Where will you be in 20 years? If you’re a young hospitalist, you may work in an enormous state-of-the-art hospital complex that includes the latest technologies, the best in amenities, and a well-thought-out design that will meet your needs and those of other staff for years to come.
“There are a lot of different approaches” to designing the hospital facility of the future, says George R. Tingwald, MD, AIA, ACHA, director of healthcare design at Skidmore, Owings, and Merrill in San Francisco. “The difference depends on whether you look at it from a constructability standpoint versus a much more consumer-based focus. Though many think they have the right approach, it’s hard to say that everybody’s decided on a single solution.”
The Future Looks … Big
It’s not just the hospital facility itself that will change in the future. The number of hospitals in each community may change as well—and the hospitals will be considerably larger.
“We will probably see fewer but larger hospitals in the future,” predicts Dr. Tingwald. “We’re in an era where we’re seeing significant growth in the number of inpatients served. Because of the baby boom and increasing longevity in Americans we’re already seeing an increase, and it’s going to continue. We’ll definitely see more hospital beds in the future.”
The type of patients who fill those hospital beds will change as well.
“We’ll continue to see sicker and sicker patients in those hospital beds,” says Dr. Tingwald. “More people will be managed on an outpatient basis as more diagnostic and treatment procedures will be done as outpatients. Look at breast cancer: From initial detection to diagnosis to biopsy to lumpectomy to chemotherapy or radiation treatment, to cure, or end-of-life care, each step can now be done on an outpatient basis.”
What does this mean? “Someone can have a very significant, multiepisodic disease and never stay in the hospital—unless there are complications,” explains Dr. Tingwald. “Therefore, we’ll have only very acute patients in the hospital. The hospital will basically become an intensive care unit.”
In the past, approximately 10% of a hospital’s beds were in the ICU. That percentage is rising—an indication of things to come. That percentage is now around 20% or 30% and growing, especially in major centers. Only seriously ill people will be admitted—but even they won’t spend a lot of time in the hospital. They will die, recover to a point where they can be moved to rehabilitation or other support facility, or be sent home.
What about the prediction that there will be fewer hospitals in the future? Dr. Tingwald predicts that technology and expertise will weed out some facilities.
“We used to have a lot of what I would call general hospitals—meaning every one was the same,” he explains. “That’s changing radically. The institutions with the expertise and wherewithal to develop technical sophistication, such as university hospitals and specialty hospitals, are doing well. Those that don’t have that sophistication can’t keep up. The big centers are growing because they have the equipment and the expertise. The smaller ones are failing.”
This trend may come as a surprise to some in healthcare, in light of previous predictions. “This is different than the futurists were saying 10 or 20 years ago, when predictions were for more home-based and community-based care,” says Dr. Tingwald. “The reverse has happened. The latest equipment is not available to everyone, let alone smaller, unaffiliated hospitals. And the people that can work with that technology are few and far between.”
The addition of new technology will have some effect on the size of the hospital. “You need a lot of physical space for wiring,” admits Dr. Tingwald. “But the ‘brains’ of the technology can be offsite at a separate IT center or data center.”