After a career working for hospitals, I am about to retire as president and CEO of the American Hospital Association (AHA), an organization that represents some 5,000 hospitals and health systems. This moment compels me to look at the past—what we have learned and how hospitals have changed—and consider the possibilities the future holds for hospitals and hospitalists.
I have watched as hospitals have triumphed over tragedies, from natural disasters to mass shootings. More recently, I saw hospitalists pour their hearts and souls into preparing for the possibility of Ebola. Time and time again, you have responded through your deep-seated commitment.
I have observed the journey toward operational excellence through a punishing recession, a government shutdown, and burdensome regulations that make day-to-day operations amazingly complicated. Yet costs have moderated in historic ways. In fact, hospitals are tackling the tough problems of quality and safety that have plagued us for generations, from preventable infections to disparities to system fragmentation, with a commitment that says to all: This is not acceptable. This will change. And the results show great improvements.
On a clinical level, we’ve made dramatic advances. New technologies and treatments mean that we routinely cure conditions in patients who would once have been without hope. We can also restore quality of life to patients who previously, after an illness or injury, would have spent the rest of their lives struggling with the tasks of everyday living.
But the most remarkable transformation that has taken place in America’s hospitals over my lifetime is in the culture. The focus on patient-centered care has required a new mindset that empowers patients to make decisions about their own care and pushes healthcare workers to much higher levels of coordination and communication. A significant factor in this has been the introduction, growth, and maturation of the hospitalist specialty.
One result of this transformation is that physicians, nurses, and other clinical staff, who once worked in separate silos, are increasingly working as teams. Hospitalists often lead these teams. Clinical integration is the catalyst for profound improvements in patient care. Team-based care is more efficient; sharing information about a patient lessens the chance of duplication of services and increases the use of protocols shown to improve patient outcomes. Clinical integration also helps hospitals develop and implement best practices, and that is making it possible to achieve dramatic progress in tackling some stubborn problems that have plagued these facilities for years, such as healthcare-associated infections.
Moving forward, hospitals are intensely focused on achieving three critical goals: improving the patient care experience, improving the overall health of the community, and reducing the per capita cost of health care. Accomplishing those goals means accelerating the pace of change even further.
For years, we’ve been moving toward a system that is more integrated, with hospitals, physicians, and post-acute care providers combining forces to make true systems of care available to patients. Payments are more at risk as we move away from the fee-for-service model we’ve had for decades to a system that rewards value and outcomes. Healthcare is also becoming far more accountable and transparent about quality and pricing. Hospitals that tried to do better with less are now trying to do less with less, demanding that expensive procedures lead to better patient outcomes. They are focusing more on prevention and less on intervention.
All of this has established the foundation for the next generation of transition. What will it look like?
Efficient, Value-Based Approaches
The clinical gains we have made in healthcare are associated with tremendous costs for specialized equipment and services. By combining in some fashion, rather than duplicating, these resources, hospitals can continue to provide patients with the most promising advances in treatment. As a result, more hospitals are part of health systems that share multiple resources in order to deliver the best care with the best value. More hospitals employ physicians and other clinicians. And this trend will accelerate.
Every hospital will need to determine the path that makes the best sense for itself and its community. Some hospitals will form strategic alliances with other healthcare providers, merging with or acquiring them to offer patients the best they have to offer. Expect to see more hospitals develop a health insurance function and still more to branch out into areas such as behavioral health, home health, or post-acute, long-term, or ambulatory care. Other hospitals will choose the opposite route—specialization in a single area where they can become a high-performing provider of essential services. Examples are children’s hospitals and rehabilitation centers.
No matter which route your hospital takes, expect to see it become increasingly involved in efforts to improve the health of the community it serves. Hospitals will define themselves less by the walls of their buildings and more by the health of their communities. They will actively seek the perspectives of patients and families on how they operate.
New Ideas Welcome
We have an aging population and a growing number of people of all ages with chronic conditions like diabetes and asthma. There’s a lot of room for improvement that will come about by engaging people in the prevention and management of chronic conditions and the employment of new technologies like telehealth. Some 40% of premature deaths stem from unhealthy behavior. By finding effective ways to help people stay healthy, hospitals can have a huge impact in controlling the growth of healthcare spending. Hospitals will also be working to engage patients and families in making decisions about treating advanced illness, including end-of-life care.
Health information technology and electronic health records, done right, will provide hospitals with new ways to improve the quality of care. With better information, we don’t have to guess. We are collecting, analyzing, and applying information—and transforming it into knowledge about what works, and what doesn’t, for patients. For example, by analyzing race, ethnicity, and language preference data, hospitals can address disparities in outcomes for certain populations. This adjustment is critical at a time when communities are changing and hospitals must change to reflect their needs. Better use of information will also allow hospitals to develop and share more evidence-based practices.
In short, hospitals will undergo nothing short of reformation in the years ahead. The demands are daunting, the excitement is contagious, and the commitment to communities is immense.
It has been a tremendous privilege to spend my career with the women and men of America’s hospitals, good people who are willing and able to do whatever it takes to deliver the highest quality care to the people who rely upon them.