Massachusetts Chapter of the American College of Surgeons

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Physicians Working in New Hospital Environments: Understanding their Challenges to Develop Real Solutions
Janaka Lagoo1, Bill Berry1, Alex Haynes2,1, Atul Gawande3,1, Susan Haas1
1Ariadne Labs, Boston MA; 2Massacuhsetts General Hospital, Boston, MA; 3Brigham and Women’s, Boston, MA

Background: Surgeons and other physicians are frequently sent to practice in hospitals different from their home institution under contracts called professional service agreements (PSAs). With highly variable onboarding processes, they are often left to “figure out” available local resources, processes of care, and crucial relationships by trial and error.

Methods: Two physicians conducted semi-structured, in-depth interviews with 11 attending physicians and 3 residents about their experiences practicing in new hospital environments while participating in PSAs. All physicians had practiced in at least one new facility, beyond their home institution. Interviews were coded and then qualitative and quantitative analysis was performed.

Results: Our sample includes 3 residents and 11 attendings. Specialties represented are: Surgery (N=5), Anesthesia (1), Internal Medicine (N=2), Emergency Medicine (N=1), Family Medicine (N=1), and Obstetrics and Gynecology (N=4). Themes raised include: 1.) Managing clinical emergencies in unfamiliar settings can result in significant perceived risk to patient safety. 2.) Basic logistics of providing care in a new environment are often not incorporated into the process of physician onboarding and can limit physicians’ ability to provide care efficiently and effectively and 3.) Strength of interpersonal relationships greatly influences physicians’ work experience in new environments.

Conclusions: Based on our interviews we believe there is a need for a comprehensive onboarding tool for surgeons and other physicians that highlights differences in resources, care processes, and culture. We foresee that such an onboarding tool has the potential to improve physician-reported ability to provide care more efficiently and safely when working in new systems.

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