Hospitals: 10 necessary structurals reforms

Hospitals are structures with a powerful influence on the overall health system. Its effectiveness in solving certain acute health problems, especially in the surgical area, gives them a major social prestige. However this fact should not undermine two structural problems that are weighing their image down:

a) The first problem is internal. The own bureaucracies are showing signs of fatigue and this affects the service quality, especially when it comes to the safety of admitted patients.

b) The second problem is relational. The hierarchical superiority of hospitals has placed them apart from the communitarian reality and the primary care, and causes now a serious difficulty in dealing, in an integrated manner, with the complex chronic disease care and with the geriatric frailty.

The 10 recommendations are focused on providing structural reforms proposals aimed at overcoming hospitals’ internal problems

1. Industrializing the processes that can be subjected to a protocol (1/3 of case mix)
2. Releasing coordinated clinical sessions and individualized care plans as a working methodology in hospital wards (2/3 of case mix)
3. Adjusting the criteria for admission in the critical care units and deploying strategies for semi-critical patients
4. Reorient the organization toward the geriatric frailty and deconstruct the care of chronic patients
5. Involve the doctors according to Max Weber’s principles (noble proposals, intrinsic motivation, respect and belonging)
6. Distribute the competencies between specialists and hospitalists
7. Increase training, organizational quality and nurses’ competencies; and generate magnetism
8. Organizational stress to ensure care continuity and to improve patient safety
9. Rethinking the organization to adapt it to patient-centred care
10. Fostering leadership, learning from mistakes and promoting innovation

When speaking of structural reforms, many think of labour rights, financing or investments. These and other aspects are important, not in vain hospitals deal with a renowned complexity. But make no mistake: only from clinical management, its business core, one can start the imperative change towards improving process effectiveness and resources optimization.

Jordi Varela
Editor