Table 1.

Potential measures for hospitalist clinical work

	Measure	Pros	Cons	Current or future use examples
Productivity measures	wRVU/cFTE	Simple and data typically available.	May not appropriately account for true effort (i.e., effects of moonlighting, how cFTE is defined, how leave is accounted for, non‐RVU generating work). Need to account for the impact of staffing models (e.g., APP, learners).	Typical measurements for productivity and for benchmarking.
	Encounters/cFTE
Financial measures	Hospital support/cFTE	Simple and data typically available.	May not appropriately account for true effort (i.e., moonlighting will impact how cFTE is defined, how is leave accounted for, non‐RVU generating work). May not capture the true value of hospitalists.	Typical measures for understanding cost/hospital offset.
	Collections/cFTE
Workload	wRVU/cFTE	Measure quantity of work and in some cases complexity of work.	While some measures are readily available, task load would require surveying or developing some measures from EHR. Need to account for staffing models (APP, learners). Need to account for patient complexity and type of work. Other modifiers may need to be accounted for such as geography and patient population/required tasks and non‐RVU generating work.	Task load is often used in high‐risk industries (NASA), but is not utilized in daily operations in medicine. Could be utilized to periodically gauge the perception of workload in conjunction with more typical measures of workload. Patient complexity should be considered when determining the appropriate workload. No standards currently exist.
	Encounters/cFTE
	Task load
	Patient complexity (case mix index, Charlson comorbidity)
	EHR measures (total EHR time, work outside of work, time on documentation, inbox time, distractions)	Accessible from the EHR; the potential for real‐time measures.	Hospitalists work variable hours (defining after‐hour work may be challenging). May not be efficient to extract large volumes of data. Does not capture all work.	There may be institutional reports on clinician‐specific work in the EHR. These measures could be incorporated into decision support tools.
Hospitalist well‐being	Burnout/well‐being inventories	A measure of how work is affecting the hospitalist.	Requires surveying. Factors beyond work may affect individual scores.	These may be utilized in annual institutional surveys, but are not typically paired with typical measures of workload (or other measures of workload as outlined above).
	Hospitalist outcomes (intent to stay, attrition rate, reduced clinical effort)	Measures that assess hospitalist thriving.	Requires surveying and tracking attrition rates and clinical effort changes (and understanding reasons for doing so).
Patient safety culture	Team culture and safety surveys	Gives an understanding of how work environment and staffing models support patient care and communication.	Requires surveying.	May be administered annually and paired with global questions about workload, but typically not paired with discrete measures of workload (e.g., what quantity of work leads to poor outcomes on the surveys).
Job performance	Patient outcomes (LOS, mortality, readmissions, ICU transfers)	Simple and data typically available.	Many factors may influence these outcomes.	Readily available in EHR; could be paired with workloads to understand how workload impacts these outcomes. When paired with workload, begins to link work models to clinician/institutional performance.
	Communication (HCAHPS)	Simple and data typically available.	Many factors may influence these outcomes.
Institutional outcomes	Patient and safety outcomes as outlined above, LOS and throughput	Simple and data typically available.	Many factors may influence these outcomes.	Must assess the trade‐offs between direct costs and outcomes. When paired with workload, begins to link work models to institutional performance.
	Financial outcomes	Must be financially viable and also must look beyond direct costs.	Assessing direct costs only may miss indirect costs/benefits.

Abbreviations: APP, advanced practice provider; cFTE, clinical fraction full‐time equivalent; EHR, electronic health record; HCAHPS, Hospital Consumer Assessment of Healthcare Providers and Systems; ICU, intensive care unit; LOS, length of stay; NASA, National Aeronautics and Space Administration; wRVU, work relative value unit.