Well, that was some fall, what with the shutdown of the federal government and the whole brinksmanship thing over default. All it did was cost the U.S. economy $23 billion, give Uncle Sam a blacker eye around the world and prompt Americans to ask, "Who elected these jokers?" Oh, yeah, that would be us.

In case you didn't notice, the Affordable Care Act came out unscathed. Yes, there was the little matter of massive computer system malfunction, but, hey, nobody said this was going to be easy.

Here at Hospitals & Health Networks and in our e-newsletter, H&HN Daily, we've been striving to keep you up-to-date about the ACA and all the other factors converging to transform health care, not all of which are government-related. Advances in technology and treatments, as well as consumer demand, also are forcing change, and so are demographic and sociological trends.

On Page 38, we wrap up our yearlong Generations in the Workplace series in which we examined the challenges of four different generations working side by side in hospitals. You can read Laura Putre's five previous articles in the series by going to www.hhnmag.com and clicking on the Generations bar on the left. In my reading of the series, three general takeaways emerged, none of them earth-shattering to those of you leading hospitals, but all worth keeping in mind. They are:

1 | Jobs will change. You will need to rethink how you staff your organization as more care occurs outside the hospital. You will probably need fewer beds and definitely tighter connections with other providers, whether you own or otherwise affiliate with them. To meet quality standards and reduce unnecessary readmissions, you will need more effective discharge planning, more aggressive follow-up communication with patients and their caregivers, and better community outreach. And you'll need employees with the skills to successfully carry all that out.

2 | Your nursing staff will change. Baby boom nurses have a wealth of experience and institutional knowledge that you will want to utilize for as long as possible. Hospitals are offering veteran nurses flexible shifts and less strenuous tasks, and making it clear how much their hard-earned skills are valued by leadership and colleagues. At the same time, Gen X and millennial nurses bring a comfort with technology, from social media to telemedicine. Technology will drive new and better ways to deliver care, and nurses, as always, will be at the forefront of making it happen.

3 | Your medical staff will change. A growing number of doctors are opting for hospital employment, where the pay is steady and set shifts allow the work-life balance they desire. Hospitals are moving more physicians into the C-suite not only to improve medical staff relations, but also to lead efforts to improve quality-of-care initiatives. As physicians increasingly balk at on-call duty, more hospitalists will fill the gap. Hospitalists also are taking more responsibility for quality improvement. The shortage of primary care doctors will intensify the demand for physician assistants and nurse practitioners. Pharmacists will become core members of the clinical team, joining in patient rounds and more actively advising on individuals' medication regimens. And, as Americans live longer, more physicians, nurses and other staff will need at least some basic training in geriatrics.

— You can reach me at bsantamour@healthforum.com.