Management of the XXI century hospital

Alexandre Lourenco.

PHOTO: Erakogu

Healthcare is one of the most exciting and innovative industries of the XXI century, and hospitals are the most complex and sophisticated organizations ever developed. 

It is becoming clear that we need to rethink the hospital and its role in the health system. We all realize that the challenges that we face as an industry (for example, the demographic shift, the pace of technological innovation, the changing user and consumer expectations, and the growing financial pressure) need different and innovative answers. Hospitals are at the top of the healthcare food chain and cannot ignore that the environment is changing. Due to the political risk of promoting hospital reforms, decision-makers usual have the temptation to prioritize other minor areas and not disturb the “lion”. As a consequence, during the last decades, hospitals have been more and more concentrated on responding passively to people’s expectations, adopting exogenous and expensive technologies, obtaining internal efficiencies and trying to assure their financial sustainability. Even though the high level of sophistication achieved, hospitals become more and more self-centred and improving the health of the population is on a second plan, shortcoming on their mission.  

Organizations, processes and flows are still organized as they were more than 50 years ago, and the model of care is more and more seen as unreliable, unsafe and prone to error. Part of the needed change is cultural. Hospitals need to rethink patients as individuals and not as acute or disease cases. Even the more advanced hospital fails its aim when its responsibility stops on discharging a patient from the ward. In this sense, hospitals need to be redesign as population health providers enlarging the hospitalization and acute facilities model. Not that hospitals need to provide all the services required by the population, but that is necessary to engage other health and social care network partners to assure better care. In this sense, hospitals need to be open to innovative ways of providing care and partner with new players. Some years ago, an article published by the New England Journal of Medicine identified the Uber’s message for healthcare. Providers have three choices: 1) ignore innovators and hope for the best; 2) call for increased regulation to make it harder for innovators to enter the market; or 3) compete on quality and efficiency, disruptive though that might be. 

Society needs that hospitals become much more than a single acute care provider. Most of the narrow view that led hospitals to the current fragile condition is the lack of proper management and wither public health perspective. Bad management leads to spoiling resources, unmotivated teams and adverse outcomes. The inability to understand hospitals as part of the public health strategy limits the hospital mission on accomplishing the improvement of the population health levels.

We all agree that achieving good outcomes is dependent on having competent physicians, nurses, and other healthcare professionals. In this sense, we rely on universities and schools to deliver demanding and extensive educational programs, and on the capacity of the healthcare, professions to be self-regulated and under continuous professional training. Unfortunately, regarding management, in most of the European countries, we live in the realm of amateurism and improvisations that, although well-intentioned, prevents the needed transformation and puts the individual health in risk and spoils resources. Sometimes this discussion is raised as physicians versus managers. Nothing more wrong. For sure that physicians don’t have necessarily managerial skills and business acumen, and parachutists managers do not understand healthcare and what it is like to work in a hospital. But, shouldn’t we be more concerned about the competencies and skills needed to manage a successful and modern healthcare organization than to have a guilds egotism contest?

Due to the level of the current challenges and complexity, the current hospital model is not enough. To overcome all the current challenges and pitfalls, we need to rethink the XXI century hospital. For that, competent management is demanded. 

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