I’m a pretty healthy guy, but I have spent much of my life in and around hospitals. My mother volunteered for one local hospital, and my father served on another’s board.
I decided to study health services management in graduate school and have worked in and with hospitals ever since. But what it means to be a hospital today is vastly different than in my youth. And tomorrow’s hospitals will redefine that meaning further.
At the end of this year, I will retire as president and CEO of the American Hospital Association, the organization that represents some 5,000 hospitals and health systems across the U.S. It’s a great time to look at how hospitals have changed during the past four decades, and more significantly, how they will continue to change to meet the future needs of Spokane and other communities.
On a clinical level, we’ve made dramatic advances. New technologies and treatments mean that we routinely cure many conditions in patients who were once without hope. We also can restore good quality of life to patients who otherwise, after an illness or injury, would have spent the rest of their lives struggling with the tasks of everyday living.
But the most remarkable transformation that has taken place in America’s hospitals over my career is in the culture. “Patient-centered care” is the term we use now to describe a mindset that empowers patients to make decisions about their own care and empowers health care workers to focus on quality and safety improvements through much higher levels of coordination and communication.
One result of this transformation is that physicians, nurses, and other clinical staff who once worked in professional silos are increasingly working as teams. We call this clinical integration, and it’s the catalyst for profound improvements in patient care.
Team-based care is more efficient; sharing information about a patient lessens the chance of duplication of services and of “fumbles” in patient care “handoffs” and increases the use of protocols shown to improve patient outcomes. Clinical integration also helps hospitals develop and implement best practices, and that is making it possible to make dramatic progress in tackling some stubborn problems that have plagued them for years, such as health care-associated infections.
Moving forward, hospitals are focused intensely on achieving three critical goals: improving the patient care experience; improving the overall health of the community; and reducing the per-capita cost of health care. Accomplishing those goals simultaneously means accelerating the pace of change even further.
For years, we’ve been moving toward a system that is more integrated, with hospitals, physicians, and post-acute care providers combining forces to create true systems of care. Payments are more at risk as we move away from the fee-for-service model we’ve had for decades to a system that rewards value and outcomes.
Health care also is becoming far more accountable and transparent about quality and pricing. Hospitals have strived to do better with less but are now actually trying to do less with less — less intervention and more prevention — as payments diminish and the focus shifts away from treatment and toward health.
This has established the foundation for the next generation of transition. What will it look like?
The clinical gains we have made in health care are associated with tremendous costs for specialized equipment and services. By combining in some fashion rather than duplicating these resources, hospitals can continue to provide patients with the most promising advances in treatment.
As a result, more hospitals are part of health systems that share resources and focus on the right care, in the right location, at the right time, all in order to deliver the best care with the best value. And this trend will accelerate.
Every hospital will need to determine the path forward that makes the best sense for it and its community. Some hospitals will form strategic alliances with other health care providers, merging with or acquiring them to offer patients the best they have to offer.
Expect to see more hospitals develop a health insurance function and still more to branch out into areas such as behavioral health, home health, or post-acute, long-term, or greater ambulatory care. Other hospitals will choose the opposite route — to specialize in a single area where they can become a high-performing provider of essential services. Examples are children’s hospitals and rehabilitation centers.
No matter which route a hospital takes, expect to see it become increasingly involved in efforts to improve the health of the community it serves. Hospitals will define themselves less by the walls of their buildings and more by the health of their communities.
We have an aging population and a growing number of people of all ages with chronic conditions like diabetes and asthma. There’s a lot of room for improvement by engaging people in preventing and managing chronic conditions and employing new technologies like telehealth.
Also, some 40 percent of premature deaths stem from unhealthy behavior. By finding effective ways to help people make better choices and stay healthy, hospitals can have a huge impact in controlling the growth of health care spending.
Health information technology and electronic health records, done right, will provide hospitals with new ways to improve the quality of care.
So in the years ahead, hospitals will undergo nothing short of full transformation. The demands are daunting, but the opportunities are great, the excitement is contagious, and the commitment to communities is immense.
It has been a tremendous privilege to spend my career with the women and men of America’s hospitals — great people who are willing and able to do whatever it takes to deliver the highest quality care.
Rich Umbdenstock is the president and CEO of the American Hospital Association. He previously had served as president and CEO of Providence Services Corp., of Spokane.
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