Robert Wachter
A management team from Singapore’s flagship hospital came to UCSF recently to study hospital medicine from Robert Wachter, MD, who pioneered the field in which physicians called hospitalists specialize in taking care of hospitalized patients.
In 1996, Wachter, UCSF professor and associate chair of the Department of Medicine, and Lee Goldman, MD, then the chair of the Department of Medicine, coined the term “hospitalist” in a New England Journal of Medicine article. The specialty is now one of the fastest growing in the history of American medicine.
“We chose UCSF because we read Bob’s papers and we know that he is a successful pioneer in this new field,” said Lee Kheng Hock, MD, head of the Department of Family Medicine and Continuing Care at Singapore General Hospital (SGH). “We’re here to learn and see how we can improve our system. Thanks to the wonderful Internet, we saw his blog and wrote to him. He wrote back and said, ‘Welcome – we are more than happy to share our vision with you.’”
Hospitalists are hospital-based specialists who oversee all the elements of a hospitalized patient’s care – lab reports, medication lists, reports from surgeons, specialists and others – and weave together the big picture, making connections between disparate pieces of information and coordinating care among health professionals to ensure that the patient receives the best care possible.
Managing Care
SGH is Singapore’s oldest and largest acute tertiary care hospital, meaning that patients are referred for specialty care that is not available at regional hospitals. About 70,000 patients are admitted each year. While SGH has a pool of about 550 specialists, there are few general internists on staff, meaning that patients’ care is managed by teams of specialists and subspecialists.
“We are looking at ways to manage inpatient care, so that patients have a personal physician throughout their journey through the hospital,” said Lee. “The personal component is very important because patients realize there is one doctor in control who is taking care of the situation. If they ask their kidney doctor, ‘How am I doing?’, the doctor may say, ‘Your kidneys are fine, but I don’t know about your heart – you’ll have to ask your cardiologist.’”
The hospitalist also plays a key role in helping with discharge planning, making sure that social workers, occupational therapists, speech therapists and others are involved as needed. The hospitalist also communicates with family members and community health centers for follow-up care. “Hospital outcomes may be done perfectly, but once they leave the hospital, without good discharge planning, all that good work is undone,” said Lee.
Best in the United States
When Lee and his colleagues began researching models, Wachter’s name and publications kept coming up. Wachter, chief of the Division of Hospital Medicine and Lynne and Marc Benioff Endowed Chair in Hospital Medicine at UCSF, is widely seen as the foremost authority on ways to achieve hospital quality.
The group decided to request a site visit to learn more about UCSF’s hospitalist program. “This is the best system in the United States, and this department is the pioneer of the hospitalist movement,” said Sandra Subner, senior manager of the SGH Medical Board.
“We can’t take everything lock, stock and barrel,” said Han Seong Ng, MBBS, chairman of the SGH Medical Board. “We have our own traditional model of education and our health care system. We have to evolve our own [hospitalist] system. But we can tease apart what we’ve seen and modify it, so we can still call it ‘Singapore.’”
During their visit, the Singapore executives learned not only about the role of the hospitalist, but also about some of the ingredients for creating an environment where they will be successful. “What strikes me most is the passion and energy of the people we met,” said Ng. “This group of people really believes in what they’re doing.”
“They believe in the hospitalist model as one that results in increased satisfaction for patients, staff and physicians,” Lee said. “It’s a win-win for the patient and the care team as a whole,” Subner said.
The group hoped that the trans-Pacific connections would continue into the future. “We would like to continue links with UCSF,” said Subner. “They’ve been excellent hosts, and we hope to repay them. We extend an open invitation for them to come visit us in Singapore.”
