The impact of a hospitalist on role boundaries in an orthopedic environment

Figures & data

Appendix 1 Semi-structured interview guide

Background information Thank person for participating, go over consent form and have them verbally agree to participate, explain process, how confidentiality and anonymity will be protected, etc.

Warm-up and establishing rapport I t would be nice if you could let me know a little bit about yourself. How long have you been working at the [Centre name]? Can you tell me a little bit about your role here?

Experiences prior to working with hospitalist How long were you working here when the hospitalist role was introduced? What was your original reaction to this role? Please describe the key problems you encountered in your work at that time. What were your expectations (if any) of how the hospitalist role would affect your work? Did you have any concerns? If so what were they?

Experiences working with hospitalist – staff impact Can you describe a time when you worked directly with the hospitalist? (Probes: what stood out for you? How would you characterize this experience?) Can you describe the top three things that have changed in the work that you perform on a daily basis since the hospitalist role was introduced? What is the most important benefit to you of working with a hospitalist? What is the least important benefit to you?

Experiences working with hospitalist – patient impact In what way do you believe the hospitalist has impacted on patient care? (Probes: why do you think that? Do others share this opinion?) Can you provide an example of the impact of the hospitalist on patient care? What is the most important benefit to patients of having a hospitalist? What is the least important benefit?

Recommendations Would you recommend working with a hospitalist to your peers? Why or why not? How could we improve this program?

Cool-down/wrap-up questions Is there anything else I haven’t asked you about that you’d like to add? The responses you have provided may stimulate some additional questions or need for further clarification. If so, may we contact you in the future? Explain rest of process (eg, that they will be invited to a meeting to provide feedback on preliminary interpretation of data)

Table 1 Themes and illustrative quotes

Theme	Illustrative quotes
Impact on patient well-being	So the hospitalist is able to look at [patients] in a big-picture kind of way, not just their orthopedic injury but whatever they’ve had from their trauma, from the infection, etc. (Number 5; Anesthetist)
Impact on clinical well-being of staff	[The hospitalist] has a pretty good list of contacts now … he knows who to call to talk to so that transfers can happen a bit quicker … So that certainly is a little more peace of mind for us. (Number 6; Nurse)
Impact on staff work practices	Knowing that he has the ability and the willingness to educate staff on the spot … frees up my time to some degree. (Number 1; Nurse) That’s no different than what I did before, except before I would ask the medicine doctors versus [hospitalist]. So my practice hasn’t changed at all. (Number 8; Surgeon) Sometimes he’ll say, ‘I’m not at the hospital, can you go write the order?’… I call it a make-work. (Number 7; Pharmacist)
Perceived benefits to other professions	The nurses, I think, find it easier contacting [hospitalist] than they would getting hold of the internist on call. (Number 12; Internist) The surgeons are very good surgeons, technically, and they can put in joints, but they’re not very good sort of general internal medicine type of people. (Number 5; Anesthetist)
Importance of interprofessional collaboration to implementation of hospitalist role	He also provides a really good link with the family physicians, which I don’t think we had all that much before. (Number 9; Administrator) He can call about my patients, and he’s happy for me to call him at any time about my patients as well. (Number 11; Surgeon) [The hospitalist] consults us frequently, like on a daily basis. (Number 10; Pharmacist)
Potential for conflict	I think that one of the reasons why the hospitalist works well here is because the surgeons recognize that they’re orthopedic surgeons, they aren’t the experts in medical fields, and the other medical internists are also busy enough with their patients … that they don’t get in a flap or in a snit and feel like someone’s stepping on their toes with someone else writing orders. (Number 6; Nurse)