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A1; 1/2018 www.advanceinstitute.cz


21st Century Hospitals: New Roles and Challenges Jim Rice

Jim Rice, Gallagher Integrated | 11. 9. 2018



The roles and scope of acute care hospitals are changing throughout the World. The recent International Health Summit in Prague surfaced five big forces that are changing the work, designs, services, staffing and technologies of hospitals. Our definition of a “hospital” is morphing as our societies explore and master monumental shifts in demography and technologies. Policy and executive leaders are at the edge of exciting but potentially unnerving transformations.

No longer just a facility providing services to people acutely ill or injured, 21st Century hospitals will look and behave differently than the hospital of today


Five transformative pressures on hospitals are:

1. An accelerating aging of societies is driving a resultant explosion of chronic disease with co-morbidities of diabetes, cancers, cardio-vascular dysfunctions, obesity and related orthopedic concerns.


2. A shortage of traditional health care professionals (especially primary care physicians and nurses) is elevating the need for hospitals to invest in new numbers and types of health care workers, such as:


• Advance practice nurses  

• Chronic care, in home assistants

• Consumer help telephone call centers and support staff 

• Community health promotion and protection specialists 

• Value based contract managers 

• Population health partnership designers 

• Wearable technology maintenance technicians 

• And many more 


3. A globalization of information via mass media stories and programs on medical care and facility design advances are stimulating demand for innovation among citizens, patients, and providers for an ever increasing use of expensive new diagnostic technologies, minimally invasive procedures, new electronic medical and health records, and more personalized DNA medical guided interventions.


4. Accelerating reliance on mobile devices for monitoring and managing health status and the impact of medical interventions is catalyzing decentralized care into the person’s clothing, into the home, workplace, and new forms of ambulatory care centers.


5. Advances in facility and process designs that enable and encourage smaller “Micro-hospitals” in more decentralized points of care access in both urban and rural communities.


As a result of these pressures, the hospital of tomorrow will be recognized as a valued concentration of technological, human, and financial resources beyond its historical focus on patients in its beds. Each country’s governmental, commercial and NGO communities need to consider how best to unleash these centers of resource concentrations to embrace and accomplish the following three transformations in hospitals over the coming 5-25 years:


Transformation One: Hub of System: The hospital must position itself less as a building in which patients enter, but more as an organizational hub of a system of services, community based micro-hospitals, financial support, and medical, pharmaceutical and information technologies. The role of this system is to protect, promote and restore health to people along a continuum - from home to physician’s office, to acute inpatient facilities to rehab and recovery centers. This will require new care delivery models and care management processes by teams, as well as new forms of facility design, capital financing, maintenance of technologies, new management structures and systems, empowerment of new health workers with new skills and workplace cultures and different payment mechanisms from health insurance companies.


Transformation Two: Alliances for Health Improvement: Hospitals must invest into their electronic medical records and cooperate with health insurance companies and other to build community health and population health records, that inform and enable Health Cities, that unleash private and governmental innovators for healthy homes, schools, workplaces, neighborhoods and highways. In this cooperation of hospitals, health insurance companies and other providers new governance structures and decision-making processes should be developed to re-allocate scarce resources among competing needs for jobs, education, safety, and cultural enhancements.


Transformation Three: Center for Venture Financing and Innovation. Because hospital in low and high income countries represent and unusual concentration of resources, debate is needed about how these concentrations of human, technological and financial resources can be redirected by ”Human Centered Design” to support not only new chronic care management processes, but re-thinking the way care is organized and financed in communities and nations. The assertive mindsets and disciplines of venture capitalists can be called into the discussion how hospital medical, executive and governance leaders allocate their resources for health gain, as well as health care.


Many in the Summit recognized, however, that it will be extremely difficult for the hospital to make such transformations on its own until reforms occur in such diverse and complex arenas as: public policy for public safety, less inter-demographic and cultural tensions and violence, life-style changes addressing childhood obesity, water and air pollution, broken health insurance systems, more stable political situations, and growing economies.


It will be these constructive and challenging debates that will enliven the work of health system and hospital leaders in the coming decade! These challenges should simulate participants in the Prague Summit to continue their cross-national conversations, exchanges and innovations. These challenges may also shape the agenda for the Prague Summit in 2020. 






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