satisfaction for hospitalists include both physician factors (age and specialty), and job factors (job demands, job control, collegial support, income, and incentives)."
Job characteristics, satisfaction, and burnout across hospitalist practice models(Citation: J Hosp Med. 2012 May-Jun;7(5):402-10. doi: 10.1002/jhm.1907. Epub 2012 Jan 23.) From the abstract: "We administered the Hospitalist Worklife Survey to a randomized stratified sample of 3105 potential hospitalists and 662 hospitalist members of 3 multistate hospitalist companies. Details about respondents' hospitalist group characteristics, their work patterns, and satisfaction with 2 global and 11 domain measures were assessed. Factors influencing job satisfaction were also solicited. These factors, job characteristics, job satisfaction, and burnout were compared across predefined practice models... Work patterns, compensation, and hospitalists' priorities varied significantly across practice models. Overall job satisfaction and burnout were similar across models, despite these differences."
Person-job fit: an exploratory cross-sectional analysis of hospitalists (Citation: J Hosp Med. 2013 Feb;8(2):96-101. doi: 10.1002/jhm.1995. Epub 2012 Nov 20.) From the abstract: "Job attrition and reselection improved job fit among hospitalists entering the job market. Better job fit was achieved through hospitalists engaging a variety of personal skills and abilities in their jobs. Job fit increased with time together with socialization and internalization of organizational values. Hospitalists with higher job fit felt they performed better in their jobs... Features of person-job fit for hospitalists conformed to what have been observed in non-physician workforces. Person-job fit may be a useful complementary survey measure related to job satisfaction but with a greater focus on function."
Worklife and satisfaction of hospitalists: toward flourishing careers (Citation: J Gen Intern Med. 2012 Jan;27(1):28-36. doi: 10.1007/s11606-011-1780-z. Epub 2011 Jul 20.) From the abstract: "Hospitalists were most satisfied with the quality of care they provided and relationships with staff and colleagues. They were least satisfied with organizational climate, autonomy, compensation, and availability of personal time. In adjusted analysis, satisfaction with organizational climate, quality of care provided, organizational fairness, personal time, relationship with leader, compensation, and relationship with patients predicted job satisfaction. Satisfaction with personal time, care quality, patient relationships, staff relationships, and compensation predicted specialty satisfaction. Job burnout symptoms were reported by 29.9% of respondents who were more likely to leave and reduce work effort."
Factors impacting career satisfaction of hospitalists (Citation: Health Care Manag (Frederick). 2012 Oct-Dec;31(4):351-6. doi: 10.1097/HCM.0b013e31826fe340.) From the abstract: "Results suggested that 41% of hospitalists were very satisfied with their careers in medicine...It was concluded that perceived quality of care, presence of formal written guidelines, gender, and race were major predictors of career satisfaction of hospitalists."
Career satisfaction and the role of mentorship: a survey of pediatric hospitalists (Citation: Hosp Pediatr. 2012 Jul;2(3):141-8.) From the abstract: "Although surveyed hospitalists have substantial overall career satisfaction, lack of mentorship is a significant problem that spans the demographic spectrum. Establishing a mentorship program may be an effective way for hospitalist groups to improve satisfaction."
Association between practice setting and pediatric hospitalist career satisfaction(Citation: Hosp Pediatr. 2013 Jul;3(3):285-91.) From the abstract: "The goal of this study was to determine whether practice in a community versus academic setting is associated with pediatric hospitalists' career satisfaction...The study was based on data from an anonymous electronic cross-sectional survey sent to the American Academy of Pediatrics Section on Hospital Medicine Listserv ... Pediatric hospitalists practicing in academic settings seem more likely to be satisfied with their careers than those in a community hospital."
Career Satisfaction and Burnout in Academic Hospital Medicine (Citation: Arch Intern Med. 2011;171(8):782-790. doi:10.1001/archinternmed.2011.153.) From the article: "Our data confirm known causes of burnout (eg, lack of control over work schedule) but suggest additional potential associations, such as lack of division chief support. While we observed that low satisfaction and burnout were associated with lower academic productivity, we cannot discern the causal link between these factors. However, we are able to develop a picture of an "at risk academic hospitalist," as one who has fewer peer-reviewed publications, lower confidence in their teaching skills, and a lower likelihood of having presented institutional grand rounds."
The State of Staff Physician Engagement: 2011 in Review Based on an analysis of more than 1.4 million survey responses from physicians in 2011, the physician engagement score was 4.12, compared with the 2010 average of 4.17. This article cites 20 key findings from the 2011 survey, including survey items physicians rated highest and lowest.
Hospitalist Case Studies in Career Satisfaction This 75-minute digital (audio and video) recording from SHM's annual conference in 2008 outlines three case studies that contain concrete lessons for hospitalist leaders interested in addressing physician satisfaction issues in their practice.
SHM Career Center This on-line job board provides extensive resources and capabilities for organizations employing hospitalists and for hospitalists seeking jobs. It is the industry's most comprehensive and expansive job board dedicated only to hospitalists.
Hospital Medicine Exchange (HMX) This is SHM’s social networking platform which has offers multiple e-communities in which hospitalists share ideas with their peers. The topics of Hospitalist Satisfaction and Engagement have been widely discussed in the HMX Practice Management community and a range of practice profiles and other materials have been posted.