Leadership and Professional Development

As hospitalists, many of us see things in our daily practice that help inform our efforts to improve quality of care, organizational efficiency, and medical education, and to reduce physician burnout. But many of those efforts, while well intended, lack rigorous empirical evaluation.

Indeed, it is the complexity of hospital care that leads scholars across many disciplines—including economics, epidemiology, and sociology—to look to hospital medicine as a place where “natural experimentation” can inform us about what works and doesn’t work in medical care. As a hospitalist and economist, I find that the very best of my ideas come from what I see in the hospital. And for many hospital-based clinicians and physician leaders, translating everyday insights into rigorous scientific explorations is not only feasible but is a natural extension of the curiosity that drives good clinical work. It is also a way to drive quality improvement.

Consider, for example, a question that hospitalists face every day: when to discharge a patient from the hospital. Hospital leaders and frontline clinicians are increasingly under pressure to discharge patients earlier and earlier, with some concerned that earlier discharge poses safety risks. Short of randomizing patients to earlier discharge and studying the effects on outcomes, how can a data-driven hospital leader identify which patients can be safely discharged earlier and how much earlier?

A simple observation of a practicing hospitalist could be a clue to elegantly and rigorously answering this question. It turns out that some patients happen to be hospitalized days before their birthday and it wouldn’t be absurd to think that a physician treating such a patient might be more likely to discharge that patient home on or before their birthday so they can celebrate it at home. The same might be true for patients who are in the hospital before an impending storm. Patient-level data could be used to assess whether length of stay is shorter for patients who are admitted to the hospital a few days before their birthday (or just before a storm), compared with otherwise similar patients admitted to the hospital several weeks earlier, and whether outcomes are any different, on average, or in specific subpopulations. For hospital leaders, this could not only be convincing “quasi-experimental” evidence that length of stay can be safely reduced, but it could also contribute to the scholarly literature.

How can hospitalists generate ideas like these, rigorously evaluate them, and translate them into practice? It turns out that examples such as these abound for the practicing hospitalist, yet few draw the link between these everyday phenomena and the larger question of how length of stay affects patient outcomes. To start, a systematic approach to generating ideas is important: “idea rounds”—a dedicated group discussion in which physicians and other providers brainstorm ideas for quality improvement—can leverage the wisdom of frontline clinicians. But, clever insights aren’t enough. Data and statistical expertise are needed, but with the growing use of electronic health record data and administrative data from large insurers, lack of data is less of a challenge. The larger challenge is data expertise. Data-driven hospital leaders should invest in personnel with statistical expertise to not only complement the scholarly endeavors of hospital medicine faculty, but also to conduct larger, more rigorous quality improvement studies. Particularly as hospitals are increasingly being measured and reimbursed on the basis of data-oriented quality-of-care metrics, it makes sense for hospital leaders to analogously invest in data infrastructure and the analytic capability to analyze that data. The innovation of this approach lies in the simple insight that the everyday activities of hospitalists can be used to answer interesting questions about what works, what doesn’t, and potentially why in healthcare.

Disclosures

Dr. Jena reports receiving consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group.

Funding

Support was provided by the Office of the Director, National Institutes of Health (1DP5OD017897, Dr. Jena).

As hospitalists, many of us see things in our daily practice that help inform our efforts to improve quality of care, organizational efficiency, and medical education, and to reduce physician burnout. But many of those efforts, while well intended, lack rigorous empirical evaluation.

Indeed, it is the complexity of hospital care that leads scholars across many disciplines—including economics, epidemiology, and sociology—to look to hospital medicine as a place where “natural experimentation” can inform us about what works and doesn’t work in medical care. As a hospitalist and economist, I find that the very best of my ideas come from what I see in the hospital. And for many hospital-based clinicians and physician leaders, translating everyday insights into rigorous scientific explorations is not only feasible but is a natural extension of the curiosity that drives good clinical work. It is also a way to drive quality improvement.

Consider, for example, a question that hospitalists face every day: when to discharge a patient from the hospital. Hospital leaders and frontline clinicians are increasingly under pressure to discharge patients earlier and earlier, with some concerned that earlier discharge poses safety risks. Short of randomizing patients to earlier discharge and studying the effects on outcomes, how can a data-driven hospital leader identify which patients can be safely discharged earlier and how much earlier?

A simple observation of a practicing hospitalist could be a clue to elegantly and rigorously answering this question. It turns out that some patients happen to be hospitalized days before their birthday and it wouldn’t be absurd to think that a physician treating such a patient might be more likely to discharge that patient home on or before their birthday so they can celebrate it at home. The same might be true for patients who are in the hospital before an impending storm. Patient-level data could be used to assess whether length of stay is shorter for patients who are admitted to the hospital a few days before their birthday (or just before a storm), compared with otherwise similar patients admitted to the hospital several weeks earlier, and whether outcomes are any different, on average, or in specific subpopulations. For hospital leaders, this could not only be convincing “quasi-experimental” evidence that length of stay can be safely reduced, but it could also contribute to the scholarly literature.

How can hospitalists generate ideas like these, rigorously evaluate them, and translate them into practice? It turns out that examples such as these abound for the practicing hospitalist, yet few draw the link between these everyday phenomena and the larger question of how length of stay affects patient outcomes. To start, a systematic approach to generating ideas is important: “idea rounds”—a dedicated group discussion in which physicians and other providers brainstorm ideas for quality improvement—can leverage the wisdom of frontline clinicians. But, clever insights aren’t enough. Data and statistical expertise are needed, but with the growing use of electronic health record data and administrative data from large insurers, lack of data is less of a challenge. The larger challenge is data expertise. Data-driven hospital leaders should invest in personnel with statistical expertise to not only complement the scholarly endeavors of hospital medicine faculty, but also to conduct larger, more rigorous quality improvement studies. Particularly as hospitals are increasingly being measured and reimbursed on the basis of data-oriented quality-of-care metrics, it makes sense for hospital leaders to analogously invest in data infrastructure and the analytic capability to analyze that data. The innovation of this approach lies in the simple insight that the everyday activities of hospitalists can be used to answer interesting questions about what works, what doesn’t, and potentially why in healthcare.

Disclosures

Dr. Jena reports receiving consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group.

Funding

Support was provided by the Office of the Director, National Institutes of Health (1DP5OD017897, Dr. Jena).

As hospitalists, many of us see things in our daily practice that help inform our efforts to improve quality of care, organizational efficiency, and medical education, and to reduce physician burnout. But many of those efforts, while well intended, lack rigorous empirical evaluation.

Indeed, it is the complexity of hospital care that leads scholars across many disciplines—including economics, epidemiology, and sociology—to look to hospital medicine as a place where “natural experimentation” can inform us about what works and doesn’t work in medical care. As a hospitalist and economist, I find that the very best of my ideas come from what I see in the hospital. And for many hospital-based clinicians and physician leaders, translating everyday insights into rigorous scientific explorations is not only feasible but is a natural extension of the curiosity that drives good clinical work. It is also a way to drive quality improvement.

Consider, for example, a question that hospitalists face every day: when to discharge a patient from the hospital. Hospital leaders and frontline clinicians are increasingly under pressure to discharge patients earlier and earlier, with some concerned that earlier discharge poses safety risks. Short of randomizing patients to earlier discharge and studying the effects on outcomes, how can a data-driven hospital leader identify which patients can be safely discharged earlier and how much earlier?

A simple observation of a practicing hospitalist could be a clue to elegantly and rigorously answering this question. It turns out that some patients happen to be hospitalized days before their birthday and it wouldn’t be absurd to think that a physician treating such a patient might be more likely to discharge that patient home on or before their birthday so they can celebrate it at home. The same might be true for patients who are in the hospital before an impending storm. Patient-level data could be used to assess whether length of stay is shorter for patients who are admitted to the hospital a few days before their birthday (or just before a storm), compared with otherwise similar patients admitted to the hospital several weeks earlier, and whether outcomes are any different, on average, or in specific subpopulations. For hospital leaders, this could not only be convincing “quasi-experimental” evidence that length of stay can be safely reduced, but it could also contribute to the scholarly literature.

How can hospitalists generate ideas like these, rigorously evaluate them, and translate them into practice? It turns out that examples such as these abound for the practicing hospitalist, yet few draw the link between these everyday phenomena and the larger question of how length of stay affects patient outcomes. To start, a systematic approach to generating ideas is important: “idea rounds”—a dedicated group discussion in which physicians and other providers brainstorm ideas for quality improvement—can leverage the wisdom of frontline clinicians. But, clever insights aren’t enough. Data and statistical expertise are needed, but with the growing use of electronic health record data and administrative data from large insurers, lack of data is less of a challenge. The larger challenge is data expertise. Data-driven hospital leaders should invest in personnel with statistical expertise to not only complement the scholarly endeavors of hospital medicine faculty, but also to conduct larger, more rigorous quality improvement studies. Particularly as hospitals are increasingly being measured and reimbursed on the basis of data-oriented quality-of-care metrics, it makes sense for hospital leaders to analogously invest in data infrastructure and the analytic capability to analyze that data. The innovation of this approach lies in the simple insight that the everyday activities of hospitalists can be used to answer interesting questions about what works, what doesn’t, and potentially why in healthcare.

Disclosures

Dr. Jena reports receiving consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group.

Funding

Support was provided by the Office of the Director, National Institutes of Health (1DP5OD017897, Dr. Jena).

“I think healthcare is more about love than most other things”
—Don Berwick

Dr. Berwick speaks of the relationship between the doctor and the patient and family. I believe this relationship is sacred. My job as CEO of Blue Cross North Carolina is hard. But it was so much harder on a recent weekend to give a new diagnosis of a certainly fatal disease of a less than 1-year old child to her parents and discuss palliative care options. I cried and they cried. Being a leader, particularly in healthcare, requires us to maintain sight of what is important and return to those things often as we lead.

Growing up, my parents stressed two things: service and education. I decided early on that I wanted to improve our health care system. I have had a sometimes-winding path to this goal - including work as a consultant, medical school and residency, an RWJ Clinical Scholar, clinical work as a pediatric hospitalist and two tours through government as a White House Fellow, the Centers for Medicare and Medicaid Services (CMS) as Chief Medical Officer, Deputy Administrator and leader of the CMS Innovation Center. With each step I have used five criteria that have allowed me to consider decisions while staying true to myself and my mission.

First, Family. My wife and I have four children, age 10 and under. I put them first as I make decisions.

Second, Impact. Better quality, lower costs, and exceptional experience for populations of people. The triple aim, as we better know it.

Third, People. In the beginning, I took jobs to work with specific mentors. Now, I look carefully at the people and culture where I serve to assess fit and how I could uniquely add value.

Fourth, Learning. How much will I learn every day? When I interviewed for my current job, I told them that they could hire an insurance executive who would be better on day one than me, but if they wanted someone who would improve every day and try to make a model of health transformation and a model health plan for the nation, then they should choose me.

Fifth, Joy in Work. Self-explanatory.

We also have a family mission statement, which was my wife’s good idea. We wrote it together right after we were married. It is too personal to share in detail, but it talks about family, public service, commitment to community, life balance, faith, etc. It is short but to the point and has guided us well.

At some point, you will have someone more senior than you who says you must do A before B and then C. My advice: ignore them. Choose your own path. During my journey, I was encouraged to go down a traditional academic path. I did not do it. Yet, somehow, I was elected to the National Academy of Medicine before I turned 40. It was poignant because it was almost the only accomplishment that my father (a PhD scientist), who passed away before I was elected, would have understood.

So please, decide on your criteria and mission for career and life. Write them down, share them if you wish. Then follow them! Passionately! When things are going well, review them. Are you still aligned with what is important to you? When you are at a crossroads to make a decision, review them again. They should help guide your choice.

I often get asked “what keeps me up at night?” Honestly, nothing as I fall asleep in 10 seconds or less. But if something did, it is the fact that I am always worried that someone is falling through the cracks and getting suboptimal care. We must continue to strive to build a more highly reliable health system that delivers better quality, lower costs, and exceptional experience to all people. We cannot do that without great leaders. So, choose your own path, use your mission as a guide and lead focused on a better health system for all!

Disclosures

Dr. Conway has nothing to disclose.

“I think healthcare is more about love than most other things”
—Don Berwick

Dr. Berwick speaks of the relationship between the doctor and the patient and family. I believe this relationship is sacred. My job as CEO of Blue Cross North Carolina is hard. But it was so much harder on a recent weekend to give a new diagnosis of a certainly fatal disease of a less than 1-year old child to her parents and discuss palliative care options. I cried and they cried. Being a leader, particularly in healthcare, requires us to maintain sight of what is important and return to those things often as we lead.

Growing up, my parents stressed two things: service and education. I decided early on that I wanted to improve our health care system. I have had a sometimes-winding path to this goal - including work as a consultant, medical school and residency, an RWJ Clinical Scholar, clinical work as a pediatric hospitalist and two tours through government as a White House Fellow, the Centers for Medicare and Medicaid Services (CMS) as Chief Medical Officer, Deputy Administrator and leader of the CMS Innovation Center. With each step I have used five criteria that have allowed me to consider decisions while staying true to myself and my mission.

First, Family. My wife and I have four children, age 10 and under. I put them first as I make decisions.

Second, Impact. Better quality, lower costs, and exceptional experience for populations of people. The triple aim, as we better know it.

Third, People. In the beginning, I took jobs to work with specific mentors. Now, I look carefully at the people and culture where I serve to assess fit and how I could uniquely add value.

Fourth, Learning. How much will I learn every day? When I interviewed for my current job, I told them that they could hire an insurance executive who would be better on day one than me, but if they wanted someone who would improve every day and try to make a model of health transformation and a model health plan for the nation, then they should choose me.

Fifth, Joy in Work. Self-explanatory.

We also have a family mission statement, which was my wife’s good idea. We wrote it together right after we were married. It is too personal to share in detail, but it talks about family, public service, commitment to community, life balance, faith, etc. It is short but to the point and has guided us well.

At some point, you will have someone more senior than you who says you must do A before B and then C. My advice: ignore them. Choose your own path. During my journey, I was encouraged to go down a traditional academic path. I did not do it. Yet, somehow, I was elected to the National Academy of Medicine before I turned 40. It was poignant because it was almost the only accomplishment that my father (a PhD scientist), who passed away before I was elected, would have understood.

So please, decide on your criteria and mission for career and life. Write them down, share them if you wish. Then follow them! Passionately! When things are going well, review them. Are you still aligned with what is important to you? When you are at a crossroads to make a decision, review them again. They should help guide your choice.

I often get asked “what keeps me up at night?” Honestly, nothing as I fall asleep in 10 seconds or less. But if something did, it is the fact that I am always worried that someone is falling through the cracks and getting suboptimal care. We must continue to strive to build a more highly reliable health system that delivers better quality, lower costs, and exceptional experience to all people. We cannot do that without great leaders. So, choose your own path, use your mission as a guide and lead focused on a better health system for all!

Disclosures

Dr. Conway has nothing to disclose.

“I think healthcare is more about love than most other things”
—Don Berwick

Dr. Berwick speaks of the relationship between the doctor and the patient and family. I believe this relationship is sacred. My job as CEO of Blue Cross North Carolina is hard. But it was so much harder on a recent weekend to give a new diagnosis of a certainly fatal disease of a less than 1-year old child to her parents and discuss palliative care options. I cried and they cried. Being a leader, particularly in healthcare, requires us to maintain sight of what is important and return to those things often as we lead.

Growing up, my parents stressed two things: service and education. I decided early on that I wanted to improve our health care system. I have had a sometimes-winding path to this goal - including work as a consultant, medical school and residency, an RWJ Clinical Scholar, clinical work as a pediatric hospitalist and two tours through government as a White House Fellow, the Centers for Medicare and Medicaid Services (CMS) as Chief Medical Officer, Deputy Administrator and leader of the CMS Innovation Center. With each step I have used five criteria that have allowed me to consider decisions while staying true to myself and my mission.

First, Family. My wife and I have four children, age 10 and under. I put them first as I make decisions.

Second, Impact. Better quality, lower costs, and exceptional experience for populations of people. The triple aim, as we better know it.

Third, People. In the beginning, I took jobs to work with specific mentors. Now, I look carefully at the people and culture where I serve to assess fit and how I could uniquely add value.

Fourth, Learning. How much will I learn every day? When I interviewed for my current job, I told them that they could hire an insurance executive who would be better on day one than me, but if they wanted someone who would improve every day and try to make a model of health transformation and a model health plan for the nation, then they should choose me.

Fifth, Joy in Work. Self-explanatory.

We also have a family mission statement, which was my wife’s good idea. We wrote it together right after we were married. It is too personal to share in detail, but it talks about family, public service, commitment to community, life balance, faith, etc. It is short but to the point and has guided us well.

At some point, you will have someone more senior than you who says you must do A before B and then C. My advice: ignore them. Choose your own path. During my journey, I was encouraged to go down a traditional academic path. I did not do it. Yet, somehow, I was elected to the National Academy of Medicine before I turned 40. It was poignant because it was almost the only accomplishment that my father (a PhD scientist), who passed away before I was elected, would have understood.

So please, decide on your criteria and mission for career and life. Write them down, share them if you wish. Then follow them! Passionately! When things are going well, review them. Are you still aligned with what is important to you? When you are at a crossroads to make a decision, review them again. They should help guide your choice.

I often get asked “what keeps me up at night?” Honestly, nothing as I fall asleep in 10 seconds or less. But if something did, it is the fact that I am always worried that someone is falling through the cracks and getting suboptimal care. We must continue to strive to build a more highly reliable health system that delivers better quality, lower costs, and exceptional experience to all people. We cannot do that without great leaders. So, choose your own path, use your mission as a guide and lead focused on a better health system for all!

Disclosures

Dr. Conway has nothing to disclose.

“When you’ve worked hard, and done well, and walked through that doorway of opportunity, you do not slam it shut behind you. You reach back and you give other folks the same chances that helped you succeed.” —Michelle Obama

We are at a point in time where awareness around the existing disparities in gender equity in academic medicine couldn’t be higher. It is time for us to take this knowledge and move swiftly into action. What’s one of the best ways to do this? Become a sponsor or be sponsored. “Sponsorship can effectively catapult nascent talent from unknown to rising-star status.”¹

Catapult—an excellent and fitting word to describe the effect sponsorship can have on careers. Women start out behind and often remain behind men, even with mentoring.² With the catapult of sponsorship, however, high-level career advancement is attainable. Studies show that sponsorship is significantly associated with success: 72.5% of men and 59.0% of women who reported sponsorship were successful, compared with 57.7% and 44.8% who did not report sponsorship.³ For women and underrepresented minorities, sponsorship is especially important and can “dramatically overcome many of the tripwires to achievement.”⁴

Sponsorship is a two-way proposition—and both the sponsor and protégé have responsibility to make the relationship successful. Want to be sponsored? Here’s what to do: (1) Broadcast your achievements. You don’t have to be a braggart, but you don’t need to be humble­—celebrate and share your achievements within and outside your network. (2) Seek out leaders of different backgrounds—sponsors don’t need to be just like you. Varied viewpoints bring broader perspectives to the challenges ahead as you climb the leadership ladder. (3) Clearly spell out your leadership goals for yourself and a potential sponsor. Then work to achieve your shared goals in a timely way.

Consider how you can be a sponsor, particularly for junior faculty and those from under-represented groups. Ask yourself: Who have you sponsored this week? Whose success have you celebrated this quarter? Who will you nominate for an award or recognition this year?

Sponsorship is an essential component of good leadership. Individual leaders and academic health centers (AHCs) must take a step forward toward equity by making sponsorship an expectation and strategic priority. Set the expectation that senior leaders will act as sponsors, set clear goals to work toward (ie, more female chairs, increasing recruitment and retention of underrepresented minorities, etc.), and track metrics.2 While “pay it forward” may seem cliché, sponsorship can truly be a remarkable opportunity for growth for both the sponsor and the protégé, and a winning proposition for the institution.

Disclosures

Dr. Spector reports other from I-PASS Patient Safety Institute, outside the submitted work; and she is a co-founder and holds equity in the I-PASS Patient Safety Institute and the Executive Director of Executive Leadership in Academic Medicine. Ms. Overholser has nothing to disclose.

“When you’ve worked hard, and done well, and walked through that doorway of opportunity, you do not slam it shut behind you. You reach back and you give other folks the same chances that helped you succeed.” —Michelle Obama

We are at a point in time where awareness around the existing disparities in gender equity in academic medicine couldn’t be higher. It is time for us to take this knowledge and move swiftly into action. What’s one of the best ways to do this? Become a sponsor or be sponsored. “Sponsorship can effectively catapult nascent talent from unknown to rising-star status.”¹

Catapult—an excellent and fitting word to describe the effect sponsorship can have on careers. Women start out behind and often remain behind men, even with mentoring.² With the catapult of sponsorship, however, high-level career advancement is attainable. Studies show that sponsorship is significantly associated with success: 72.5% of men and 59.0% of women who reported sponsorship were successful, compared with 57.7% and 44.8% who did not report sponsorship.³ For women and underrepresented minorities, sponsorship is especially important and can “dramatically overcome many of the tripwires to achievement.”⁴

Sponsorship is a two-way proposition—and both the sponsor and protégé have responsibility to make the relationship successful. Want to be sponsored? Here’s what to do: (1) Broadcast your achievements. You don’t have to be a braggart, but you don’t need to be humble­—celebrate and share your achievements within and outside your network. (2) Seek out leaders of different backgrounds—sponsors don’t need to be just like you. Varied viewpoints bring broader perspectives to the challenges ahead as you climb the leadership ladder. (3) Clearly spell out your leadership goals for yourself and a potential sponsor. Then work to achieve your shared goals in a timely way.

Consider how you can be a sponsor, particularly for junior faculty and those from under-represented groups. Ask yourself: Who have you sponsored this week? Whose success have you celebrated this quarter? Who will you nominate for an award or recognition this year?

Sponsorship is an essential component of good leadership. Individual leaders and academic health centers (AHCs) must take a step forward toward equity by making sponsorship an expectation and strategic priority. Set the expectation that senior leaders will act as sponsors, set clear goals to work toward (ie, more female chairs, increasing recruitment and retention of underrepresented minorities, etc.), and track metrics.2 While “pay it forward” may seem cliché, sponsorship can truly be a remarkable opportunity for growth for both the sponsor and the protégé, and a winning proposition for the institution.

Disclosures

Dr. Spector reports other from I-PASS Patient Safety Institute, outside the submitted work; and she is a co-founder and holds equity in the I-PASS Patient Safety Institute and the Executive Director of Executive Leadership in Academic Medicine. Ms. Overholser has nothing to disclose.

“When you’ve worked hard, and done well, and walked through that doorway of opportunity, you do not slam it shut behind you. You reach back and you give other folks the same chances that helped you succeed.” —Michelle Obama

We are at a point in time where awareness around the existing disparities in gender equity in academic medicine couldn’t be higher. It is time for us to take this knowledge and move swiftly into action. What’s one of the best ways to do this? Become a sponsor or be sponsored. “Sponsorship can effectively catapult nascent talent from unknown to rising-star status.”¹

Catapult—an excellent and fitting word to describe the effect sponsorship can have on careers. Women start out behind and often remain behind men, even with mentoring.² With the catapult of sponsorship, however, high-level career advancement is attainable. Studies show that sponsorship is significantly associated with success: 72.5% of men and 59.0% of women who reported sponsorship were successful, compared with 57.7% and 44.8% who did not report sponsorship.³ For women and underrepresented minorities, sponsorship is especially important and can “dramatically overcome many of the tripwires to achievement.”⁴

Sponsorship is a two-way proposition—and both the sponsor and protégé have responsibility to make the relationship successful. Want to be sponsored? Here’s what to do: (1) Broadcast your achievements. You don’t have to be a braggart, but you don’t need to be humble­—celebrate and share your achievements within and outside your network. (2) Seek out leaders of different backgrounds—sponsors don’t need to be just like you. Varied viewpoints bring broader perspectives to the challenges ahead as you climb the leadership ladder. (3) Clearly spell out your leadership goals for yourself and a potential sponsor. Then work to achieve your shared goals in a timely way.

Consider how you can be a sponsor, particularly for junior faculty and those from under-represented groups. Ask yourself: Who have you sponsored this week? Whose success have you celebrated this quarter? Who will you nominate for an award or recognition this year?

Sponsorship is an essential component of good leadership. Individual leaders and academic health centers (AHCs) must take a step forward toward equity by making sponsorship an expectation and strategic priority. Set the expectation that senior leaders will act as sponsors, set clear goals to work toward (ie, more female chairs, increasing recruitment and retention of underrepresented minorities, etc.), and track metrics.2 While “pay it forward” may seem cliché, sponsorship can truly be a remarkable opportunity for growth for both the sponsor and the protégé, and a winning proposition for the institution.

Disclosures

Dr. Spector reports other from I-PASS Patient Safety Institute, outside the submitted work; and she is a co-founder and holds equity in the I-PASS Patient Safety Institute and the Executive Director of Executive Leadership in Academic Medicine. Ms. Overholser has nothing to disclose.

“If it is true that the full humanity of women is not our culture, then we can and must make it our culture.”
—Chimamanda Ngozi Adichie

A young boy is on the way home from soccer when a driver hits his car head-on. His father dies immediately, but the boy survives. The boy is transported to the hospital and immediately rushed into the OR. The surgeon takes one look at him and says, “I can’t operate on this patient. He’s my son!” The riddle asks: If the father is dead, who is the surgeon?

Struggling to realize that the surgeon is a mom highlights the depth of gender bias in medicine. Gender bias leads to inequities which are magnified when compounded with differences in race, ethnicity, sexual orientation, gender identity and/or socioeconomic status. The recent National Academies report described the toll of gender inequities, including sexual harassment, and their impact on women in medicine.¹ But like this riddle, the focus was directed towards those at the top of the hierarchy: physicians. It is undeniable that women physicians suffer the effects of inequities, but why exclude other women in healthcare? For example, over 90% of nurses are female, yet male nurses make higher salaries with lower degrees.² If we only focus on physicians, we risk ignoring a problem faced by the entirety of our workforce.

Healthcare is a team sport. The practice of hospital medicine is a prime example of how each team member brings critical value. One would never be able to run an effective code without excellent nursing or successfully intubate a patient without a skilled respiratory therapist. Yet, when it comes to conversations about gender bias and sexual harassment, we rarely work together. The work of equity in healthcare must therefore become more like a lattice than a ladder, with many of us advocating for or with one another.

As hospital medicine has grown, hospitalists have become genuine agents of change. Therefore, this change too, must begin with hospitalists. As leaders in healthcare, we must advocate for equity for all, from the lab technician to the CEO. We must engage and respond when direct care workers (often minorities), face gender or racial bias. In short, if we see something, we must say something.

To create a culture of inclusivity and intersectionality in healthcare, we suggest the following:

• Unite healthcare workers across fields. View your fellow healthcare worker as a team member, not as a subordinate or ancillary staff. Ask them what their experiences regarding inequity have been. See things from their perspective.
• Be a champion for those affected by harassment and inequity. Offer direct support to anyone affected by harassment or inequity. Accompany them to human resources or use your influence to advocate for gender-based salary audits.
• Raise awareness and knowledge. Know the resources in your institution and share them with others. Encourage teams to discuss the impact of microaggressions and implicit bias together as opposed to in role-specific groups. Use communication to lend allyship and support. If you see microaggressions based on gender or race, inquire by asking “I’m curious...why would you say that?” or share the impact a statement has on you by noting “The comment doesn’t just affect one person, it affects all of us.”

People create culture. Meaningful cultural change must be inclusive and intersectional. Historically, movements focused on equity have failed to be inclusive, leading to certain groups feeling marginalized. The time has come to affect change in healthcare across all differences. Whether in the role of physician, nurse, advanced practice provider, or paramedical staff, it’s time to stand together and say: “time is up.”

Disclosures

Dr Kass and Dr. Acholonu are founding members of TIME’S UP Healthcare

“If it is true that the full humanity of women is not our culture, then we can and must make it our culture.”
—Chimamanda Ngozi Adichie

A young boy is on the way home from soccer when a driver hits his car head-on. His father dies immediately, but the boy survives. The boy is transported to the hospital and immediately rushed into the OR. The surgeon takes one look at him and says, “I can’t operate on this patient. He’s my son!” The riddle asks: If the father is dead, who is the surgeon?

Struggling to realize that the surgeon is a mom highlights the depth of gender bias in medicine. Gender bias leads to inequities which are magnified when compounded with differences in race, ethnicity, sexual orientation, gender identity and/or socioeconomic status. The recent National Academies report described the toll of gender inequities, including sexual harassment, and their impact on women in medicine.¹ But like this riddle, the focus was directed towards those at the top of the hierarchy: physicians. It is undeniable that women physicians suffer the effects of inequities, but why exclude other women in healthcare? For example, over 90% of nurses are female, yet male nurses make higher salaries with lower degrees.² If we only focus on physicians, we risk ignoring a problem faced by the entirety of our workforce.

Healthcare is a team sport. The practice of hospital medicine is a prime example of how each team member brings critical value. One would never be able to run an effective code without excellent nursing or successfully intubate a patient without a skilled respiratory therapist. Yet, when it comes to conversations about gender bias and sexual harassment, we rarely work together. The work of equity in healthcare must therefore become more like a lattice than a ladder, with many of us advocating for or with one another.

As hospital medicine has grown, hospitalists have become genuine agents of change. Therefore, this change too, must begin with hospitalists. As leaders in healthcare, we must advocate for equity for all, from the lab technician to the CEO. We must engage and respond when direct care workers (often minorities), face gender or racial bias. In short, if we see something, we must say something.

To create a culture of inclusivity and intersectionality in healthcare, we suggest the following:

• Unite healthcare workers across fields. View your fellow healthcare worker as a team member, not as a subordinate or ancillary staff. Ask them what their experiences regarding inequity have been. See things from their perspective.
• Be a champion for those affected by harassment and inequity. Offer direct support to anyone affected by harassment or inequity. Accompany them to human resources or use your influence to advocate for gender-based salary audits.
• Raise awareness and knowledge. Know the resources in your institution and share them with others. Encourage teams to discuss the impact of microaggressions and implicit bias together as opposed to in role-specific groups. Use communication to lend allyship and support. If you see microaggressions based on gender or race, inquire by asking “I’m curious...why would you say that?” or share the impact a statement has on you by noting “The comment doesn’t just affect one person, it affects all of us.”

People create culture. Meaningful cultural change must be inclusive and intersectional. Historically, movements focused on equity have failed to be inclusive, leading to certain groups feeling marginalized. The time has come to affect change in healthcare across all differences. Whether in the role of physician, nurse, advanced practice provider, or paramedical staff, it’s time to stand together and say: “time is up.”

Disclosures

Dr Kass and Dr. Acholonu are founding members of TIME’S UP Healthcare

“If it is true that the full humanity of women is not our culture, then we can and must make it our culture.”
—Chimamanda Ngozi Adichie

A young boy is on the way home from soccer when a driver hits his car head-on. His father dies immediately, but the boy survives. The boy is transported to the hospital and immediately rushed into the OR. The surgeon takes one look at him and says, “I can’t operate on this patient. He’s my son!” The riddle asks: If the father is dead, who is the surgeon?

Struggling to realize that the surgeon is a mom highlights the depth of gender bias in medicine. Gender bias leads to inequities which are magnified when compounded with differences in race, ethnicity, sexual orientation, gender identity and/or socioeconomic status. The recent National Academies report described the toll of gender inequities, including sexual harassment, and their impact on women in medicine.¹ But like this riddle, the focus was directed towards those at the top of the hierarchy: physicians. It is undeniable that women physicians suffer the effects of inequities, but why exclude other women in healthcare? For example, over 90% of nurses are female, yet male nurses make higher salaries with lower degrees.² If we only focus on physicians, we risk ignoring a problem faced by the entirety of our workforce.

Healthcare is a team sport. The practice of hospital medicine is a prime example of how each team member brings critical value. One would never be able to run an effective code without excellent nursing or successfully intubate a patient without a skilled respiratory therapist. Yet, when it comes to conversations about gender bias and sexual harassment, we rarely work together. The work of equity in healthcare must therefore become more like a lattice than a ladder, with many of us advocating for or with one another.

As hospital medicine has grown, hospitalists have become genuine agents of change. Therefore, this change too, must begin with hospitalists. As leaders in healthcare, we must advocate for equity for all, from the lab technician to the CEO. We must engage and respond when direct care workers (often minorities), face gender or racial bias. In short, if we see something, we must say something.

To create a culture of inclusivity and intersectionality in healthcare, we suggest the following:

• Unite healthcare workers across fields. View your fellow healthcare worker as a team member, not as a subordinate or ancillary staff. Ask them what their experiences regarding inequity have been. See things from their perspective.
• Be a champion for those affected by harassment and inequity. Offer direct support to anyone affected by harassment or inequity. Accompany them to human resources or use your influence to advocate for gender-based salary audits.
• Raise awareness and knowledge. Know the resources in your institution and share them with others. Encourage teams to discuss the impact of microaggressions and implicit bias together as opposed to in role-specific groups. Use communication to lend allyship and support. If you see microaggressions based on gender or race, inquire by asking “I’m curious...why would you say that?” or share the impact a statement has on you by noting “The comment doesn’t just affect one person, it affects all of us.”

People create culture. Meaningful cultural change must be inclusive and intersectional. Historically, movements focused on equity have failed to be inclusive, leading to certain groups feeling marginalized. The time has come to affect change in healthcare across all differences. Whether in the role of physician, nurse, advanced practice provider, or paramedical staff, it’s time to stand together and say: “time is up.”

Disclosures

Dr Kass and Dr. Acholonu are founding members of TIME’S UP Healthcare

“The most radical act anyone can commit is to be happy.”
—Patch Adams

Patch Adams understood that laughter was important not only in healing, but also for filling the souls of those who care for patients. Each of us has a well within us, full of compassion, caring, and healing. Yet we daily face fear, pain, frustration, exhaustion, grief, and loss. All of these can deplete us while our patients are expecting more. There is perhaps no quicker way to replenish our wells than by the simple act of laughing.

As we take on the responsibilities of the world, many of us come to believe that laughter is something only children do. Research shows that children laugh about 400 times a day, but adults on average laugh only about 15 times. Especially in a healthcare environment plagued by burnout, we tend to become serious and don a stoic professional face. Some of us even believe that laughing makes us less professional.

As already mentioned, laughter brings physiological benefits to the body. It lessens people’s pain, so if anything, we need to be spreading more healing laughter in all of our interactions. It is like a bee pollinating flowers and bringing them to life. But how can you as a busy hospitalist do this? Here are five ways to bring smiles and giggles to the health care:

• Smile. Smiling is contagious. So called “mirror neurons” (important in early human development) allow babies to mimic facial and emotional responses and fire in response to sensory input. Have you ever noticed when someone yawns, others in a room will yawn as well? Those are mirror neurons at work. Smiling and laughter activate mirror neurons in the brain of primates and humans.1 This is why sitcoms often include laugh tracks—hearing the laughter makes us laugh. So laugh and watch: others will join you.
• Have some jokes ready. According to research those who can tell a good joke are viewed as more competent. Some data even suggests that employees with a good sense of humor are more likely to get a raise or promotion.2 However, humor can be tricky, as it is subjective. So, keep your jokes simple, nonoffensive, and short. Remember to know and read your audience.
• Plan silly times. Theme days replete with outfits or with sundries that may reflect your patients tastes or those of your inpatient teams can add smiles and joy while breaking a dismal routine.
• Be a good sport. Self-deprecation can be a way not only to bring a smile or two, but can help diffuse a tense situation. Being a good sport not only helps people spread joy to others but is a good way to be seen in a positive light by employers.
• Celebrate success and fun. Encourage smiling, pleasure, and laughing. When managers and administrators look like they are enjoying themselves, they set the company culture that it is a fun place to work.

Laughter is the best medicine. It not only heals others, but also helps lighten our daily loads, and brings a smile to our face and everyone we meet. Consider trying this opportunity to bring you and those around you a world of good.

Disclosures

The author has nothing to disclose.

“The most radical act anyone can commit is to be happy.”
—Patch Adams

Patch Adams understood that laughter was important not only in healing, but also for filling the souls of those who care for patients. Each of us has a well within us, full of compassion, caring, and healing. Yet we daily face fear, pain, frustration, exhaustion, grief, and loss. All of these can deplete us while our patients are expecting more. There is perhaps no quicker way to replenish our wells than by the simple act of laughing.

As we take on the responsibilities of the world, many of us come to believe that laughter is something only children do. Research shows that children laugh about 400 times a day, but adults on average laugh only about 15 times. Especially in a healthcare environment plagued by burnout, we tend to become serious and don a stoic professional face. Some of us even believe that laughing makes us less professional.

As already mentioned, laughter brings physiological benefits to the body. It lessens people’s pain, so if anything, we need to be spreading more healing laughter in all of our interactions. It is like a bee pollinating flowers and bringing them to life. But how can you as a busy hospitalist do this? Here are five ways to bring smiles and giggles to the health care:

• Smile. Smiling is contagious. So called “mirror neurons” (important in early human development) allow babies to mimic facial and emotional responses and fire in response to sensory input. Have you ever noticed when someone yawns, others in a room will yawn as well? Those are mirror neurons at work. Smiling and laughter activate mirror neurons in the brain of primates and humans.1 This is why sitcoms often include laugh tracks—hearing the laughter makes us laugh. So laugh and watch: others will join you.
• Have some jokes ready. According to research those who can tell a good joke are viewed as more competent. Some data even suggests that employees with a good sense of humor are more likely to get a raise or promotion.2 However, humor can be tricky, as it is subjective. So, keep your jokes simple, nonoffensive, and short. Remember to know and read your audience.
• Plan silly times. Theme days replete with outfits or with sundries that may reflect your patients tastes or those of your inpatient teams can add smiles and joy while breaking a dismal routine.
• Be a good sport. Self-deprecation can be a way not only to bring a smile or two, but can help diffuse a tense situation. Being a good sport not only helps people spread joy to others but is a good way to be seen in a positive light by employers.
• Celebrate success and fun. Encourage smiling, pleasure, and laughing. When managers and administrators look like they are enjoying themselves, they set the company culture that it is a fun place to work.

Laughter is the best medicine. It not only heals others, but also helps lighten our daily loads, and brings a smile to our face and everyone we meet. Consider trying this opportunity to bring you and those around you a world of good.

Disclosures

The author has nothing to disclose.

“The most radical act anyone can commit is to be happy.”
—Patch Adams

Patch Adams understood that laughter was important not only in healing, but also for filling the souls of those who care for patients. Each of us has a well within us, full of compassion, caring, and healing. Yet we daily face fear, pain, frustration, exhaustion, grief, and loss. All of these can deplete us while our patients are expecting more. There is perhaps no quicker way to replenish our wells than by the simple act of laughing.

As we take on the responsibilities of the world, many of us come to believe that laughter is something only children do. Research shows that children laugh about 400 times a day, but adults on average laugh only about 15 times. Especially in a healthcare environment plagued by burnout, we tend to become serious and don a stoic professional face. Some of us even believe that laughing makes us less professional.

As already mentioned, laughter brings physiological benefits to the body. It lessens people’s pain, so if anything, we need to be spreading more healing laughter in all of our interactions. It is like a bee pollinating flowers and bringing them to life. But how can you as a busy hospitalist do this? Here are five ways to bring smiles and giggles to the health care:

• Smile. Smiling is contagious. So called “mirror neurons” (important in early human development) allow babies to mimic facial and emotional responses and fire in response to sensory input. Have you ever noticed when someone yawns, others in a room will yawn as well? Those are mirror neurons at work. Smiling and laughter activate mirror neurons in the brain of primates and humans.1 This is why sitcoms often include laugh tracks—hearing the laughter makes us laugh. So laugh and watch: others will join you.
• Have some jokes ready. According to research those who can tell a good joke are viewed as more competent. Some data even suggests that employees with a good sense of humor are more likely to get a raise or promotion.2 However, humor can be tricky, as it is subjective. So, keep your jokes simple, nonoffensive, and short. Remember to know and read your audience.
• Plan silly times. Theme days replete with outfits or with sundries that may reflect your patients tastes or those of your inpatient teams can add smiles and joy while breaking a dismal routine.
• Be a good sport. Self-deprecation can be a way not only to bring a smile or two, but can help diffuse a tense situation. Being a good sport not only helps people spread joy to others but is a good way to be seen in a positive light by employers.
• Celebrate success and fun. Encourage smiling, pleasure, and laughing. When managers and administrators look like they are enjoying themselves, they set the company culture that it is a fun place to work.

Laughter is the best medicine. It not only heals others, but also helps lighten our daily loads, and brings a smile to our face and everyone we meet. Consider trying this opportunity to bring you and those around you a world of good.

Disclosures

The author has nothing to disclose.