Hospital of the Future Report Urges Major Changes

A report released today from The Joint Commission offers guiding principles and actions for the hospital of the future to meet the daunting challenges of older and sicker patients, patient safety and quality of care, economics and the work force. As these challenges escalate, hospitals can lead the effort to meet these demands.

“Healthcare at the Crossroads: Guiding Principles for the Development of the Hospital of the Future” contends that hospitals must respond in new ways as escalating healthcare costs are hitting record highs and the conditions and care needs of hospitalized patients are growing more 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, MD, MPP, MPH., president of 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 Joint Commission has brought together broad expertise in healthcare to point to directions for optimizing healthcare in hospitals. Hospitals have an enduring role in the delivery of healthcare and have provided major contributions to enhancing the treatment of disease,” says Herbert Pardes, MD, president and CEO of New York Presbyterian Hospital and New York Presbyterian Healthcare System and roundtable chair. “Looking forward, this white paper describes issues ranging from technology to personnel, patient relationships, and fiscal and architectural design among many other ways hospitals can enhance healthcare for all patients.”

The report recommends action in five core areas:

 Economic Viability

While some hospitals today enjoy healthy profit margins, many hospitals continue to be unprofitable. There is a growing gap between the have and have-not 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 both fulfill the social mission for healthcare delivery

Technology Adoption

Information technology plays a major role in improving healthcare quality and safety, and can help to 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

Patient-Centered Care

It is the patient who is at the center of care. The patient has the greatest stake in their care and as such, should be respected as an equal partner in their 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

Staffing

Work force 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

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 work flow and patient safety, and 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 www.jointcommission.org.