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The Hospital of the Future


 

What will the hospital of the future look like? How will it function differently than it does today? What will the patient’s experience be like? What role will hospitalists play?

Imagining the hospital of the future may be an exercise in idealism for many of us, but specialists around the world are currently at work redesigning and improving many different components of the modern hospital, from changing how medical professionals work together to introducing new technologies such as “smart clothing” that house a patient’s medication history and needs.

What’s more, hospital-centric organizations, experts, and participants are moving ahead with new approaches, theories, and technology. As time passes, we’ll see which ideas and theories shake out as the best and most practical.

The current system is primarily physician-centered and driven by increasing units of activity rather than how well the job is done. … In order to change this complex system many institutions will need to be overhauled.

—Larry Wellikson, MD, FACP

What a Hospital will Look Like

The Hospitalist began focusing on what the future will look like earlier this year. “The vision of a re-engineered hospital with patient-centered care, delivered by a fully empowered team of professionals, which is data- driven with clear quality measurements, where better performance is rewarded by better compensation, is coming to a hospital near you during your professional career,” wrote SHM CEO Larry Wellikson, MD, FACP, in our March/April 2005 issue.1

Dr. Wellikson then pointed out that “the current system is primarily physician-centered and driven by increasing units of activity rather than how well the job is done. … In order to change this complex system many institutions will need to be overhauled. The physical plant of the hospital may need to change … .”

Other healthcare professionals have specific dreams or goals for the future. Robin Orr, MPH, president of The Robin Orr Group, Tiburon, Calif., works with healthcare organizations to affect patient-centered care.

“You have to look at an entire culture to truly affect lasting change,” she explains. “This change will encompass the physical environment of the hospital, the patient’s access to information, and, of course, the human side—everyone from doctors to the guy who sweeps the floor.”

Sean Thomas, MD, assistant professor and chief, Division of Medical Informatics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa (Honolulu), envisions changing the way physicians review and interpret patient information.

“There’s a constant increase in the amount and complexity of clinical information collected on each patient, and this will only continue to grow,” says Dr. Thomas. “Right now the chart consists of static, self-contained narratives on the care of patients. Little bits of important information are buried in the prose of physician notes ... H&Ps, progress notes, study interpretations—pathology, imaging studies, etc.

“In order to find these bits of info, a physician must read—or likely scan—these documents and pull out what is important,” he continues. “This is a time-consuming process, and the physician runs the risk of missing vital information.”

Dr. Thomas has a vision of “smart” computer software that can pull information into a clinical abstract that provides a dynamic view of the patient’s status. This change calls for re-education of physicians and advances in technology—both of which are realistically attainable.

Regardless of their specific goals for change, most healthcare professionals agree: Improving patient care is the first priority, but so are heightening efficiency, improving costs, and reducing errors in hospitals.

What Lies Ahead?

Curious about what changes and innovations you and your patients might encounter in the hospital of the future? Read on.

  • New technology: So many changes are on the horizon, including computerized medical records/information management. President George W. Bush has appointed a “health IT czar,” David Brailer, MD, PhD, to expand and integrate information capabilities in healthcare.
  • Fewer medication errors: Technology can reduce the number of medication errors in hospitals, thanks to the introduction of computerized information on smart cards and even smart clothing that indicates what medications are needed when.
  • Better patient flow: More than turning beds over, improved patient flow at the hospital of the future will mean a more efficient and effective admissions process, discharge process, and everything in between.
  • Improved transition from hospital to long-term care: With baby boomers heading toward their twilight years, this transition is being fine-tuned so your patients make the move to long-term care seamlessly and easily for them, their families, and staff at both institutions.
  • More specialty hospitals: A number of procedures may move from a general community hospital to a specialized hospital or even a nonhospital setting.1

There are many, many more specific areas where improvements will occur in your hospital. Watch future issues of The Hospitalist for articles focused on the hospital of the future.

Reference

  1. Wilson, CB. The impact of medical technologies on the future of hospitals. BMJ. 1999;319:1287.

Works in Progress

Numerous professional organizations are working to advance some or all aspects of hospital medicine and administration. Some of the work that is currently underway includes:

  • The Institute for Healthcare Improvement (IHI) hosted the 1st Annual International Summit on Redesigning Hospital Care, June 2005 in San Diego, where medical professionals and hospital executives attended sessions on critical care, patient safety, flow, and workforce development.
  • The Agency for Healthcare Research and Quality (AHRQ) awarded 108 grants totaling $139 million to advance the use of information technology in healthcare to reduce medical errors, improve the quality of patient care, and reduce the cost of healthcare.

    AHRQ also created a National Resource Center for Health Information Technology and is facilitating expert and peer-to-peer collaborative learning and fostering the growth of online communities who are planning, implementing, and researching health information technology (IT).

  • Denver Health (DH) has received a $350,000 hospital redesign grant—an Integrated Delivery System Research Network Project Award, which is part of the AHRQ. Its focus will be removing silos of care, or independent treatment groups, between and across hospital disciplines. DH is redesigning its internal and external processes, as well as its infrastructure.


    DH is receiving input from operational, organizational, and regulatory experts (among them representatives from the Joint Commission on Accreditation of Healthcare Organizations, CMS, IHI, Microsoft, Siemens, and Ritz Carlton), providers and administrators, patients and their families. DH is creating a hospital command center to collect, control, and disperse information from a central location. It’s also focusing on improving operating room turnover time to accommodate more surgeries.

Hospitalists as Change Agents

Who will be involved in redesigning the hospital? Currently the major players in designing and implementing change include professional, nonprofit, and government associations (such as those listed above), universities, and independent healthcare consulting groups. Many groups work directly with hospitals on pilot programs for change.

Once change reaches the hospital level, different professionals can become involved, including administrators, physicians, and nursing staff.

But what role can (and should) hospitalists play in getting their institution to become a hospital of the future? “In looking farther to the future, one role that hospitalists may increasingly assume is that of change agent,” says David L. Bernd in “The Future Role of Hospitalists.”2 “The nature of the hospitalist’s work ideally situates him to act as a change agent, enabling him to identify process management initiatives and corral physician support. As a result, hospitalists will increasingly serve as administrative partners and leaders of medical staff initiatives to help facilitate organizational change. … hospitalists themselves may become the solution to some of the systems that need changing.”

Dr. Wellikson agrees: “Hospitalists, who for the most part are in the beginning of a 20- to 30-year professional career, are primed to play significant roles in this changing dynamic.

Next Month: an In-depth Look

In a series of articles over the next year or so, The Hospitalist will examine specific aspects of the hospital of the future. Experts and leading thinkers will provide their perspectives and plans regarding everything from what the hospital of the future will look like in terms of its physical layout, to how the admissions process might work, to the role that specialty hospitals will play.

Our series will envision the future of medical records and medications, critical care, patient flow, and how teamwork and collaboration might change the way medical personnel work.

In addition, each month we’ll contrast this vision of the future with a look into the distant past of hospitals (see “Flashback: The power of words,” below), providing a glimpse of the earliest beginnings of the institution and the medical profession.

This series on the hospital of the future is designed to encourage you to think progressively and plan ahead. Change waits for no one in hospital medicine, as we all know. Hospitalists must be poised to become active participants in those changes. So stay tuned; the future is coming. TH

Jane Jerrard is an editorial change agent based in Chicago.

References

  1. Wellikson L. SHM point of view. The Hospitalist. 2005;2:5.
  2. Bernd DL. The future role of hospitalists. How hospitalists add value. The Hospitalist. 2005;9(S1):4.

Flashback

The Power of Words

What’s a hospital? This is a seemingly simple question for anyone who spends half of his or her life working in such a place. But the answer actually isn’t so easy. In this issue of The Hospitalist we introduce this section “Flashback.” To savor our medical world and to concoct a recipe for the future, knowledge of the past is a key ingredient. After all, a chef can make a stew, but without the bay leaf it’s just meat and vegetables. We hope that this historic section adds that spice.—Eds

Much of our medical terminology comes from Latin and Greek roots. Terms like iatrogenic and nosocomial are all familiar. This month, we explore these words.

In ancient Greece, the Temples of Aesculapius were places of healing. There are many versions of the origin of Aesculapius. Apollo, son of Zeus, could cause plagues by shooting arrows. When not driving his chariot of fire across the sky, he impregnated a nymph named Coronis. Her unfaithfulness led to her murder by Apollo or his sister, Artemis, who then placed Coronis on a burning pyre. At the last moment Apollo—regretting the deed—cut the baby, Aesculapius, from the body of Coronis. Aesculapius was raised by a centaur named Chiron (namesake of the company which recently produced unusable influenza vaccine) and instructed in the art of medicine. His two daughters, Hygeia and Panacea (familiar sounding names in their own right), assisted him.

The iatros was the classic Greek physician, epitomized by Hippocrates. The term iatros is the root of many modern words, such as psychiatry and pediatrics. The iatroi began as lay practitioners in the temples of Aesculapius, but eventually shifted from a religious role to a professional one.

In the age of Pericles (mid-fifth-century BC) the physician might receive a fixed annual fee—in essence, Hellenic managed care. The bed-bound sick patient was generally cared for at home.

Now shift half a millennium forward to Constantinople (present-day Istanbul, Turkey), established in 330 AD. This city’s shrines were dedicated to Christian martyrs, such as Saint Cosmos and Saint Damian, who were known for their healing powers and for helping the infirm. In 420 a shelter—called a nosokomion—was erected; it was dedicated to the care of the sick and poor. Thirty years later another nosokomion was built in Constantinople to care for lepers. After 499 when the bubonic plague decimated the city, its Great Church of Hagia Sophia was pressed into duty as an infirmary. Caring for the sick became institutionalized when the Egyptian and Jewish models of social welfare for marginalized groups were adopted into the Christian model. “I was a stranger and you took me in; naked and you covered me; sick and you visited me,” wrote St. Matthew. The age of the hospital had begun.

Language has power, and the words we use have meaning. The next time you see an iatrogenic illness or a nosocomial infection, think about Panacea and her sister Hygeia.

—Jamie Newman, MD

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