Future Hospital or Hospital of the Future? Incorporating Inclusion and Diversity for Greater Health Equity
There is a saying attributed to Albert Einstein that defines insanity as "doing the same thing over and over yet expecting a different result" (I paraphrase). The context of the axiom is quantum mechanics and high-energy particles rather than human behavior, yet the parallel is frequently applied psychosocially across multiple types of industry. To become comfortable with a successful model and replicate it is safe and predictable. What the recent past has brought to light is that success is often in spite of the model and how providers manage to innovate through the flaws. What if you take the innovations uncovered and turn them into a model with new purpose and greater success?
Expanding practice modalities
American healthcare has remained somewhat myopic, even in this exciting time of innovation and discovery. Providers often default to retrofitting and updating existing models of care, upgrading outdated equipment to new versions of the same and enhancing programs — but often remain tied to what is comfortable, like resoling old shoes.
Western medicine has evolved to include other modalities, like acupuncture and chiropractic. Still, there is a lot of room to invite other practitioners into care models that may offer lower cost and less toxic alternatives. There are different schools of thought on "functional medicine" and health coaching, but there also may be unexplored value.
While there has always been hesitance around managing the quality of care delivered with integrative or holistic practices and treatments, excluding them has not made them safer or unavailable — instead, they have gained increased adoption. What if your organization embraced rather than excluded them? What if there was vetting and accountability to ensure safety, efficacy and alignment with your mission statement and practices? After all, according to research from Feedback, 53.1% of all U.S. physicians recommended at least one complementary health approach to their patients in the past 12 months, and the same percentage of psychiatrists recommended mind-body therapies (Feedback provided output from their proprietary social listening process to help us understand the patient and provider views of how incorporating additional modalities of care might benefit healthcare systems and communities).
Where organizations include holistic or non-Western modalities within their walls, the existing credentialling process might be updated to incorporate additional provider and reviewer specialists to ensure practices meet expected standards of care. The military has had success with incorporating chiropractic care and massage with orthopedic programs, and the Veterans Administration includes acupuncture treatments as an option in their pain and spine clinic offerings at some locations or by outsourcing to local providers. According to the American College of Education, John Hopkins has been studying many common herbal remedies and have found some positive results. As with any treatment, patients should be encouraged to discuss with their physician, PA, NP and/or pharmacist whether adding herbal supplements to their diet and current medications is safe to avoid potential interactions.
Will the hospital of the future be built on a narrow view of healing, or will it be more inclusive of other modalities that bring healing, comfort and perhaps even substantial cost savings to our ailing system?
The conversation includes different points of view, especially around sites of care. Many procedures have moved from inpatient to outpatient, telemedicine, hospital-at-home and even infrastructure design that lead to greater efficiency. There are more minimally invasive procedures that require only a day or two of recovery that now replace costly surgical procedures that once meant days to weeks of downtime, lost wages and rehabilitation.
A successful strategy will include discussions regarding reimbursements, especially where increased access through coverage expansion has occurred but is complicated by administrative requirements. Expanding reimbursement to allow lower-cost therapies may be one way to help level costs for patients, providers and insurers and provide more choices for patients who wish to engage in other therapies that better fit their economic, religious, cultural and/or ethnic preferences.
Futuristic physical designs
The loyalty to hospital architectural design from 100 years ago means health facilities often still function within boxes and cubicles. Some organizations are seeking to update and create more efficient physical layouts and departmental organization, but they continue to build new facilities with outdated supporting infrastructures for energy delivery, sterilization and waste management rather than starting from a clean slate.
But hospitals like Valley Health are employing technologies across the design plan in unique ways. RFID, normally used to track objects, will be used to provide the real-time location of patients in transit between testing and procedures while also allowing for visibility into patient room access, which will improve patient safety and provide data that can be analyzed to improve workflows. The planned building design minimizes unnecessary patient interaction with the public through a more thoughtful layout — for example, by co-locating the ER near the imaging department and the operating room, Valley expects to improve outcomes and the overall care experience.
Many groundbreaking advancements have been stifled in the past by financial constraints. Now, the irony is that those financially crippling circumstances are the very drivers of progress. Health systems are so strained that they are thinking out of the box about what the new Hospital of the Future will look like — not simply what their current hospital will look like in the future.
After all, the internal structure for care delivery has evolved. For example, declining birth rates have left wards unused; telemedicine has enabled reduction in office visits but not the visits themselves nor the workload for staff; wearable diagnostic technologies are useful adjuncts but are limited by broadband access in rural communities where increased access to care is sorely needed. Change offers opportunities, but organizations must recognize and create an appropriate and intentional response that allows for provision of more equitable and inclusive care to an increasingly blended population.
Most recently, an exciting new opportunity for the forward-thinking organization has evolved: nuclear power. We want to explore the "what if" to create an early blueprint for the Hospital of the Future that can mean a safe, sustainable both ecologically respectful but also internally self-reliant, disaster-impervious and community supporting that creates a path toward a healthier population and environment. Hint: I plan to bring much more discussion around this topic.
Diversity, equity and inclusion in practice
As an industry, it may be that healthcare's academic devotion leads to the discounting of unfamiliar practices or those that lack contemporary scientific evidence to support them. Many of those interventions may not have been subjected to the rigor of clinical trials but may have provided consistent anecdotal comfort and emotional healing for centuries. For example, we do know that alleviating anxiety contributes to healing through reducing the release of catecholamines. Even in the absence of randomized controlled trials, self-reports of a better sense of well-being related to a chosen modality, like yoga for instance, may offer inherent benefit through reducing anxiety.
The acceptance, or at least openness to discussion, of these practices may build trust amongst the patient and practitioner as more providers learn to acknowledge patients' choices and encourage them to consider their recommendations. As a growing number of organizations advocate for diversity and inclusion within the workforce, it's also important to support diversity through equitable access to treatment modalities reflective of the inclusion that healthcare providers so firmly attempt to employ in practice.
The ideal "Hospital of the Future" is not just about the appropriate filling or emptying of hospital beds, managing supply categories, or even maximizing service line profits, although it may well accomplish these objectives. It is about truly looking to the future to optimize the capabilities that have emerged and allow us to move from what is to what should be — a hospital for the future.