Re-designing Hospital Care: Learning from the Experience of Hospital Medicine in Canada

Abstract

The emergence of the hospitalist model (a model of inpatient care delivery by physicians referred to as hospitalists who spend the majority of their time in the hospital setting) has been a major development in the Canadian healthcare landscape over the past decade. Similar to the United States, the number of hospitalist programs in Canada has grown exponentially since the late 1990's. More recently, the model is being adopted in other countries such as Singapore and Brazil. The Canadian hospitalist model is still evolving, but its development can provide learning opportunities for policy makers and healthcare practitioners in other countries who are developing their own versions of this health delivery model.

This article provides a comparative overview of the development of hospital medicine (an emerging medical specialty dedicated to the delivery of comprehensive medical care to hospitalized patients) in Canada and the United States and proposes strategies for more effective integration of Canadian hospitalists into the medical establishment. It outlines the results of national hospitalist surveys in Canada and discusses some of the main challenges and opportunities facing its adoption.

National surveys have demonstrated an increase in the number of physicians providing hospitalist care in Canada. There is increasing evidence for the effectiveness of the hospitalist model in enhancing the efficiency of resource utilization and improving quality of care indicators. Hospitalists across North America are increasingly taking part in quality improvement initiatives and establishing themselves as major contributors to the broader healthcare system.

Despite their success, Canadian hospitalists continue to face challenges gaining acceptance for alternate funding models, establishing sustainable working conditions, and overcoming criticisms of discontinuity of care by improving communication with other physician groups. Healthcare leaders in other parts of the world that are looking to develop hospitalist programs need to consider such challenges to ensure successful adoption of this emerging inpatient care model.