Introduction
Hospitals have undergone tremendous changes over the past twenty years. This has been in line with the many pressures that hospitals have been facing during the same period of time. These pressures include increased patient loads; higher operating costs; lower budgetary appropriations; lack of adequate medical staff; and inadequate hospital resources. To increase the pressure faced by hospitals, patients have become more aware of their rights and are therefore now actively demanding quality and safe care. The result of these pressures has been the adoption of structural and procedural improvement practices by hospitals similar to those employed by the manufacturing industries over the past thirty years. Specifically, such improvement practices have included: the adoption of advanced technology, the establishment of a hospital at home care units, and hospital reorganization and re-engineering through processes such as total quality management and the use of interdisciplinary teams. Due to these considerable changes facing hospitals around the globe, hospitals have been forced to change not only the manner in which they provide their services but also the types of services provided and the staff employed. The changes adopted by healthcare organizations imply that hospitals are now better able to address the complex needs of their clientele in the 21st century. This paper will examine the changes that hospitals have experienced in the past two decades and the effect of such changes on the care provided to patients.
Acquisition of medical technology
Acquisition of medical technology remains one of the most fundamental changes that most healthcare systems around the globe have experienced. The notion of an integrated healthcare information system has attracted significant interest because of advances in digital communications and hospital information technologies. Patients are also demanding high-quality healthcare services that do not compromise their time and geographical location. The lack of real-time information regarding patients’ health conditions usually leads to delays in treatment, lack of informed decisions, and waste of resources, and medical errors that may have adverse effects on the patients’ health (Shi & Singh 2008). These negative results can be minimized by the implementation and utilization of advanced technologies such as electronic medical records (EMR) and diagnostic imaging systems in healthcare organizations.
EMR systems provide numerous benefits to patients by improving the quality of care provided and reducing the possibilities of errors on the part of the healthcare providers. EMRs facilitate the electronic documentation of patients’ information and the sharing of such information by the multitude of specialists that are involved in the care of patients. In addition, EMRs enable providers to make decisions based on evidence (Follen et al. 2007). On the other hand, diagnostic imaging systems enable healthcare providers to accurately diagnose patients’ illnesses. This is important given the increase in the number of people suffering from chronic (in many cases multiple) illnesses. Besides EMR and diagnostic imaging systems, modern technology makes it possible for patients and their healthcare providers to communicate without necessarily meeting physically. This saves both time and money for patients as well as healthcare providers. Although the implementation and utilization of advanced technological systems in healthcare are highly beneficial, such an undertaking is very costly to the organization. The costs involved in implementing and utilizing health IT systems range from the initial cost of purchasing and installing the systems, to training and education of health personnel and meeting federal policy requirements of their use. As a result, healthcare organizations located in poor regions may lag behind as far as healthcare technologies are concerned. Another disadvantage of medical technology is that it has pushed up the cost of healthcare which in turn has widened the rich-poor gap as far as health is concerned. This is especially true in countries that lack a universal healthcare system.
Shift away from inpatient care to hospital-at-home care
The trend in the decline of inpatient care has been parallel to the increase in Hospital at Home programs in the recent past. Leff et al. (2006) state, “Hospital at Home is a care model designed to deliver acute medical care in the home as a substitute for an acute inpatient hospital admission,” (p. 1355). The justification for this trend lies in the fact that critical patients are more likely to experience high-quality care that has fewer complications, more satisfaction for both patients and families, and less cost than in the inpatient acute care setting. The research carried out by Leff et al. (2006) showed that patients move away from inpatient acute care units to hospital-at-home care because the latter provides patients with greater advantages than the former. Relationship between the healthcare providers and the patients, the issue of safe care, comfort and convenience are some of the major factors that influence patients to use hospital-at-home care rather than inpatient acute care facilities. The underutilization of the inpatient acute care hospital experienced in many healthcare organizations may be due to the lack of quality healthcare services provided at the inpatient units and the subsequent lack of satisfaction on the part of the patients. To encourage more patients to use the inpatient facilities, the management of healthcare organizations has started adopting the hospitalist model of inpatient care.
The hospitalist model encompasses the use of inpatient physicians to effectively oversee the process of inpatient hospitalization and care. These physicians take on the fundamental task of supervising the patients’ medical and surgical procedures from the time of admission to discharge. Hence, once a patient is hospitalized, all the responsibilities of his outpatient physician are transferred to the inpatient physician. Harrison and Ogniewski (2004) state that, “the hospitalist model is a process to move patients from an office practice to an increasingly technical inpatient level of hospital care,” (p.310). The hospitalist model provides numerous benefits while at the same time cutting down the costs incurred by both the patients and the hospitals. This model results in the matching of patient needs to the suitable levels of care, higher accessibility to physicians by patients and their families, and more timely communication between physicians and patients concerning treatment options, recovery progress, and discharge plans. In addition, the hospitalist model enhances the level of competence of hospitalist physicians. The net effect is a high quality of care for patients and higher levels of utilization of the inpatient acute care facilities (Harrison & Ogniewski 2004).
Hospital reorganization and re-engineering
The focus of hospitals on patient care over the last twenty years has been linked to an overall force of reorganizing hospitals with the objective of efficiency. While this drive started to take hold of hospitals in the mid-1990s, other industries such as the business industry had already put it into effect between the 1970s and the 1980s. This process was widely referred to as re-engineering. In the healthcare industry, a comparison was made to total quality management which “makes merely marginal improvements to existing processes while re-engineering discards and replacing them,” (Wiener 2000, p. 101). Unfortunately, by the time re-engineering began to be implemented in the hospital sector in the mid-1990s, healthcare workers were apprehensive about losing their jobs because of the negative impact the process had on other sectors including the government. However, hospitals were encouraged by management gurus to undertake re-engineering processes by maintaining high staff morale and adopting strategies such as brainstorming and mind-mapping to address the major challenges. These challenges included: lengthy routine procedures such as laboratory tests and x-rays; a lot of time spent by medical staff on non-care activities; centralization of capital-intensive resources even in cases that were labour-intensive; bureaucratic managerial procedures and decision-making; and unnecessary specialization of staff; and frequent delays and cancellations in clinical processes due to poor communication between medical staff and departments. Because of these challenges, hospitals were unable to provide quality care to patients at affordable costs. Re-organization and re-engineering of hospitals’ structures and processes were undertaken as a means of enhancing patient satisfaction while at the same time cutting down costs.
Hospital structure refers to the particular organization responsible for providing care. It is characterized by elements such as “staffing patterns, programs, finances, facilities, and size of the organization,” (Wong and Chung, 2005, p. 360). Elements of structure that support the quality improvement efforts of a hospital include: supportive organization’s vision and mission; a committed management (demonstrated through the management’s vision for the organization); open communication lines between all levels of employees (employees on the lower levels should be able to communicate directly with those on higher levels); cooperation among all employees; and adequate resources to implement recommended measures, including both financial and human resources.
Hospital process entails “examining what must happen when, by whom, and in what sequence,” (Wong and Chung, 2005, p. 361). The processes used to re-engineer and reorganize hospitals include: planning, implementing, assessing and revising the necessary changes. The planning process entails planning for the implementation of programs that will enhance the hospital’s productive ability by addressing the problematic procedures. In order to ensure successful planning, brainstorming is usually used by the hospital’s quality improvement team in which all team members give his/her opinion concerning the problems at hand and the possible solutions. Once the team decides on the most effective solutions possible, it embarks on the implementation process. The implementation process of the programs is done in accordance with the plans laid down. Regular assessments of the programs are normally carried out through data collection and analysis techniques and the necessary changes are made to them.
An example of hospital re-engineering process is the use of interdisciplinary teams. Interdisciplinary teams refer to a group of multidisciplinary teams of healthcare practitioners (a multidisciplinary team is a team of experts drawn from different fields of practice). Interdisciplinary teams first originated in the 1920s from missionary hospitals but have only gained momentum in the past few decades. The argument behind interdisciplinary teams is that the sharing of information among all healthcare practitioners would result in better management decisions and ultimately better outcomes for patients. Members of interdisciplinary teams collaborate with each other in a way that promotes each member’s contributions. These teams are not commonly found on general medical-surgery units but are instead commonly used in specialty areas such as intensive care units and acute care units for the elderly patients. The teams have always been implemented in units that experience shortage of physicians and other healthcare professionals such as the critical care units. Unlike in specialty teams, interdisciplinary teams in hospitals are not hierarchical in nature. Team leadership changes in accordance with the patient and the nature of the issues that need to be addressed (Ouslander et al. 1997).
Interdisciplinary teams play several major functions which include: the sharing of expert knowledge and skills among the teams members from different fields; obtaining an all-rounded opinion concerning the patient; developing an integrated strategy towards patients that have behavioural problems; assessment of the need for patients’ rehabilitation; the resolution of interpersonal conflicts in the hospital; developing and conducting education programs where needed; addressing administrative challenges; participating in hospitals’ quality assurance programs; assisting caregivers in managing stress; developing individualized plan of care for patients; and reducing the use of constraints in critical care units. The major advantage of interdisciplinary teams is that they provide contributions from different experts who are at liberty to voice their opinions and disagreements in a manner that is not possible in unidisciplinary and multidisciplinary teams. The disadvantage of interdisciplinary teams is that they tend to be cumbersome and consume a lot of time before they are able to work well (Siegler et al., 2003).
The outcomes of the general hospitals’ reorganization and re-engineering have been both positive and negative. On the positive side, re-engineering of hospitals has resulted in improvements in hospitals’ efficiency for instance shorter admission procedures, fewer reported incidents, fewer delays in receiving laboratory and such-like examinations, reduced bureaucracy, enhanced communication among the hospital staff, more attention provided by healthcare practitioners to patients, and less focus on administrative duties (Patti 2000). On the negative side, the efforts made by hospitals towards re-engineering have failed to successfully accomplish their major objectives. According to the Health Care Advisory Board, the engineering process adopted by hospitals has been “a disappointment all around,” (Patti 2000, p. 513). This is especially the case for re-engineering of hospitals’ structures done without process re-engineering. For a hospital to have effective re-engineering outcomes, it has to re-engineer both its structure and process. Nevertheless, re-engineering has improved the quality as well as the safety of care provided to patients.
Conclusion
Hospitals have undergone tremendous changes in the past twenty years. Some of the changes include: the utilization of advanced technologies, the shift away from inpatient care to hospital-at-home care; and hospital reorganization and re-engineering. On the other hand, patients have become more empowered during the past two decades. As a result, patients today are more actively involved in their health care and are demanding high quality and safe care from their healthcare providers. Towards this end, hospitals have been forced to change their internal and external structures as well as the processes they use to provide medical and health treatments and services. The result of these profound changes is that hospitals are now able to meet the diverse health needs of their patients faster and more efficiently. Most importantly, patients are now able to receive higher quality and safer care than would be possible twenty years ago.
Reference List
Follen, M, Castaneda, R, Mikelson, M, Johnson, D, Wilson, A & Higuchi, K 2007, ‘Implementing health information technology to improve the process of healthcare delivery: A case study’, Disease Management, vol. 10, no. 4, pp. 208-215.
Harrison, J, & Ogniewski, R 2004, ‘The hospitalist model: A strategy for success in US hospitals?’ The Health Care Manager, vol. 23, no. 4, pp. 310-317.
Leff, B, Burton, L, Mader, S, Naughton, B, Burl, J, Clark, R, Greenough, W, Guido, S, Steinwachs, D, & Burton, J 2006, ‘Satisfaction with Hospital at Home care’, Journal of American Geriatrics Society, vol. 54, no. 9, pp. 1355-1363.
Ouslander, J, Osterweil, D & Morley, J 1997, Medical care in the nursing home, McGraw-Hill, New York.
Patti, R 2000, The handbook of social welfare management, Sage Publications, Thousand Oaks, CA.
Shi, L & Singh, D 2008, Essentials of the U.S. healthcare system, Jones & Bartlett Publishers, Canada.
Siegler, E, Mirafzali, S & Foust, J 2003, An introduction to hospitals and inpatient care, Springer Publishing Company, New York.
Wiener, C 2000, The elusive quest: accountability in hospitals, Aldine De Gruyter, Hawthorne, NY.
Wong, F & Chung, L 2005, ‘Establishing a definition for a nurse-led clinic: structure, process, and outcome’, Nursing and Healthcare Management and Policy, vol. 53, no. 3, pp. 358-369.