Report Urges Changes for Future Hospitals

Nov. 26, 2008

A report released from Oakbrook Terrace, IL-based The Joint Commission offers guiding principles and actions to help future hospitals meet the challenges of older and sicker patients, patient safety and quality of care, economics, and the workforce. As these challenges escalate, hospitals can lead the effort to meet these demands.

Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future contends that hospitals must respond in new ways as healthcare costs are hitting record highs and the conditions and care needs of hospitalized patients are increasingly complex. The report is the work of an expert panel comprising hospital executives and clinical leaders, as well as experts in technology, healthcare economics, hospital design, and patient safety. The roundtable analyzed how socio-economic trends, technology, the physical environment of care, patient-centered care values, and ongoing staffing challenges will impact the hospital of the future.

"The importance of hospital-based care will not diminish in the future, but hospitals will have to meet the high expectations of the public and all stakeholders in an increasingly challenging environment," says Mark R. Chassin, president at The Joint Commission. "As they have been in the past, hospitals must be equally transformative as the future unfolds. The Joint Commission urges hospitals and public policymakers to use the principles in this report to achieve that aim."

The white paper describes issues ranging from technology to personnel to architectural design, and recommends action in five core areas ... a few of which involve the facilities themselves:

1. Economic Viability
There is a growing gap between the profitable and unprofitable hospitals. An aging population and a continuing decline in employer-sponsored insurance means that hospitals can expect increases in publicly insured patients and uncompensated care. This is expected to create more competition for the fewer patients to whom costs may be shifted. For hospitals to be economically viable in the future, the following principles must be pursued by hospitals, healthcare stakeholders, and policymakers:

--Align performance and payment systems to meet quality and efficiency-related goals.
--Use process improvement tools to increase efficiency and reduce costs.
--Pursue coverage options to ensure patient access to, and affordability of, healthcare services.
--Address how general acute hospitals and specialty hospitals can fulfill the social mission for healthcare delivery.

2. Technology Adoption

Information technology plays a major role in improving healthcare quality and safety, and it can help support the migration of hospital-based care into the community, and even the home. The technological transformation of healthcare also invites the redefinition of the hospital, according to the report. To address technology in the hospital of the future, the expert roundtable suggests the following:

--Make the business case and sustainable funding to support the widespread adoption of health information technology.
--Redesign business and care processes in tandem with health information technology adoption.
--Use digital technology to support patient-centered hospital care and extend that care beyond the hospital walls.
--Establish reliable authorities to provide technology assessment and technology investment guidance for hospitals.
--Adopt technologies that are labor-saving and integrative across the hospital.

3. Patient-Centered Care

The patient is at the center of care and has the greatest stake in his or her care and, as such, should be respected as an equal partner regarding care. The elevation of the patient to partner is not a ceremonial title bestowed for a "feel-good" moment, but has significant implications for the quality and safety of patient care. Family members or others to whom the patient is emotionally tied are also part of the healthcare partnership. According to the report, achieving patient-centered care should be driven by the following actions:

--Make adoption of patient-centered care values a priority for improving patient safety and patient and staff satisfaction.  
--Incorporate patient-centered care principles into the activities of hospital oversight bodies and transparency initiatives.
--Address barriers to patient and family engagement, such as low health literacy and personal and cultural preferences.
--Eliminate disparities in the quality of care for minorities, the poor, the aged, and the mentally ill. 
--Improve the quality of care for the chronically ill through coordinated, multi-disciplinary care.
--Use robust process improvement tools to improve quality and safety.

4. Staffing

Workforce shortages have persistently plagued hospitals over the last several years. To address the fact that demand for certain healthcare professionals outstrips supply, and to meet the needs of patients in the future, the report makes the following recommendations:

--Establish fair migration and compensation policies for countries facing shortages of healthcare workers.
--Expand health professional education and training capacity to accommodate the growing demand for healthcare workers.
--Create workplace cultures that can attract and retain healthcare workers.
--Develop professional knowledge and skills necessary in a more complex healthcare environment.   
--Educate health professionals to deliver team-based care.
--Develop the competence of health professionals to care for geriatric patients.

5. Hospital Design

Hundreds of studies have revealed hospital design characteristics that work for improving patient safety and healthcare outcomes and providing a supportive environment for hospital staff. Yet, most new hospitals are not being built "safe by design." To achieve this goal, the report calls for the following actions:

--Improve safety with evidence-based design principles, such as single rooms, decentralized nursing stations, and noise-reducing materials.
--Address high-level priorities, such as infection control and emergency preparedness, in hospital design and construction.
--Include clinicians and other staff, patients, and families in the design process to improve staff workflow and patient safety, and to create patient-centered environments.
--Design flexibility into the building to accommodate advances in medicine and technology.
--Incorporate green principles in hospital design and construction.

The full report can be found at

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