title: A qualitative evaluation of geographical localization of hospitalists: how unintended consequences may impact quality.
abstract: BACKGROUND
  Geographical localization of hospitalist teams to nursing units may have an impact on the quality of inpatient care. The perceptions of individuals who provide patient care in a localized model of care have not been adequately studied.
  
  
  OBJECTIVE
  To determine the impact of geographic localization of hospitalist teams by evaluating the perceptions of hospitalists (faculty and physician assistants) localized to a single nursing unit and the nurses who staffed that unit.
  
  
  METHODS
  Focus group study.
  
  
  METHODS
  Six hospitalist faculty and three hospitalist physician assistants who provided patient care while localized to a single nursing unit, as well as 29 nurses who staffed the nursing unit where localization occurred.
  
  
  METHODS
  Themes that emerged from grounded theory analysis of focus group transcripts.
  
  
  RESULTS
  Participants perceived an overall positive impact of localization on the quality of patient care they provide and their workflow. The positive impact was mediated through proximity to patients and between members of the healthcare team, as well as through increased communication, decreased wasted time and increased teamwork. The participants also identified increased interruptions, variability in patient flow, mismatches in specialization and perverse incentives as mediating factors leading to unintended consequences. A model emerged that can inform future deployment and evaluation of localization interventions.
  
  
  CONCLUSIONS
  Geographical localization of hospitalist teams is perceived to be desirable by both hospitalists and nurses. Others who attempt localization could use our conceptual model as a guide to maximize the benefit and minimize the unintended consequences of this intervention.
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA, ssingh@mcw.edu.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Singh
authors.forename: Kathlyn E
authors.initials: KE
authors.lastname: Fletcher
mesh_terms: D005260:Female; D020445:Hospitalists / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012189:Retrospective Studies; D014922:Wisconsin