The Physician Leadership Development Program offered by the WashU Department of Medicine was designed to help faculty boost team performance and achieve goals with advanced leadership skills, master key concepts for leading healthcare improvements, and improve problem-solving and decision-making for better leadership. In 2024, three physicians from the Division of Hospital Medicine completed this extensive workshop: Rachel Bardowell, MD, Safa Farrag, MD, and Rob Young, MD. In May of 2025, four hospitalists graduated from the leadership program. As part of the program, each participating physician creates a project and presents their findings at the graduation commencement.
Katy Filson, MD, and Zach Morgan, MD, collaborated on a project targeting the daily medicine bed deficit, which leads to “prolonged ED boarding, increased length of stay, unnecessary costs, and worse patient outcomes.” They recommended implementing a method to track unnecessary bed days and discharge delays on the Med 2 unit to monitor how many patients stayed past the point of being medically ready and what the delays were.
“Feedback on the project was that it was extremely helpful. I had never done a waste walk or heard of going to ‘Gemba,’ and I found those skills to be incredibly valuable. This has led to a few other projects to improve throughput that Zach and I are working on now.”
Katy Filson, MD
Dr. Filson and Dr. Morgan discovered several high-impact root causes: the doctor not specifically stating when a patient is “medically ready,” IDR focusing on estimated discharge date instead of using both metrics, and the care team’s lack of knowledge of the current IDR dashboard. To address these issues, they suggested three key countermeasures: firstly, educating staff and providers on the definition of medical readiness and the difference between medical readiness and the estimated discharge date; secondly, adjusting the IDR process to include the nurse manager asking about and inputting medical readiness; and finally, increasing the visibility of the dashboard so the care team can update it outside of IDR.
“Feedback on the project was that it was extremely helpful,” Katy shared. “I had never done a waste walk or heard of going to ‘Gemba,’ and I found those skills to be incredibly valuable. This has led to a few other projects to improve throughput that Zach and I are working on now.”
Cady Edwards, MD, and Gina LaRossa, MD, also partnered on a project. Their project pinpointed a current problem with cross-covering hospitalists who work overnight being overwhelmed by the number of phone calls and Epic chats they receive from nurses, particularly when focused on an acutely ill patient. Dr. Edwards’ and Dr. LaRossa’s pilot aimed to decrease the number of Epic chats from 3500-night RNs to south cross covers by 50% one month after their intervention.
Several high-impact root causes were identified, including the large number of patients that has increased in recent years, inefficiencies when RNs call the cross-cover provider (calling from an unknown number, cross-cover having to locate the patient manually in Epic), the large number of newer RNs working at night contributing to unnecessary calls/chats, and the chat “etiquette” contributing to chat bloat. To tackle these issues, Cady and Gina created a rounding pilot that started in April of 2025. In this pilot, the in-person cross cover on 3500 would come at 21:00 and 4:00 each night, and the nurses would try to batch non-urgent questions and issues to address during those times.
Congratulations to Doctors Filson, Morgan, Edwards, and LaRossa on their completion of this program! We look forward to seeing more hospitalists participate in upcoming years.