What will the hospital of the future look like? That question was posed to American Hospital Association members recently to stimulate future thinking and to develop a clearer vision of where health care is headed and how hospitals can prepare and adapt. Size, configuration, workforce, reimbursement, and even the name "hospital" itself were considered in the feedback from members.
What emerged was a surprising consensus on key strategies and metrics that members consider essential as transformation moves forward. The "Hospitals and Health Care Systems of the Future" report, developed by the AHA's Performance Improvement Committee, includes 10 must-do strategies coupled with metrics of change that are seen as essential in the future state. The report is not a prescription for hospital health nor does it set a timetable for change. Rather, it is a broad look at the strategic planning, measurement and metrics as well as organizational competencies that will be needed to succeed as transformation proceeds.
The first four strategies are considered top priorities for hospitals:
- Physician alignment — getting in sync with doctors whose current incentives and view of the world may be very different from that of hospitals — is considered essential. A spectrum of alignment strategies may range from simply engaging greater physician leadership all the way to sharing financial risk in an accountable care organization or capitated contract. Engaging physicians as partners in the journey ahead is a top priority.
- Information systems that are intuitive, adaptable, and connect doctors to patients, colleagues and hospitals are viewed as fundamental to the hospital's future. Systems that facilitate excellent and efficient care but do not add to health care's complexity will form the e-network required to succeed.
- Quality and safety programs that grow in depth and strength to benefit the patient as well as the bottom line are a fundamental strategic priority. Saving patients from harm also brings savings in health care spending essential under global payments.
- Improving efficiency through productivity and financial management will require greater creativity than ever before as reimbursement shifts from a fee-based to a value-based system. The aging workforce, the demands of new technology and pressures on costs will create challenges that must be met to succeed.
Going from the current state to a future state requires new thinking and change, but how do you know when you have arrived? Performance metrics were developed to assist in measuring progress. The move from counting admissions to tracking the number of covered lives in risk contracts is an example of a changing metric. Examining expense per episode of care rather than expense per discharge is another example.
When an athlete shifts from one sport to another, different muscles are needed. Training and hard work develop new strengths to compete and win. Similarly, new competencies are required for leaders and staff to succeed in the future. Organizational core competencies of accountable governance and leadership, strategic planning in an unstable environment, and both internal and external collaboration are examples of those that must be mastered.
Change is rarely easy but often necessary for good health and a better future. America's hospitals are well on their way to creating an even stronger value-driven health care system for patients and payers alike.
Jeanette G. Clough is president and CEO of Mount Auburn Hospital in Cambridge, Mass.
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