Multiple, intersecting environmental forces will drive the transformation of health care delivery and financing over the next decade, say industry experts. Changing demographics, increased health care spending, the shift to value-based reimbursement — these forces and others are putting unprecedented pressure on hospitals and health systems. A new report from the American Hospital Association identifies strategies and core competencies for hospitals to pursue in planning for the future. One academic medical center exemplifies a path for trustees in leading long-range planning.

Must-do Strategies

The AHA Committee on Performance Improvement focused its attention on the "hospital of the future," conducting interviews with AHA constituency groups and policy boards. The results are aggregated in the report "Hospitals and Care Systems of the Future," which identifies 10 must-do strategies for the field to implement. The first four strategies are considered major priorities.

  1. Aligning hospitals, physicians and other providers across the continuum of care
  2. Utilizing evidence-based practices to improve quality and patient safety
  3. Improving efficiency through productivity and financial management
  4. Developing integrated information systems

The CPI report also outlines seven core competencies in care delivery and organizational management. These competencies range from engaging employees' full potential to creating accountable governance and leadership.

Competencies Self-Assessment

The report highlights self-assessment questions for hospitals to track success in mastering each competency. For example, questions for one such competency, "strategic planning in an unstable environment," include:

  • Do we have a clear and compelling vision?
  • Do we have a plan and timeline for moving toward value-based care delivery?
  • What size and scale of our organization will be sustainable in the future?
  • Are we using scenario-based planning techniques to monitor key changes in our assumptions and making necessary adjustments?
  • Do we assess the health needs of the community we serve? Do we also identify potential partners to improve access to necessary care?

The Horizon Committee

Overcoming the unstable health care environment to plan successfully for the future: That is the work of the Horizon Committee at Albany (N.Y.) Medical Center. After a board retreat several years ago, the committee was created to take a long-range look at the medical center and its future. "We are good at strategic planning, but had limited it to three years," says James J. Barba, president and CEO. "Being in a very volatile industry, it was important to think beyond that horizon." The 18-member committee includes board members, senior leaders and community members not on the board.

After identifying and prioritizing the "essential charges" most critical for the medical center's future, the committee first focused on maintaining and funding Albany Medical College, explains John B. Robinson Jr., former board chair and current Horizon Committee chair. The committee developed a 15-year budget for the medical college, which was adopted. Recently, committee members have discussed accountable care organizations and other alternative forms of care delivery. According to Robinson, "Our committee is a forum to have discussion and debate on emerging trends and be on top of things as they develop."

Barba believes this work is critical and doable. He adds, "It requires a lot of imagination and cooperation. It is absolutely possible to take a longer-range look — even in a volatile industry like health care — and decide, if not specifics, general themes and how themes might sort out and impact one's institution."

To download "Hospitals and Care Systems of the Future," visit and click on "Performance Improvement," then "AHA Committee on Performance Improvement."

Jill Seidman, M.P.H. (, is program manager and Cynthia Hedges Greising ( is communications specialist, both at the Health Research& Educational Trust, Chicago.