The hospital of 2030

Hospitals could have the best inventions in the world, but if they were not introduced in the best interests of patients, they would not be beneficial, Dr. Magda Rosenmöller, Academic Director, IESE Business School, the graduate business school of the University of Navarra in Spain, told the Conference.

Dr. Magda Rosenmöller
Dr. Magda Rosenmöller

She said one of the key messages she would like those attending to take away was that hospitals must be patient orientated.

This was as true now as it was in 1910. when William J Mayo, one of the founders of the Mayo Clinic said, ‘The best interest of patients is the only interest to be considered.’
Dr. Rosenmöller was speaking on “Healthcare Excellence and Integrated Care.”

Advertisement
RCSI Leadership

She said the triple aim of the Institute for Healthcare Improvement initiative was better health care, to be achieved with the best use of available resources, as we would never have enough resources and to create the best patient experience possible.

If patients had a better experience it would have an impact on their health.

The IHI had carried out a study with two of the leading hospitals in Europe, in Barcelona and Stockholm, and asked many of the leaders how they saw the future of hospitals and healthcare in 2030 and how we could prepare for this.

“We have 14 key messages from this report that encapsulate the most relevant ideas of a new role for leading public hospitals in Europe.

“Leading hospitals are expected to initiate or evolve a new role as orchestrators in a network of healthcare, as facilitators of innovation and research, and advisers for re-designing healthcare processes.”

Leading hospitals would also be expected to build a network of care provision, co-ordinating care in the network and leading the redesign of processes and services.

Dr. Rosenmöller said that in the next 15 years hospitals would have to respond to a challenging context in which citizens’ demand for healthcare services would be increasing, with chronic conditions representing a great part of healthcare costs and life expectancy continuing to improve.

Leading hospitals would be expected to provide excellent complex care, while reducing costs and also to develop a new scope of services, including personalised medicine treatment and genome-based diagnosis and treatments.

There would also be an opportunity for hospitals to deliver new services for chronic and population health management, as health insurers would develop new contract schemes such as chronic disease management service, which might include monitoring, treatment and management.

Leading hospitals would also be expected to build a network of care provision, co-ordinating care in the network and leading the redesign of processes and services. They would have to be aware of, and adapt to, any changes in society’s values and expectations.
New professional roles would emerge. These services would be provided by a more complex organisation, but one that was smaller in terms of activity, where more complex activities would be shifted away to smaller providers in the network. Medical doctors and others were needed to take on a leadership role.

“One of the things which came out of the Hospital for the Future report is that hospitals may be one of the driving forces They have a role as a knowledge driver and connecting with care outside the hospitals, but hospitals that do best are those who realise they must drive change.

“A lot is happening in the area of technology, for example, a new way to treat Alzheimer’s which might revert some of the symptoms.”

Dr. Rosenmöller said we should also think about the healing architecture of the hospital of the future, how it would be laid out, the material which would be used. There was a very interesting experience in using healing materials in a hospital in Boston, where they had also integrated a garden into the space.

Medical staff could develop professionally by using technology. An interesting aspect was coaching. In one hospital, the surgeon queried why leading tennis players had coaches, while leading surgeons didn’t. He said he wanted a coach in the operating theatre.

To achieve operational excellence, with buy-in from patients, nurses and doctors, it was important that we joined forces between different organisations, hospitals, home care and primary care and designed processes so that they really benefitted patients.

The patient experience was a vital element. There were portals where patients’ views were sought but we also needed to actively ask patients how they felt services should develop. “We don’t have enough resources inside the health sector, so let’s get patients and families to help us.”

Dr. Rosenmöller said that an example of how services could be developed was an initiative on the care of chronic disease in the Basque country. In four years, they had made fantastic progress – they introduced risk stratification of the population to help ascertain the patients most likely to need admission and how this could be prevented. They put technology in people’s homes, with a red button they could press when they had an emergency and they reduced acute hospital care access.

They tried to use health impact bonds, which uses tomorrow’s money to make changes today.

“The message here was how policy could allow the creation of an environment to facilitate change, but it requires the investment of resources.”

Another initiative in Spain centered on diabetes prevention. The health service worked with the whole community on ways to encourage people to be healthier, more physically active and to have better nutrition.

“They tried to use health impact bonds, which uses tomorrow’s money to make changes today. The basis for this is that if they don’t need the money in five years, they will pay it back. This is a wonderful way to think about how we can achieve a better outcome and allows incentives to make a difference in the future.”

Dr. Rosenmöller said another initiative was the cross-world network to provide a second medical opinion, which was used by a number of private companies, but could make a difference in the public system. This was part of the health insurance cover and was really patient orientated.

For example, they had a rare diseases network, with a case manager who would contact a network of experts across the world. Not only were they able to make correct diagnoses but in terms of economic impact they reduced the cost of treatment by earlier diagnoses.
Another example of innovation were the dancing grandmothers in South Korea, where people up to the age of 90, some on crutches, benefitted mentally, physically and emotionally from getting together to dance.