Academic journal article Journal of Healthcare Management

Coevolution of Patients and Hospitals: How Changing Epidemiology and Technological Advances Create Challenges and Drive Organizational Innovation/PRACTITIONER APPLICATION

Academic journal article Journal of Healthcare Management

Coevolution of Patients and Hospitals: How Changing Epidemiology and Technological Advances Create Challenges and Drive Organizational Innovation/PRACTITIONER APPLICATION

Article excerpt

EXECUTIVE SUMMARY

Over the last 20 years, hospitals have revised their organizational structures in response to new environmental pressures. Today, demographic and epidemiologic trends and recent technological advances call for new strategies to cope with ultraelderly frail patients characterized by chronic conditions, high-severity health problems, and complex social situations. The main areas of change surround new ways of managing emerging clusters of patients whose needs are not efficiently or effectively met within traditional hospital organizations.

Following the practitioner and academic literature, we first identify the most relevant clusters of new kinds of patients who represent an increasingly larger share of the hospital population in developed countries. Second, we propose a framework that synthesizes fhe major organizational innovations adopted by successful organizations around the world. We conclude by substantiating the trends of and the reasoning behind the prospective pattern of hospital organizational development.

INTRODUCTION: TIME TO ENRICH THE FOCUS

Over the last 20 years, hospitals in developed countries have greatly altered their organizational structures in response to the pressures posed by financial, social, and technological challenges. Attention has been paid to improving (1) the management of assets and operations and (2) disease and risk management practices (McKee and Helay 2002; Porter and Teisberg 2006; IHF 2007; IHF 2008; Böhmer 2009; De Souza 2009). Both directions of change are necessary for the development of safe and efficient hospitals, but they are not sufficient if we consider the impact of current demographic and epidemiologic trends on hospital populations (Parker, Fadayevatan, and Lee 2006).

The population of Western developed countries is aging. The median age of the total European Union population is expected to increase from 40.4 to 47.9 years; the age group over 65 is forecasted to almost double in size between 2008 and 2060 (United Nations 2001; Giannakouris 2008). This aging of the population is associated with a higher prevalence of chronic diseases, a higher risk of polymorbidities and adverse outcomes (Anderson and Hussey 2000), and an increased use of longterm care facilities (Coyte, Goodwin, and Laporte 2008). Several studies highlight that hospitals are increasingly facing ultra-elderly frail patients characterized by chronic conditions, highseverity health problems, and complex social situations (Townsend et al. 1988; Wan, Lin, and Ma 2002; Leichsenring 2004; Recheletal. 2009).

Under the pressure of these changes, hospital management has searched for guiding ideas and conceptual frameworks (Helay and McKee 2002). However, the literature shows a gap in the evolution and redesign of modern hospitals due to epidemiologic and technological trends (Lega 2008; Neogy and Kirkpatrick 2009). Several challenges are emerging as a consequence of these trends.

1 . The management of frail frequent users, patients with multiple chronic illnesses who are frequently readmitted. Their situations call for better-orchestrated services in which hospitals mediate this new complexity (Clarfield, Bergman, and Kane 2001).

2. The management of "quasiunstable" patients characterized by a high severity of illness and deteriorating health conditions. These patients require a level of care intensity and surveillance between those of a traditional ward and an intensive care unit (Iapichino et al. 2000; Iapichino et al. 2005b; Wild and Narath 2005; Boots 2009).

3. The development of a post-acute care setting and quick rehabilitation tracks, as the timing of rehabilitation may significantly affect health recovery and clinical outcomes, especially with elderly patients (Rollow et al. 2006).

4. The development of stable medical guidance for pre- and post-surgical patients with critical health conditions, such as orthogeriatric patients or patients with evolving symptoms (Parker, Fadayevatan, and Lee 2006). …

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