Background: One hopes that all hospitals strive for service excellence, and by 2010 there were more than 30,000 hospitalists delivering the lion’s share of inpatient care in our nation’s hospitals. Although patient satisfaction metrics like Press Ganey attempt to measure service excellence, no empiric research has characterized optimal hospitalist comportment.
Methods: Respected clinicians in Hospital Medicine across five different hospitals were observed during their routine clinical care of patients. A data extraction sheet was developed which helped the observer to focus on their comportment as they took care of patients in the hospital. Detailed field notes, both quantitative and qualitative, were collected. A comportment score (CS) was calculated based on the quantitative data collected for each hospitalist during the patient encounters.
Results: A total of 26 hospitalists were shadowed. The mean age of the physicians was 38 years, and their average experience in hospital medicine was 6 years. The hospitalists were observed for a mean of 5 hours, during which time they saw an average of 7 patients (total number of patient encounters observed = 181). While the range of possible comportment scores was 37-80, the mean CS for the study population was 61 (SD: 10.6). The distribution of CS across hospital location, amount of clinical workload, age, gender of hospitalist, race, time observing hospitalist, amount of clinical experience, academic vs community setting was not significantly different when the hospitalists were categorized according to above or below the mean CS, all p >0.05. CS was found to be statistically significantly different in new patient encounters compared to follow-up encounters with known patients (68.1% with CS > 60 vs. 39.7% with CS <= 60, p < 0.05). Longer encounters (>13 minutes) were also associated with higher CS compared to shorter encounters, p < 0.05.
Conclusions: Assessing physician comportment to determine optimal behavior is challenging. This study represents a first step in trying to characterize comportment styles among hospitalists caring for inpatients. Future studies may assess the association between these behaviors and patient satisfaction, and whether those performing sub-optimally can be trained to do better.
To cite this abstract:Kotwal S, Torok H, Khaliq W, Landis R, Howell E, Wright S. Variability in Comportment Styles Among Respected Clinicians in Hospital Medicine. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. https://www.shmabstracts.com/abstract/variability-in-comportment-styles-among-respected-clinicians-in-hospital-medicine/. Accessed December 10, 2018.