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The Role of the Hospital in a Changing Environment Bulletin of the WHO, 2000,78(6)

The Role of the Hospital in a Changing Environment Bulletin of the WHO, 2000,78(6). Martin McKee & Judith Healy LSHTM, London By: Keerti Bhusan Pradhan keerti@aravind.org. Summary. Hospitals a challenge in Healthcare Reform Evolving role of hospitals Changing Healthcare Needs

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The Role of the Hospital in a Changing Environment Bulletin of the WHO, 2000,78(6)

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  1. The Role of the Hospital in a Changing EnvironmentBulletin of the WHO, 2000,78(6) Martin McKee & Judith Healy LSHTM, London By: Keerti Bhusan Pradhan keerti@aravind.org

  2. Summary • Hospitals a challenge in Healthcare Reform • Evolving role of hospitals Changing Healthcare Needs Emerging Technologies Size and Distribution of hospitals

  3. Essence of the Article • Hospitals must continue to evolve in response to factors • Changing healthcare needs • Emerging Technologies

  4. Key Reform Strategies • Behavioral Interventions-Quality Assurance Programs • Changing Organisational Culture • Use of Financial Incentives

  5. Reform Challenges • Hospital Buildings, Designs • Hospital functions • Barriers to change

  6. Crucial Questions I. 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)

  7. 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

  8. Why Hospitals? • Changing pattern of diseases • Changing life style • Changing environment • Technology advancement • Clinical specialties • Financially-50% of overall healthcare expenditure is for hospitals • Organizationally-Dominate the health care system • Symbolically-viewed as main manifestation of healthcare system

  9. 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

  10. 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

  11. 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)

  12. Economies of Scale & Scope For Concentration • Large hospitals (200-400 beds) • Different specialties under one roof • Links between different specialties • Optimal use of expensive equipment Against Concentration: • Reduce access to care • Access is more important in primary care, out patient services and screening programmes

  13. Improving Clinical Performance • Incentives 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. THANK YOU

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