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What will the hospital of tomorrow look like? If it is successful, it will be distinguished by a number of quality attributes, says Duke Rohe, FHIMSS, performance improvement specialist at the M.D. Anderson Cancer Center in Houston. "A successful hospital is going to be one where the leadership itself is ingrained to a common vision — not just something on a poster, but something that’s driven from the heart. I haven’t seen it work any other way," he says. "What they say with their mouths actually matches the direction their feet are going."
That includes a clear vision of what quality is and should be, says Rohe. "You must take a diagonal look at processes in each department, and then run them crossline with the patient’s experience. You can’t just worry about the front end — for example, where the patient meets the receptionist; you have to include all the infrastructure behind the front end that allows the patient’s experience to be as quick and as pleasant as possible." This view, he adds, must pertain within the department as well as within the crossview of the patients as they "ping-pong" through the hospital.
"What will distinguish you from somebody else will be how you design processes to be friendly — how well you treat your customers," Rohe predicts. "I remind all my employees that one out of every two patients will not beat his or her disease. That’s why it’s so important to do everything in your power to provide a positive spin. If you serve someone who serves someone who serves the patient, what you do will ultimately have an impact that gets to the patient."
On the operational side, the key will be processes and handoffs, says Rohe. "Like in Japan, the end of one process should be the beginning of the next — in just-in-time’ fashion," he says. "You should get just what you need at the point you need things. Included is the mindset that this grows out into other aspects of what you do; it’s a whole new frame of reference."
From the clinical standpoint, quality in the hospital of the future will apply to doing what’s appropriate. "If you’re in the ICU and you truly need to be in a step-down unit, or on the floor itself, there need be good guidelines," says Rohe. "For example, if a patient fits three specific criteria, then he can go home. For that to happen, the physician has to be more empowered in the planning process."
There will be less distinct lines drawn between hospital departments. "For example, you may find that some decisions are better made closer to the patient," Rohe explains. "Instead of respiratory therapy deciding, perhaps you should give the skill to the nurse. It would basically save her the time she was spending bugging respiratory therapy."
The hospital of tomorrow will be statistically data-driven vs. just data-driven, Rohe predicts. "This requires understanding the difference between common cause [a normal variation within your system] and special cause [things that happen only once in awhile] problems. You don’t rearrange everything around a special cause. With a common cause, you should understand what that variation is and try to shrink it over time. You might rearrange your system for a common cause but not for a special cause."
Above all, says Rohe, in the successful hospital of the future, things will be more people-friendly for everybody. "Such a hospital will value personnels' contributions," he says. "If someone has an idea, that organization will be hungry to adopt it and then generalize it within the institution. The person who generated the idea is grateful because he is valued." The final measure of success will be how well the institution takes that great idea and generalizes it, says Rohe.