Hospitals of Tomorrow: 10 Characteristics for Future Success

What are the most critical capabilities health systems must have, or actively be working to develop, to be successful in a future that will increasingly reward value over volume?

Healthcare organizations today are facing a variety of challenges that are forcing them to redefine the very way they do business — from focusing on heads in beds to delivering high quality, low cost and highly reliable care.

The ability to transition to this "new world order" requires specific capability and organizational characteristics, to be sure. But, what are they, specifically? At the Hospital of Tomorrow leadership forum taking place earlier this week in Washington. D.C., I asked several leading health system executives what they believe are "must-haves" for health systems in the years to come. Their responses provide valuable insight regarding what areas hospitals and health systems must focus on developing, if they wish to sustain and grow their organizations.

1. Focused and dedicated leadership
According to Peter Butler, president and COO of Rush University Medical Center in Chicago, the most important competency needed to ensure future success is "superb, stable, focused leadership."

"The key to success is not a brilliant strategy, but people that can execute," he said.

J. Michael Henderson, MD, chief quality officer for Cleveland Clinic Health System, agreed that engaged leadership is paramount for developing a high-reliability organization. He believes Cleveland Clinic's high-quality outcomes are due largely to the fact that senior leadership demands accountability for obtaining certain quality improvement goals, year after year. "Senior leadership gets it," he said.

2. Coordinated care (for health systems)
Health systems that will succeed will be those that can provide coordinated care throughout the entire continuum of care — from outpatient office visits to inpatient stays and post-acute rehabilitation.

Cleveland Clinic is roughly one year into its efforts to improve care coordination through developing standardized care paths for some of the most common conditions its physicians treat. Each of the Clinic's institutes have been tasked with developing care paths for selected conditions (high volume and high cost conditions and services are targeted). An interdisciplinary team of clinicians within each institute works collaboratively to develop the care paths, which aim to "reduce unnecessary variability," said Dr. Henderson. These paths will eventually be embedded in the system's electronic medical record system.

3. Focused-factory mentality (for individual sites of care)
"Not all hospitals will be all things to all people," said Toby Cosgrove, MD, president and CEO of the Cleveland Clinic. Individual hospital sites, then, should focus on providing one or two core services and ensure those services are high quality, low cost and highly reliable.

"Every hospital was built to provide [comprehensive] care to its community, but as care's gotten more sophisticated, that's not possible," he said.

4. Openness to technology and acceptance of resulting workflow changes
"The other competency I would highlight is technology in the broadest sense of the word," said Rush's Mr. Butler. "It's hard to believe the iPhone is only five years old, but it is one example of a technology that really transformed. It's astounding, and how quickly [transformation] can happen [in healthcare], I think we underestimate."

In the future, hospitals will rely heavily on data mining and analytics to guide care. "You need to be able to handle the patient in a seamless way. If you're going to do that, you have to have clinical information systems that are very effective," said Michael Blaszyk, CFO of Dignity Health.

5. Efficient
Provider organizations are already under scrutiny for healthcare costs, and growing pressure on reimbursement will only intensify the need to drive all unnecessary costs out of care delivery. Organizations must be able to remove waste from processes, standardize care and do all they can to lower supply and labor costs.

"You've got to drive costs down, and you have to have the capability to be able to control labor costs. You've got to have the capability to drive down supply costs, said Mr. Blaszyk.  

Ora Pescovitz, MD, CEO of University of Michigan Health System, agrees that health systems "need to contain costs," in order to be competitive. This applies to all health systems, including academic medical centers like UMHS, which are forced to absorb additional costs related to training physicians. "Academic medical centers have a higher cost structure," yet consumers will choose competitors over AMCs for all but the most specialized care if AMCs aren't able to compete on cost, quality and service.

6. Transparent pricing
Health systems will need to be increasingly transparent about costs in the future, a trend that is already taking hold but hasn't yet reached critical mass.

As patients take on more financial responsibility for their care, they will increasingly make healthcare decisions by "shopping for the lowest cost healthcare," assuming comparable quality, said Dr. Cosgrove.

7. Risk-based contracts
Reimbursement models are quickly evolving toward shifting risk to providers, and this isn't expected to go away. As a result, organizations will need to be providers of efficient, coordinated care and be able to enter into risk-based contracts.

"First and foremost, you have to have the ability to take risk, said Mr. Blaszyk. "If you're going to take risk, you have to have a seamless integrated system that is all around the patient."

8. Team-based care
In the future, consumers and payers will demand health systems play a role in keeping populations healthy. Population health management requires advanced analytics as well as an expanded caregiver base. Because the number of physicians in the United States is not expected to keep pace with demand, care delivery must be reengineered to allow non-physician caregivers the opportunity to be "working at the top of their license," said Dr. Henderson.  

9. Patient-centeredness
Cleveland Clinic's Dr. Cosgrove believes putting the patient at the center of care will be critical. "Always put the patient first," he said. Cleveland Clinic has demonstrated its dedication to this reimagining of the traditional delivery system by taking 43,000 of its employees offline for a half day to talk about the Cleveland Clinic experience and what it really means to put the patient first.

10. Nimbleness
What healthcare delivery "looks like" in 10 years will likely be very different than what it looks like today, and as a result, health systems must be "nimble, more flexible and adaptable to change," said Dr. Pescovitz. Health system leaders must work now to develop an organizational culture that is "prepared to evolve," she said.

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