The Hospital of the Future

"If you build an admitting department today, it has to be like Fort Knox because of HIPAA. We want to eliminate as much waiting as possible," Herbert explains.

Admitting isn't the only traditional area of the hospital that is missing. The emergency department has no waiting room; instead, patients coming into the ED are brought straight to an ED bed. And because all medical-surgical patient rooms are acuity adaptable, the hospital doesn't have a geographically distinct ICU. Patients are admitted to a room and stay there—no matter how sick they may become.

"We don't spend our time and money transferring patients. Every time you hand a patient off, it increases the risk of medical error, and it frustrates patients and families," Herbert says.

Although patient comfort and wellness take center stage in the new facility, Herbert emphasizes that Dublin Methodist's design is intended to improve patient stays, not increase them.

"I shy away from descriptors that make our hospital sound spalike or homelike. We want to create an environment that's more comfortable, but we want to get patients home," Herbert says.

A shifting patient base
Most acute-care hospitals are facing an influx of aging patients over the next 10 years. But Nationwide Children's Hospital in Columbus, OH, is facing a different kind of challenge. Thanks to sophisticated neonatal services and increasingly robust genetic testing, premature babies are surviving at lower birthrates and younger ages. So while patients everywhere else are getting older, in pediatric hospitals, they are growing younger—and their families are expecting more in terms of care.

When Nationwide's leaders decided to build a new hospital, they launched an extensive investigation into how the hospital of the future should take shape. The research involved visits to more than a dozen new or in-construction hospitals, as well as interviews with current and former patients and families. What Nationwide executives learned is that although technology will play a significant role, the hospital of the future will be less about software or gadgets and more about patient care.

"The thing that characterizes healthcare is that unless there is that emotional and spiritual connection, you haven't met what people need. There will always have to be that personal touch that goes above and beyond whatever technology is able to do," says Nationwide CEO Steve Allen, MD.

The personal touch is at the core of Nationwide's new facility, slated to open in 2012 with 300 new beds. Patients and their families increasingly expect the hospital of the future to be run like a full-service hotel with room service and other hospitality services, says Patty McClimon, Nationwide's senior vice president of planning and facilities. So, like a nice hotel, Nationwide's "front-of-house" patients and families will be kept completely separate from "back-of-house" services such as room service. Most hospitals already do this to some degree by offering separate elevators for patients and visitors, McClimon says. But at Nationwide, all back-of-house services, including laundry and housekeeping and pharmaceuticals and supplies, will be separated from the general public and patients.

The hospital is also reinventing the way it structures patient care. Typically, a hospitalized patient is at the mercy of the schedule and availability of nurses and doctors, McClimon says. But Nationwide's care will be coordinated around the patients themselves. To outline this care, patients (and their families) will receive a care itinerary when they check into the hospital.

"You have your itinerary when you come in, and you know that at 10 a.m. you're going to radiology for an MRI and at 11:30 the radiologist is going to come in and talk about your results and what that means for your treatment protocol, then your attending is going to come … It's an agenda of care," McClimon explains.

Maintaining this agenda requires careful coordination between the lab, pharmacy, radiology, nursing, and other departments. But it also requires a physical space that is proximate to patients and centered around them. Nationwide's new hospital will make this process seamless, McClimon says.

The staffing model
Spectrum Health in Grand Rapids, MI, tells a similar story about its new children's hospital and cancer pavilion. Like Dublin Methodist and Nationwide, the new facilities include larger patient rooms and smaller waiting areas, as well as gardens, atriums, and energy-saving improvements. But one of the biggest changes is the way the entire Spectrum system will address another key issue for tomorrow's hospitals: staffing.

"Across the country, the model of care is predominantly private practitioners in hospitals trying to figure out how they can work and play together in an ever-increasingly hostile economic environment," says Matthew Van Vranken, executive vice president for the system and president of Spectrum Health-Grand Rapids.

Spectrum (which also runs a 500,000-member health plan) is adding a 501(c)3 nonprofit medical group to its business lineup to help integrate its existing doctors into a physician-employment model of care. Physician-led and physician-governed, Spectrum Health Medical Group will allow Spectrum to "support physicians in ways that are patient-centric and drive superior outcomes," Van Vranken says.

All physicians under the medical group's umbrella will be connected through technology, which will allow them to mine research data and move clinical data between ambulatory sites. Currently, 200 of the system's 1,400 physicians have become part of the group, but Van Vranken expects that number to show significant growth over the next year.