Kirsten N. Kangelaris MD, MAS, Angela Keniston PhD, MSPH, Andrew D. Auerbach MD, MPH, Gregory Bowling MD, Marisha Burden MD, MBA, Shradha A. Kulkarni MD, Luci K. Leykum MD, MBA, MSc, Anne S. Linker MD, Matthew Sakumoto MD, Jeffrey Schnipper MD, MPH, Gopi Astik MD, MS
{"title":"学术医院医学危险系统的多机构多方法分析。","authors":"Kirsten N. Kangelaris MD, MAS, Angela Keniston PhD, MSPH, Andrew D. Auerbach MD, MPH, Gregory Bowling MD, Marisha Burden MD, MBA, Shradha A. Kulkarni MD, Luci K. Leykum MD, MBA, MSc, Anne S. Linker MD, Matthew Sakumoto MD, Jeffrey Schnipper MD, MPH, Gopi Astik MD, MS","doi":"10.1002/jhm.70045","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Hospital medicine programs use backup (“jeopardy”) systems to cover unexpected staffing gaps, but little is known about their structures or optimal practices.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To describe jeopardy structures, assess clinician perceptions, and identify potential approaches across a broad sample of hospital medicine groups.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This multi-methods study, conducted within a national hospitalist consortium, used virtual focus groups and an email survey to (1) describe the presence and structure of jeopardy systems and (2) explore features perceived as fair, equitable, and tolerable. Rapid qualitative analysis identified major themes, while descriptive methods analyzed survey data.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-five individuals participated in focus groups, and 26 completed the survey, representing 31 unique institutions. Participants were primarily physicians in academic hospital medicine groups. Three themes emerged: (1) jeopardy systems are widely used but vary in structure, activation criteria, and compensation, leading to inconsistencies in clinician experiences; (2) many clinicians report stress and dissatisfaction due to unpredictability, perceived inequities in assignment, and concerns about inappropriate use; and (3) strategies to improve fairness, equity and tolerability include structured scheduling, support for sick days, and compensation for the burden of jeopardy coverage. Survey data confirmed high variability in jeopardy systems across institutions. Common practices included jeopardy activation over redistributing patients and compensating clinicians for covered shifts.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Jeopardy systems are essential for hospital medicine staffing but contribute to clinician dissatisfaction due to unpredictability and perceived inequities in coverage. Implementing deliberate scheduling, formalized support for absences, and equitable compensation models may reduce dissatisfaction and improve jeopardy system sustainability.</p>\n </section>\n </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"953-962"},"PeriodicalIF":2.3000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70045","citationCount":"0","resultStr":"{\"title\":\"A multi-institutional multi-methods analysis of jeopardy systems in academic hospital medicine\",\"authors\":\"Kirsten N. Kangelaris MD, MAS, Angela Keniston PhD, MSPH, Andrew D. Auerbach MD, MPH, Gregory Bowling MD, Marisha Burden MD, MBA, Shradha A. Kulkarni MD, Luci K. Leykum MD, MBA, MSc, Anne S. Linker MD, Matthew Sakumoto MD, Jeffrey Schnipper MD, MPH, Gopi Astik MD, MS\",\"doi\":\"10.1002/jhm.70045\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Hospital medicine programs use backup (“jeopardy”) systems to cover unexpected staffing gaps, but little is known about their structures or optimal practices.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>To describe jeopardy structures, assess clinician perceptions, and identify potential approaches across a broad sample of hospital medicine groups.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This multi-methods study, conducted within a national hospitalist consortium, used virtual focus groups and an email survey to (1) describe the presence and structure of jeopardy systems and (2) explore features perceived as fair, equitable, and tolerable. Rapid qualitative analysis identified major themes, while descriptive methods analyzed survey data.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Twenty-five individuals participated in focus groups, and 26 completed the survey, representing 31 unique institutions. Participants were primarily physicians in academic hospital medicine groups. Three themes emerged: (1) jeopardy systems are widely used but vary in structure, activation criteria, and compensation, leading to inconsistencies in clinician experiences; (2) many clinicians report stress and dissatisfaction due to unpredictability, perceived inequities in assignment, and concerns about inappropriate use; and (3) strategies to improve fairness, equity and tolerability include structured scheduling, support for sick days, and compensation for the burden of jeopardy coverage. Survey data confirmed high variability in jeopardy systems across institutions. 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A multi-institutional multi-methods analysis of jeopardy systems in academic hospital medicine
Background
Hospital medicine programs use backup (“jeopardy”) systems to cover unexpected staffing gaps, but little is known about their structures or optimal practices.
Objectives
To describe jeopardy structures, assess clinician perceptions, and identify potential approaches across a broad sample of hospital medicine groups.
Methods
This multi-methods study, conducted within a national hospitalist consortium, used virtual focus groups and an email survey to (1) describe the presence and structure of jeopardy systems and (2) explore features perceived as fair, equitable, and tolerable. Rapid qualitative analysis identified major themes, while descriptive methods analyzed survey data.
Results
Twenty-five individuals participated in focus groups, and 26 completed the survey, representing 31 unique institutions. Participants were primarily physicians in academic hospital medicine groups. Three themes emerged: (1) jeopardy systems are widely used but vary in structure, activation criteria, and compensation, leading to inconsistencies in clinician experiences; (2) many clinicians report stress and dissatisfaction due to unpredictability, perceived inequities in assignment, and concerns about inappropriate use; and (3) strategies to improve fairness, equity and tolerability include structured scheduling, support for sick days, and compensation for the burden of jeopardy coverage. Survey data confirmed high variability in jeopardy systems across institutions. Common practices included jeopardy activation over redistributing patients and compensating clinicians for covered shifts.
Conclusions
Jeopardy systems are essential for hospital medicine staffing but contribute to clinician dissatisfaction due to unpredictability and perceived inequities in coverage. Implementing deliberate scheduling, formalized support for absences, and equitable compensation models may reduce dissatisfaction and improve jeopardy system sustainability.
期刊介绍：
JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children.
Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.
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