Hospitals: 10 necessary structural reforms

Hospitals are structures that generate a powerful influence on the overall health system. Their effectiveness in the resolution of certain acute diseases, especially surgical, gives them a great social prestige. This fact should not, however, hide two structural problems that are burdening their perspective:

a) The first problem is internal. Bureaucracies themselves are showing signs of fatigue and this affects the quality of services, especially in the safety of admitted patients.

b) The second problem is relational. The hierarchical superiority of hospitals has kept them away from the community reality and from primary care. And now that have a serious difficulty to face, in an integrated manner: attention to the complex chronicity and geriatric frailty.

This Decalogue is focused on providing proposals for structural reforms to overcome the internal problems in hospitals.

1. Industrialize the process that can be subjected to a protocol (1/3 case mix)
2. Introduce coordinating clinical sessions and individualized working plans methodology in hospital plants (2/3 of case mix)
3. Adapt the admission criteria in critical care units and deploy semi-critical strategies
4. Re-orient the organization towards geriatric frailty and deconstruct the care of chronic patients
5. Involve physicians according to the principles of Max Weber (noble proposals, intrinsic motivation, respect and a sense of belonging)
6. Rethink the competencies between specialists and generalists
7. Increase training, organizational quality and nurses’ skills; generate magnetism
8. Stressing the organization to ensure continuity of care and improve patient safety
9. Rethink the organization to adapt it to patient-centred care
10. Encourage leadership, learn from mistakes and promote innovation

When we talk about structural reforms; many think of labour rights, or financing or investment. These and other aspects are important, not surprisingly, hospitals are characterised by a renowned complexity. But nobody should be misled, only from clinical management, its core business, can the change vital to improving the effectiveness of processes and optimize resources be initiated.


Jordi Varela
Editor