Providing health care in 2030: a new role for public hospitals

How can hospitals deliver better care to more patients at a lower cost? A 2015 study by IESE and Accenture takes a close look at the new role that Europe's leading public hospitals will be playing in the future health care system.

Europe's leading public hospitals are facing growing challenges. As populations grow older and resources grow scarcer, the pressure is on to change for the better. To this end, Europe's top hospitals should shed more routine work to become smaller, more specialized and more flexible, with health care provision spread out across communities.

These are among the recommendations from a study by CRHIM, the Center for Research in Healthcare Innovation Management, a joint initiative of IESE and Accenture. The study was carried out from 2013 to 2015 by Jaume Ribera, Gabriel Antoja and Magda Rosenmöller of IESE, along with Pablo Borrás, executive director of Accenture. Based on interviews, surveys and workshops with hospital executives and key stakeholders, the study aims to help prepare hospitals for the decades to come.

Two takes on 21st -Century challenges

The study focuses on two public hospitals: Karolinska University Hospital in Stockholm, Sweden and Hospital Clínic of Barcelona (HCB), Spain. These two were selected as leading hospitals in Europe based on their long-standing track records for safety and high-quality service combined with the complexity and range of their offerings. Both also serve as reference hospitals for their communities and are recognized for their excellence in innovation. For Ribera et al., working with two leading hospitals allows for in-depth questioning as well as comparisons to bolster findings.

"The Hospital of the Future" has been a hot topic recently. The co-authors first consulted the growing body of research and conducted interviews with top hospital executives as well as with other executives and policymakers working with the hospitals in order to identify the most important drivers of change. They then turned to online surveys and finally group workshops to prioritize the most pressing issues. The final recommendations aim to promote positive change and mitigate future risks.

According to the findings, preventive medicine is sure to become increasingly important in health care, with the development of genome-based diagnoses and related technologies. What's more, chronic health issues will increasingly be monitored remotely, via mobile apps and medical sensors. These technologies should allow patients to spend less time in hospitals, freeing up resources.

At the same time, a number of factors are making it increasingly difficult for leading hospitals to deliver health care effectively. Namely:

• Some European governments have been steadily cutting health care spending (as a percentage of GDP), increasing the pressure to cut costs while maintaining outcomes.
• Increasing workloads and stagnating salaries have contributed to a shortage of qualified professionals, particularly nurses and therapists.
• Many patients increasingly expect to be treated like customers, with their convenience taken as a priority.

The implications of these challenges and changes are stark. Without decisive and well-planned actions, health care services could become stretched beyond their limits. But with the right moves, positive change is possible.

Hubs of health care networks

The report suggests an overhaul of the way health care is delivered. Leading hospitals should become smaller, focusing on complex services which require specialist knowledge or technologies. The rigid boundaries between medical departments should be broken down, allowing resources to be shared between them more flexibly.

Meanwhile, routine work should be undertaken at lower costs by community hospitals and clinics. Leading hospitals need to build stronger links with these community health care providers, sharing clinical expertise within these networks. Case managers then become increasingly important, coordinating patient care throughout the system.

The report also suggests that leading clinicians and other health professionals should be incorporated into the hospital management structure. To that end, it recommends that clinicians and other professionals receive more training in management and communication skills. New career paths should allow them to move upwards into management without any loss of status.

The specific recommendations also include the following:

• Leading hospitals need to strengthen their partnerships with universities, businesses and other hospitals. This would allow them to continue to act as research hubs and training centers, while benefiting from networks of experience.
• Hospitals should engage with patient advisory councils to improve patient experience, especially when redesigning health care provision.
• Decisions should be made locally and closer to the level where problems arise.
• Leading hospitals need to design new ways to deal with ever-increasing bodies of clinical knowledge. New technologies should allow them to filter this information and rapidly disseminate it to professionals throughout the health care network.

Transforming the health care landscape

Taken together, the study proposes transforming the role of leading public hospitals, moving them away from the provision of routine care. Instead, they would become multidisciplinary centers of excellence, receiving referrals of difficult cases and coordinating health care provision throughout the community.

In addition, clinical staff should be brought into management, allowing their medical experience and expertise to inform health care planning. At the same time, patient satisfaction should be put at the heart of decision-making. Hospitals will need to embrace new technologies in order to monitor and treat patients efficiently.

Transforming the health care system is likely to be a difficult task, especially given the current realities noted by the authors. However health care providers must take this task seriously, and this report will provide them with much food for thought.

14 key messages re: leading hospitals' new role

1. Leading hospitals will strive in a challenging context with a combination of an increase in healthcare needs, a decrease in resources, and changing social values.

2. Leading hospitals will be expected to focus on high-value and highly complex services and to become highly efficient organizations, without requiring high activity volumes.

3. Leading hospitals will embrace new services such as personalized medicine and genome-based diagnosis, with a broader scope of services, which may include chronic care management.

4. Leading hospitals will provide complex services to referred patients and also manage the provision of acute services in a catchment area.

5. Leading hospitals' knowledge will play a central role in the knowledge-driven redesign and planning of healthcare services.

6. Leading hospitals will not be defined by the physical structures and will be organized so they deliver services at different locations.

7. Leading hospitals will be reference centers for process and technology innovation and healthcare service design.

8. Leading hospitals will continue to be the main centers for research and for the education of new professionals, which means generating knowledge and capabilities.

9. Leading hospitals will develop new risk-sharing models with insurers, industry and/or other providers.

10. Hospital professionals will actively participate in the strategy and leadership of the organization.

11. Leading hospitals will be organized into process-oriented teams and seek to create integrated care models (either virtually or merging companies).

12. Improvement of the patient experience will lead to connected hospitals where case managers will reach out to coordinate care for patients at home.

13. Leading hospitals will need health coaches, genetic counsellors, disease specific case managers, information management experts and “med-engineers.”

14. Leading hospitals will systematically redesign the service experience with innovation to become really patient centered.