January 25, 2017

Five Steps to be More Productive at Your Hospital

By
This is the start of my third year as a physician advisor, after leaving a decade of clinical medicine as a pediatric hospitalist.  Moving from a career I essentially prepared for my entire adult life, into a career I did not even know existed the month before I was hired, has been quite a ride.  Throw in the fact that I moved from a health system where I’d trained as a medical student (i.e., I already knew most of the physicians as former attendings when I joined them as a peer,) to a system in another state (i.e., I didn’t know a soul,) and you can say I’ve learned a thing or two.  So, for all of you– listen up. 

ONE – Take Control of Your Calendar 

When you get good at your job, (which, yes, you will one day recognize as fact,) lots of folks are going to notice.  Suddenly, everyone wants you at the table to help solve problems, brainstorm new policies, and identify how to improve upon existing processes.  This is a good thing.  But, it can also sabotage your schedule.  I found myself persistently faced with eight-hour days filled with five hours of meetings and a handful of 30-minute breaks in-between.  It got to the point that the meetings, which inevitably led to more projects I needed time to focus on and work out, were getting in the way of having any time to COMPLETE said projects.  One day, it occurred to me that I needed to schedule my own meetings – meetings with me, myself, and I – to get work done.  Every day, I block off two consecutive hours of time so I know I have at least that protected.  If I receive a meeting invite at that time, and there is another block I can move my “office hours” to, I do it.  If not, I decline the meeting and ask for it to be re-scheduled.  Do yourself a favor and block out your own office hours in 2017, now.

TWO – Trust Your Spidey Senses 

Recognize that there are many who seem knowledgeable, but don’t fully grasp the concepts at hand.  This is particularly important when you are new to the work involving the Centers for Medicare & Medicaid Services (CMS) rules and regulations, private payer games, and the world of clinical documentation improvement.  If you are the first physician advisor in your health system, there certainly are a handful of individuals who were grappling part-time with the issues you are now taking on at full-speed.  While you grow into your role, you will learn a great deal from these individuals.  But, at some point, your knowledge base will surpass theirs because, well, that’s your job.  When you first come to realize this, you will be filled with self-doubt.  You will be unsure of yourself, and might try to push away the nagging feeling at the back of your mind that your assessment of the situation is right, and theirs is not quite hitting the mark.  Ignore this feeling.  Do your double and triple-checking online (CMS.gov, RACMonitor.com, ACPAdvisors.org, ABQAURP.org, etc.) and in the literature, perhaps run your train of thought by your hundreds of adopted kin on the RAC Relief listserv, and then present your argument with authority.  You’ve got this!

THREE – Assign Time for Projects 

Similar to number one, this is another time-management trick I learned last year.  Faced with a growing list of problems I needed to address, opportunities I wanted to pursue, and ideas I wished to flesh-out, things were getting out of hand.  You can easily feel excited about all of the good you can accomplish and the great things that will come of the work, but when faced with a growing list that rarely has anything checked off, it’s easy to become discouraged.  Assigning blocks of time in my schedule to address single items on my list made all the difference in the world.  Instead of hoping I will eventually have enough time to get around to things, now I receive regular pop-up reminders to take an hour or two to address this issue or that.

FOUR – Take Road Trips

The amount of information you need to disseminate on a regular basis to providers throughout your health system can be daunting.  Unless you work in a hospital that features a full breakfast spread and gourmet short-order chef at lunchtime in the med staff lounge, (I have heard these places actually exist,) you’ve learned you won’t have much luck regularly happening upon your docs there.  While e-mail, electronic health record messages, and even snail mail are a staple part of communication, I’ve found there’s simply nothing as impactful as delivering your message in person.  Granted, if you drive off to a physician’s office every time you need to explain why Inpatient billing isn’t supported in the documentation for a specific patient, you’ll never get anything else done. 

But, when rolling out big initiatives, presenting compliance concepts that really need to be understood, or illustrating changes in practice or workflow, scheduling a barrage of road trips makes a difference.  Yes, it takes a ton of time.  And, especially this time of the year in southeastern Wisconsin, I want to hustle my butt out into the frigid weather as infrequently as possible.  However, physicians really do seem to appreciate the opportunity for some face time.  They get to hear from me directly what they need to know, and best yet – I can immediately answer any questions or clarify any misconceptions they may have.  In the end, it’s a win-win.

FIVE – Keep Balls from Dropping 

Has this ever happened to you?  You have a productive meeting about a specific topic, or exchange a constructive series of e-mails.  The next step involves others obtaining more information, or formulating some conclusions before the work can proceed.  Suddenly, it’s two months later and while walking back from the restroom, it hits you.   What the heck happened with that topic?  Wait…did anyone ever get back to you?  Damnit.  Now, whenever I’ve asked about something, or I’m waiting for follow-up, even if it’s a simple thing, I add a reminder a few days or a week in the future in my calendar.  This way, I don’t lose track, I keep tabs on everything, and progress is no longer stymied by my memory. 

Organization, investigation, confidence, and face time.  Try investing in these things this year and see what happens!  I think you’ll find yourself happier, more productive, and ready for whatever the industry throws at you. 

Good luck!
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Juliet B. Ugarte Hopkins, MD, CHCQM

Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV, is a physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. Dr. Ugarte Hopkins practiced as a pediatric hospitalist for a decade. She was also medical director of pediatric hospital medicine and vice chair of pediatrics in Northern Illinois before transitioning into her current role. She is the first physician board member for the Wisconsin chapter of the American Case Management Association (ACMA), a member of the RACmonitor editorial board, and a member of the board of directors for the American College of Physician Advisors (ACPA). Dr. Ugarte Hopkins also makes frequent appearances on Monitor Mondays.