Walk through a few hospitals or, better yet, follow a patient through a few. Here's what strikes you: Hospitals all look, feel and function remarkably alike. In many ways, and despite the ongoing technology revolution, the visible and physical design of hospitals has changed less than you might imagine over the past 30 years.
The big question is: Are we in for more of the same as we rebuild our national hospital infrastructure or are we on the cusp of the hospital of the future? What should the hospital of the future be, given that form should follow function? With dramatic changes to financing alongside a significant influx of new patients, and an aging existing hospital infrastructure, it is appropriate for national health care leaders to think carefully about the next generation of hospitals. So, with that backdrop, how do we think about the hospital of the future to best learn from the past, but also to prepare for an unknowable future?
Patient-centered care, flexible space and evidence-based design make great sense and should be pursued with vigor. These three themes typically dominate the discussions of the hospital of the future, and rightly so, in our estimation.
Three other concepts also might be worth careful contemplation: the connected, service and value enterprises. The unifying theme is using clinical and information technology better, faster and smarter to integrate and make those three concepts come alive. In other words, advances in technology drive our hospital care system toward breakthroughs that change the game in those areas that matter the most.
The Connected Enterprise
While the quest to connect patients through electronic health records has become a goal for every institution, the connected enterprise represents both a deeper and broader aspiration than simply carrying historical data along with the patients. It says that clinical care devices, information systems, workflow systems, and patient and family communication systems should integrate more seamlessly in both time and space.
Numerous technological advances may help push this concept. For example, new sensor technologies will provide more real-time and mobile monitoring. Instead of a nurse taking a patient's blood pressure and pulse periodically, a mobile sensor monitors those vital signs continuously. And instead of a patient checking his or her blood glucose, a portable sensor monitors it continuously. When changes happen, the information becomes available in real time to the entire care team — not just a nurse or the central station monitor.
Further, telepresence robots already can help extend the reach of care teams so that all members are able to interact in real time with patients whether they are in the hospital, at home, in town or in a rural community.
Patients often feel disconnected in the hospital, despite being surrounded by caregivers, specialists and technology, and hooked up to an array of machines. This paradox has puzzled us for years but seems to result from being episodically managed rather than comprehensively engaged by the health care system. This is no one's fault; the processes and incentives, the spaces and technology, have led to care that produces this feeling in patients. So, the mindset shaping the hospital of the future should be better integrated space, technology and processes all focused on seamless communication during, rather than following, care delivery.
The Service Enterprise
In many ways, this disconnected feeling dovetails perfectly with the service enterprise. The hospital of the future must treat service as a central principle and embed it in all the workflows throughout the enterprise, from delivering meals to transplanting organs. This is difficult in any organization and especially so in a hospital, but that's where new technology should be pursued rigorously. Great service relies on helping staff do their jobs effectively and efficiently; consistently delivering the desired outcome; and treating patients in a manner that acknowledges their humanness, not simply their biological status.
The hospital of the futures solves this by tackling issues such as patient alarms. As any patient and many nurses will tell you, alarms are a nightmare — literally, in some cases — because they go off throughout the night. They are a noisy, dinging challenge to a patient's restful night's sleep. Furthermore, it's a bit unnerving for the patient when he or she must ring the nurse call bell to get someone to respond after five minutes of uninterrupted alarm dinging. Meanwhile, nurses know that most of the alarms are nuisances, yet they cannot ignore or disable them without risking the patient's health.
This problem has become so serious that the Joint Commission in April published a Sentinel Event Alert on medical device alarm safety. Better clinical monitoring and alarm technology, better patient space design and better clinical care workflow are needed. Our technology-enabled hospital of the future focuses on solving this issue. The rooms are quieter, the nurses are happier and the patients are safer and well-rested.
The Value Enterprise
Technology should help the hospital of the future become value-driven. Though it has partially led to increased costs because we now can do more than ever before, hospitals must acquire clinical and information technology to create the value enterprise. They must improve outcomes and the patient experience while creating cost-efficiencies that help the masses — and the government — afford care.
Adopting new clinical or information technologies, and using existing clinical or information technologies can make a difference right now if we focus on longer-term value rather than shorter-term improvement proxies. Moving imaging closer in time and space to where it is most urgently needed, for example, would improve outcomes. If we combine imaging and real-time data analytics, we could eliminate unnecessary or redundant imaging studies by learning what makes a real difference in care and maximizing that gain to apply imaging in places where it will further improve outcomes or clinician efficiency.
Helping clinicians and caregivers become more efficient in the hospital of the future should be as important as purely improving patient outcomes because clinician efficiency allows room for concentrating behaviors and time on new areas of value. Better patient outcomes for individuals and better population health for communities become the ultimate benefit of the virtuous circle of continuous improvement. This is surely easier said than done. Nonetheless, when it comes to imagining the future of hospitals, we should remember two little words: Dream big.
Anthony J. Montagnolo, M.S. (amontagnolo@ecri.org) is executive vice president and chief operating officer of ECRI Institute, Plymouth Meeting, Pa.
