Joseph Hopkins

All Publications

• Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remediation. Academic medicine : journal of the Association of American Medical Colleges Hopkins, J., Hedlin, H., Weinacker, A., Desai, M. 2018

  Abstract

  PURPOSE: Physician disrespectful behavior affects quality of care, patient safety, and collaborative clinical team function. Evidence defining the demographics, ethnography, and epidemiology of disrespectful behavior is lacking.METHOD: The authors conducted a retrospective analysis of reports of disrespectful physician behavior at Stanford Hospital and Clinics from March 2011 through February 2015. Events were stratified by role, gender, specialty, and location in the hospital or clinics where the event occurred. Event rate ratios were estimated using a multivariable negative binomial regression model. Correlation of rates of faculty and trainees in the same specialty were assessed.RESULTS: One-hundred-ninety-nine events concerned faculty; 160 concerned trainees. Events were concentrated among a small number of physicians in both groups. The rates of faculty and trainee events within the same specialty were highly correlated (Spearman's rho: 0.90; P < .001). Male physicians had an adjusted event rate 1.86 (95% CI = 1.33 - 2.60; P < .001) times that of females. Procedural physicians were 3.67 times (95% CI = 2.63 - 5.13; P < .001) more likely to have a disrespectful behavior event than non-procedural physicians when adjusting for other covariates. Most common location for faculty was the operating rooms (69 events, 34%); for trainees, the medical/surgical units (43 events, 27%).CONCLUSIONS: Patterns of physician disrespectful behavior differed by role, gender, specialty, and location. Rates among faculty and trainees of the same specialty were highly correlated. These patterns can be used to create more focused education and training for specific physician groups and individualized remediation interventions.

  View details for DOI 10.1097/ACM.0000000000002126

  View details for PubMedID 29319539

• Designing a physician leadership development program based on effective models of physician education. Health care management review Hopkins, J., Fassiotto, M., Ku, M. C., Mammo, D., Valantine, H. 2017

  Abstract

  Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management.The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance.The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011).Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members.All participants completed a team project during the program, adding value to the institution.Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system.Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care institutions. Active learning projects provide opportunities to practice leadership skills addressing real word problems.

  View details for DOI 10.1097/HMR.0000000000000146

  View details for PubMedID 28157830

• A long-term follow-up of a physician leadership program Journal of Health Organization and Management Fassiotto, M., Maldonado, Y., Hopkins, J. 2017: 56–68

  Abstract

  Purpose Physician leadership programs serve to develop individual capabilities and to affect organizational outcomes. Evaluations of such programs often focus solely on short-term increases in individual capabilities. The purpose of this paper is to assess long-term individual and organizational outcomes of the Stanford Leadership Development Program. Design/methodology/approach There are three data sources for this mixed-methods study: a follow-up survey in 2013-2014 of program participants ( n=131) and matched (control) non-participants ( n=82) from the 2006 to 2011 program years; promotion and retention data; and qualitative in-person interview data. The authors analyzed survey data across leadership knowledge, skills, and attitudes as well as leadership titles held, following program participation using Pearson's χ2 test of independence. Using logistic regression, the authors analyzed promotion and retention among participants and non-participants. Finally, the authors applied both a grounded theory approach and qualitative content analysis to analyze interview data. Findings Program participants rated higher than non-participants across 25 of 30 items measuring leadership knowledge, skills, and attitudes, and were more likely to hold regional/national leadership titles and to have gained in leadership since program participation. Asian program participants were significantly more likely than Asian non-participants to have been promoted, and women participants were less likely to have left the institution than non-participants. Finally, qualitative interviews revealed the long-term impact of leadership learning and networking, as well as the enduring, sustained impact on the organization of projects undertaken during the program. Originality/value This study is unique in its long-term and comprehensive mixed-methods nature of evaluation to assess individual and organizational impact of a physician leadership program.

  View details for DOI 10.1108/JHOM-08-2017-0208

• Surgical Comanagement by Hospitalists Improves Patient Outcomes: A Propensity Score Analysis. Annals of surgery Rohatgi, N., Loftus, P., Grujic, O., Cullen, M., Hopkins, J., Ahuja, N. 2016; 264 (2): 275-282

  Abstract

  The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution.Prior studies may have underestimated the impact of SCM due to methodological shortcomings.This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics.The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74-0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67-0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52-0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49-0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87-1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%.The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.

  View details for DOI 10.1097/SLA.0000000000001629

  View details for PubMedID 26764873

• Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation. Joint Commission journal on quality and patient safety / Joint Commission Resources Levin, C. M., Hopkins, J. 2014; 40 (11): 484-412

  Abstract

  A growing body of evidence suggests that patient (including family) feedback can provide compelling opportunities for developing risk management and quality improvement strategies, as well as improving customer satisfaction. The Patient Representative Department (PRD) at Stanford Health Care (SHC) (Stanford, California) created a streamlined patient complaint capture and resolution process to improve the capture of patient complaints and grievances from multiple parts of the organization and manage them in a centralized database.In March 2008 the PRD rolled out a data management system for tracking patient complaints and generating reports to SHC leadership, and SHC needed to modify and address its data input procedures. A reevaluation of the overall work flow showed it to be complex, with over-lapping and redundant steps, and to lack standard processes and actions. Best-practice changes were implemented: (1) leadership engagement, (2) increased capture of complaints, (3) centralized data and reporting, (4) improved average response times to patient grievances and complaints, and (5) improved service recovery. Standard work flows were created for each category of complaint linked to specific actions.Complaints captured increased from 20 to 270 per month. Links to a specific physician rose from 16%-36% to more than 80%. In addition, 68% of high-complaint physicians improved. With improved work flows, responses to patients expressing concerns met a requirement of less than seven days.Standardized work flows for managing complaints and grievances, centralized data management and clear leadership accountability can improve responsiveness to patients, capture incidents more consistently, and meet regulatory and accreditation requirements.

  View details for PubMedID 26111366

• Assigning a team-based pager for on-call physicians reduces paging errors in a large academic hospital. Joint Commission journal on quality and patient safety / Joint Commission Resources Shieh, L., Chi, J., Kulik, C., Momeni, A., Shelton, A., DePorte, C., Hopkins, J. 2014; 40 (2): 77-82

  Abstract

  As complexity of care of hospitalized patients has increased, the need for communication and collaboration among members of the team caring for the patient has become increasingly important. This often takes the form of a nurse's need to contact a patient's physician to discuss some aspect of care and modify treatment plans. Errors in communication delay care and can pose risk to patients. This report describes the successful implementation of a standardized team-based paging system at an academic center. Results showed a substantial improvement in nurses' perceptions of knowing how to contact the correct physician when discussion of the patient's care is needed. This improvement was found across multiple medical and surgical specialties and was particularly effective for services with the greatest communication problems.

  View details for PubMedID 24716330

• Improving and sustaining core measure performance through effective accountability of clinical microsystems in an academic medical center. Joint Commission journal on quality and patient safety / Joint Commission Resources Pardini-Kiely, K., Greenlee, E., Hopkins, J., Szaflarski, N. L., Tabb, K. 2010; 36 (9): 387-398

  Abstract

  Evidence-based performance measures, known as core measures, have been established by The Joint Commission to improve the quality of care for patient populations, such as those with acute myocardial infarction (AMI), heart failure, and community-acquired pneumonia (CAP), as well as to improve the quality of surgical care--the Surgical Care Improvement Project (SCIP) measures. Hospital administrators have traditionally held academic and community physicians and hospital clinicians accountable for integrating the core measures into daily practice. Such efforts have often led to suboptimal results because of the belief that the "organization" (macrosystem) is the appropriate level at which to work to improve quality. Stanford Hospital and Clinics (Stanford, California) has instead held leaders of clinical microsystems--the clinical units where care is provided--accountable to improve performance on the core measures. The strategic approaches taken for this initiative include engagement of the hospital's board of directors; clear assignment of accountability among interdisciplinary care teams to drive the change; implementation of a unit-based medical director program; transparency of core measure performance at the microsystem, mesosystem, and macrosystem levels; and concurrent monitoring with rapid feedback of results.In 2007, the first year of this initiative, the 24-metric composite compliance score for all four core measures increased from 64% to 82%. The composite score was sustained at a minimum of 90% during 2009 and Quarter 1 of 2010.Holding clinical microsystems accountable for improving unit performance proved beneficial to macrosystem performance of the Joint Commission core measures.

  View details for PubMedID 20873671

• Accountability of Unit-Based Teams Leads to Improved and Sustained Performance of Core Measures Am J Medical Quality Pardini-Kiely K, Greelet E, Hopkins J 2009; 24 (Suppl): 34S-35S
• A new instrument to measure appropriateness of services in primary care INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE Thom, D. H., Kravitz, R. L., Kelly-Reif, S., Sprinkle, R. V., Hopkins, J. R., Rubenstein, L. V. 2004; 16 (2): 133-140

  Abstract

  To develop a new instrument for judging the appropriateness of three key services (new prescription, diagnostic test, and referral) as delivered in primary care outpatient visits.Candidate items were generated by a seven-member expert panel, using a five-step nominal technique, for each of three service categories in primary care: new prescriptions, diagnostic tests, and referrals. Expert panelists and a convenience sample of 95 community-based primary care physicians ranked items for (i) importance and (ii) feasibility of ascertaining from a typical office chart record. Resulting items were used to construct a measure of appropriateness using principals of structured implicit review. Two physician reviewers used this measure to judge the appropriateness of 421 services from 160 outpatient visits.Primary care practices in a staff model health maintenance organization and a large preferred provider network.Inter-rater agreement was measured using intraclass correlation coefficient (ICC) and kappa statistic.For overall appropriateness, the ICC and kappa were 0.52 and 0.44 for new medication, 0.35 and 0.32 for diagnostic test, and 0.40 and 0.41 for referral, respectively. Only 3% of services were judged to be inappropriate by either reviewer. The proportion of services judged to be less than definitely appropriate by one or both reviewers was 56% for new medication, 31% for diagnostic test, and 22% for referral.This new measure of appropriateness of primary care services has fair inter-rater agreement for new medications and referrals, similar to appropriateness measures of other general services, but poor agreement for diagnostic tests. It may be useful as a tool to assess the appropriateness of common primary care services in studies of health care quality, but is not suitable for evaluating performance of individual physicians.

  View details for DOI 10.1093/intqhc/mzh029

  View details for Web of Science ID 000220614500003

  View details for PubMedID 15051707

• The Midpeninsula Health Service: action research using small primary care groups to provide evidence-based medicine that empowers patients while continuously improving quality and lowering costs. Medical care Goldberg, H. I., Rund, D. A., Hopkins, J. R. 2002; 40 (4): II32-9

  Abstract

  A Joint Planning Committee Report was issued in 1974 exploring how Stanford University might itself provide primary care to students, faculty, employees and their dependents at low cost. The report called for the creation of a health maintenance organization owned by its subscribers in affiliation with Stanford Medical Center. However, because the report was dismissed by the dean of the School of Medicine as being unworkable, the Midpeninsula Health Service (MHS) began operating as an unaffiliated, nonprofit health plan in downtown Palo Alto in January 1976. The MHS's planning, early operation, move to the Stanford campus, financial viability and ultimate fate are examined as an example of action research in health care.Source documents were examined by the authors, a founding MHS board member and its two inaugural medical directors, in compiling a 30-year organizational history.The MHS was remarkably prescient in its early use of small primary care groups that included midlevel practitioners, the principles of evidence-based medicine, the participation of patients in self-care activities, and a commitment to the continuous monitoring and improvement of quality. Imputed annualized costs of care were 30% lower than contemporary fee-for-service care and 20% lower than that of Kaiser, with no discernible difference in health outcomes.Action research methods can be useful in identifying and testing potential solutions to vexing problems in health care delivery.

  View details for PubMedID 12064579

• Financial incentives for ambulatory care performance improvement. Joint Commission journal on quality improvement Hopkins, J. R. 1999; 25 (5): 223-238

  Abstract

  Measuring and improving the quality of care while curtailing costs are essential objectives in capitated care. As patient care moves from the hospital to outpatient settings, quality management resources must be shifted to ambulatory care process improvement. The Quality Improvement and Efficiency Financial Incentives Program at Stanford University Medical Center was adopted to increase quality improvement efforts and contain costs. THE INCENTIVE PROGRAM: Each department's budget for care of capitated patients was reduced by 5% from the previous year. Return of a reserve fund (10% of payments for specialty care) required completion of substantive quality improvement projects and containing costs. Successful departments were also eligible for bonus funds. Implementation strategies included endorsement by clinical leaders, physician education, use of administrative data to identify project topics and support measurement of quality and cost variables, project templates and time lines, and the availability of clinical quality managers with special expertise in clinical process improvement.Eight of 13 clinical departments developed and implemented 19 ambulatory quality improvement projects to varying degrees. Success in the program was roughly correlated with the potential impact of the incentive on revenues and the status of the lead person selected by the department to spearhead their efforts. Only 5 departments achieved their cost containment goals.Financial incentives are one method of encouraging physicians to use clinical process improvement methods. Endorsement by clinical leaders and selection of realistic beginning projects enhance chances for success. The capitated population has attributes that make it an attractive focus for initial quality improvement efforts.

  View details for PubMedID 10340207

• Drug therapy: the impact of managed care. Advances in pharmacology (San Diego, Calif.) Hopkins, J., Siu, S., Cawley, M., Rudd, P. 1998; 44: 1-32

  View details for PubMedID 9547883

• An interdisciplinary teaching program in geriatrics for physician's assistants J. Allied Health Stark R, Hopkins J, et. al. 1984; 13: 280-287
• Multidisciplinary geriatrics training using elders as consultants and community senior resources as classrooms Gerontology and Geriatric Education Yeo G, Hopkins, JR, et. al. 1982; 2: 227-232
• FAMILY-PRACTICE RESIDENCY GRADUATES AS FACULTY MEMBERS JOURNAL OF FAMILY PRACTICE Hopkins, J. R., Green, W. M. 1978; 6 (4): 823-826

  Abstract

  The demand for teachers of family practice is being met in part by recent residency graduates. The background of these individuals would not predict that they would become teachers, and a major role adaptation is required of them. Yet a number of factors lead them to elect to become faculty members. They possess several qualities different from faculty members coming from practice backgrounds and are, therefore, able to make unique contributions. A combination of recent graduates and practice-experienced faculty members may represent the ideal mix for the further development of academic family practice.

  View details for Web of Science ID A1978EV43000014

  View details for PubMedID 641466

• EXPERIENCE OF FAMILY-PRACTICE RESIDENTS AS ATHLETIC TEAM PHYSICIANS JOURNAL OF FAMILY PRACTICE Hopkins, J. R., Parker, C. E. 1978; 7 (3): 519-525

  Abstract

  Providing exposure for family practice residence to all aspects of community medicine is a common goal of training programs. The Antelope Valley Hospital Medical Center Family Practice Program has initiated an innovative project which involves residents serving as team physicians for local college athletic teams. This provides a valuable opportunity for residents to learn skills they can be expected to need in their future practice. The team physician's role offers educational potential for family practice residents through experience with acute orthopedic problems as well as the preventive and psychological aspects of sports medicine. This role also serves as an example of physician responsibility for health-related activities in the acommunity.

  View details for Web of Science ID A1978FR49000009

  View details for PubMedID 690584

• PROTEIN BINDING OF CALCIUM AND STRONTIUM IN GUINEA PIG MATERNAL AND FETAL BLOOD PLASMA AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Twardock, A. R., KUO, E. Y., AUSTIN, M. K., Hopkins, J. R. 1971; 110 (7): 1008-?

  View details for Web of Science ID A1971J978900020

  View details for PubMedID 5558962