September 2009 Issue #4
Hospitals of the future
The food is lousy. The décor, painfully minimalist. And the staff are so busy, they barely have time to exchange basic pleasantries with you – let alone be of service.
Sound like a stay at a hotel from hell? This is unfortunately the reality of many hospital visits today. While many hospitals offer formidable medical service, the quality of service on other fronts often leaves a lot to be desired.
The result is inefficient patient flows, dissatisfied staff and slower recovery rates. Bad hospital service can indeed damage your health.
Poor prognosis
The need for service improvement at public sector hospitals is undeniable and urgent. In the future, public hospitals will face an array of socio‐economic challenges, which together will present an unprecedented burden on the public sector.
Budget cuts will force hospitals to save money where possible. Hospitals will be understaffed. The elderly population will increase, as will the incidence of lifestyle diseases. And private hospitals, with their increasingly optimised service offering, will present tough competition.
Prescription for recovery
Change is underway at many hospitals – public and private – across the world. Recognising the economic, social and medical need for service optimisation, hospitals have set about trying to create the magic potion for service success.
Of course, initiatives vary. Some hospitals have chosen to focus investment in technology-driven initiatives such as electronic administration systems (Chang Gung Memorial Hospital, Taiwan) and telemedicine.
Others have chosen a more people-centred approach, developing facilities such as alternative breast cancer treatment (Beth Israel Hospital, New York) and recreative gardens (Glasgow Homeopathic Hospital, Scotland).
Some hospitals are taking communication so seriously, that they’ve established Twitter (Johns Hopkins Hospital, Baltimore) and web forums that allow patients to exchange knowledge and provide each other with emotional support.
Patient power and choice
Key to almost all successful service innovation initiatives at hospitals, however, is patient empowerment. Today there is a growing understanding that patients must and should be at the centre of any hospital service – and active too. Patient choice, activation and self-care are now widely recognised as a prescription for recovery.
Trends to watch
Just now there is a tendency that all new hospitals have an abundance of individual rooms. But is this wise? We need to ensure that patients don’t feel isolated and still have that all-important opportunity to exchange experiences and knowledge with other patients. Individual space is important, but should be supplemented with opportunities for social interaction.
Another trend is super hospitals – large, specialist institutions that replace local, community hospitals. This is a paradigm shift will place new demands on hospital service offerings. For example, it will become increasingly important to ensure that patients feel like individuals, not numbers. And inter-departmental communication will have to be both efficient and effective.
Innovation challenge
Hospitals are not easy environments for service innovation. Life and death are at stake every second, so patient health will and should be always the priority. Politics and hierarchy abound. Staff and resources are short supply. And as with any process of change, user groups will invariably oppose certain elements of service innovation.
In this context especially, it’s important to collaborate with patients, relatives and staff and test concepts in real-life environments. It also requires a brave and motivated management that supports the initiative and helps communicate its importance throughout the organisation. This will be how hospitals survive future challenges and grow stronger.
More to think about
How to get started
From ward to wonderland
Technology saves lives and money
Architecture that improves health
The Sarah Network is a network of hospitals in Brazil developed as a result of a unique partnership between medicine and architecture. Five hospital complexes – all with considerable bed capacity - have been built since 1980 and more are on the way.
This represents a massive contribution to a public healthcare system that has had to cope with the country’s many economic and political changes over the past 20 years. The hospitals contain the following architectural and construction elements:
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Green areas that allow for relaxation and outdoor exercise
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Daylight and natural ventilation
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Flexible, multi-functional areas
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Industrialised components and opportunity for expansion
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Flexible installations with maintenance procedures that disturb patients as little as possible
For example, Sara Fortaleza uses a steel construction system to create large, open rooms that can integrate various functions and are multi purpose. A curvy roof catches the daylight and allows for natural ventilation.
The hospitals are very visually appealing, but privacy is at a minimum. Do patients have the choice of being alone when they wish? While communal spaces are important for patient’s social and medical needs, private spaces can be key in securing patients’ individual identity and personal integrity.
From ward to wonderland
Right now Walt Disney is putting the final touches to a collection of Disney characters that will lend their magic to the new, three-story lobby of the Walt Disney Pavilion at Florida Hospital for Children.
Characters from “The Lion King” and “The Jungle Book” will have leading roles in the hospital’s interactive lobby, which is due to open early 2010.
Children will be able to draw on a cave wall, make jungle sounds on musical step pads, fish for virtual salmon or play in a magical world of popping bubbles and dancing sea horses. And each night as the sun sets, the lobby ceiling will transform into a celestial display to the sound of a musical score created by the young patients.
By 2011, units will open throughout the hospital with concepts, colours, sounds and themes inspired from the lobby.
The initiative is one of several collaborations between Disney and children’s hospitals in the U.S.. It aims to deliver a new service model based on creativity, interaction and fun – creating a healing environment and enhancing the patient experience.
“When kids and families come to our hospital, they will experience something different, and with the help of Disney, we are able to create an environment that will hopefully help improve the healing process for all paediatric patients,” said Tim Burrill, assistant administrator of Florida Hospital for Children.
But this will cost a whopping US$10 million. Is this money really well spent? What effect will it have on recovery rates or anxiety levels? It will be interesting to see whether this fantasy world has the healing effect as the creators claim.
A fantasy façade isn’t enough – even children can see through that. If this concept is to present a meaningful value proposition, the visual effects and physical surroundings must be supported by considered and seamless communication.
And what hope is there of applying this concept in a public sector hospital, where cash is strapped? While this model is inspired, it is unquestionably best suited to a children’s hospital with considerable funding. It would be interesting to see how elements such as interactive visual displays could be implemented in an adult context with a public budget.
Technology saves lives and money
El Camino Hospital is a completely wireless hospital that is well on its way to becoming paper and film free. The hospital estimates that the new system has saved them 120,000 dollars a year in medical costs and 300,000 dollars a year in avoidable errors.
The hospital’s wireless technology includes:
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Voice-activated communicators: Nurses and doctors use a small voice-controlled, hands-free device that they wear around the neck to communicate with each other. The device is made by Silicon Valley start-up Vocera Communications Inc.
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Biometric supply cabinets: A device that enables authorised personnel to open doors or cupboards for medicine and other medical items by reading a thumbprint.
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Automated laboratory system: Laboratory tests go through various ‘stations’ that together make up an automated production line. Staff call it ‘race track’. Automisation is made by Beckman Coulter Inc.
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Tablet PCs and handhelds: Doctors test small, tablet computers and handhelds devices. In time, these will replace the clipboard. These devices are manufactured by Hewlett-Packard Corp.
But this system would appear to be particularly exposed to terror attack or technical failure – unfortunately key considerations in the future. How will medical staff cope if the system goes down? Will they be able to treat patients?
While innovative, this hospital must also be fool proof. Otherwise technology will control people rather than vice versa.
How to optimise hospital service
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Seamless and effective patient flow
Accelarated patient flows will become increasingly important in the future, as resources become increasingly scare and the need to reduce hospitalisation days will grow. Two ways in which this can be achieved are patient activation or efficient and effective communication between patients and staff.
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Patient empowerment and self‐care
Activate patients so they can take an active role in their treatment. This can be achieved by establishing rehabilitation and exercise facilities, and information centres. Good communication is required, however, so that patients are aware of their role and choices.
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Inspirational physical surroundings
Use light, sound and visuals to create an inspirational, healing environment. An effective approach is to integrate nature into the hospital - either by improving access to the outdoors or allowing patients to see the outdoors from indoors.
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Considered and consistent communication
Communicate effectively and efficiently with patients, visitors and staff. This will accelarate patient flows, improve cross-departmental collaboration and support patient empowerment.
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Professional pride and recognition
Instil a strong sense of professional pride and recognition amongst hospital staff - it is crucial if hospitals are to attract and keep competent and motivated staff. Make professions more attractive by creating new opportunities for training and promotion.