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. 2023 Aug 1;6(8):e2328165.
doi: 10.1001/jamanetworkopen.2023.28165.

Salient Measures of Hospitalist Workload

Marisha Burden  1 , Lauren McBeth  1 , Angela Keniston  1
Affiliations

Salient Measures of Hospitalist Workload

Marisha Burden et al. JAMA Netw Open. .

Abstract

Importance: The ideal hospitalist workload and optimal way to measure it are not well understood.

Objective: To obtain expert consensus on the salient measures of hospitalist workload.

Design, setting, and participants: This qualitative study used a 3-round Delphi technique between April 5 and July 13, 2022, involving national experts within and external to the field. Experts included hospitalist clinicians, leaders, and administrators, as well as researchers with expertise in human factors engineering and cognitive load theory.

Main outcomes and measures: Three rounds of surveys were conducted, during which participants provided input on the salient measures of hospitalist workload across various domains. In the first round, free-text data collected from the surveys were analyzed using a directed qualitative content approach. In the second and third rounds, participants rated each measure's relevance on a Likert scale, and consensus was evaluated using the IQR. Percentage agreement was also calculated.

Results: Seventeen individuals from 14 organizations, encompassing clinicians, leaders, administrators, and researchers, participated in 3 rounds of surveys. In round 1, participants provided 135 unique qualitative comments across 10 domains, with 192 unique measures identified. Of the 192 measures presented in the second round, 6 (3%) were considered highly relevant, and 25 (13%) were considered moderately relevant. In round 3, 161 measures not meeting consensus were evaluated, with 25 (16%) considered highly relevant and 95 (59%) considered moderately relevant. Examples of measures considered highly relevant included a patient complexity score and outcome measures such as savings from hospital days avoided and clinician turnover.

Conclusions and relevance: In this qualitative study measuring hospitalist workload, multiple measures, including those quantifying work demands and the association of those demands with outcomes, were considered relevant for measuring and understanding workloads. The findings suggest that relying on traditional measures, such as productivity-related measures and financial measures, may offer an incomplete understanding of workloads and their association with key outcomes. By embracing a broader range of measures, organizations may be able to better capture the complexity and nuances of hospitalist work demands and their outcomes on clinicians, patients, and organizations.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Burden and Keniston reported receiving grants from the Agency for Healthcare Research and Quality not related to this work and having a trademark for an app-based application in development called GrittyWork, which measures perception of workload. No other disclosures were reported.

Figures

Figure.
Figure.. Delphi Flowchart
See this image and copyright information in PMC

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