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The Role of the Hospital in a Changing Environment
Bulletin of the WHO, 2000,78(6)
Martin McKee & Judith HealyLSHTM, London
By: Keerti Bhusan [email protected]
Summary
Hospitals a challenge in Healthcare Reform
Evolving role of hospitals
Changing Healthcare Needs
Emerging Technologies
Size and Distribution of hospitals
Essence of the Article
Hospitals must continue to evolve in response to factors• Changing healthcare needs
• Emerging Technologies
Key Reform Strategies
Behavioral Interventions-Quality Assurance Programs
Changing Organisational Culture
Use of Financial Incentives
Reform Challenges
Hospital Buildings, Designs
Hospital functions
Barriers to change
Crucial QuestionsI. Why are hospitals created?• Has the growth in knowledge & technology
invalidated the 19th century foundations?• What do we mean by Hospital?
II. If hospitals are to be integral parts of healthcare system?
What should they look like?
How should they be distributed?
What should they look like inside?
How can hospitals be designed in ways that enhance their performance (outcome & economic)
Questions………
Why do some hospitals seen to work well where as others not?
How can hospital performance be optimized?
Hospitals are not black boxes but are complex adaptive human systems
Why Hospitals?Changing pattern of diseasesChanging life styleChanging environmentTechnology advancementClinical specialtiesFinancially-50% of overall healthcare expenditure is for hospitalsOrganizationally-Dominate the health care systemSymbolically-viewed as main manifestation of healthcare system
Challenges
Scarce resources in terms of skilled staff and equipment hence needs concentrated facilities. Not dispersed across small facilities
To provide care rather than cure. Care requires people rather than equipment, generalists rather than specialists. Access is more important
What Should a Hospital Look Like?
Configuration of hospital services-Centralized or Dispersed
Centralized-High volume-Better outcome and Economies of scale
Dispersing Hospital-Improves access and reduces inequalities
Greater Volume-Better Health Outcome
Practice make perfect
Selective referral
Greater specialization than the size
Process of care is important than just the outcome
Physician volume or Hospital Volume
(Collective expertise of the entire team)
Economies of Scale & Scope
For ConcentrationLarge hospitals (200-400 beds)Different specialties under one roofLinks between different specialtiesOptimal use of expensive equipment
Against Concentration:Reduce access to careAccess is more important in primary care, out patient services and screening programmes
Improving Clinical PerformanceIncentives for optimizing clinical performance
-Quality Assurance Models
-Clinical Audit
-Clinical Governance (Managerial and Clinical responsibility)
Clinical behavior is resistant to change
No change following conferences/short educational events
Behavioral change-Range of interventions
Organizational Environment
Relationship between organizational culture and quality of care
Better relationship b/w Doctors and Nurses
Organisational and Professional job satisfaction
Patient centered culture
Effective collaboration
Open approach to problem solving
Changing payment mechanisms
The ideal mechanism would be one that offered incentives for producing effective, efficient and equitable treatment, with no perverse incentives and with minimal transaction costs
A perfect system is not achievable, since there are inevitable tradeoffs
Financial incentives, while good at pushing behavior in a certain direction, are less good at putting limits upon financial motivation
Looking ahead
What the hospital of the future should look like?
Will we still need the hospital or can its functions be performed elsewhere?
Factors-Changing burden of disease
Emergence of previously unknown disease
Size of the workforce in healthcare
Development in Technology
Hospital of the Future
The hospital of the future must respond to all these challenges. It must balance economies of scope with optimal access, drawing on advances in technology.
It may need fewer beds, but it will need more operating theatres and recovery areas………
The hospital need to be flexible, because the diseases it treats and the ways in which it treats them will be very different from those of today
