What does the hospital of the future look like?

Literature review and survey

Based on a thorough literature review, the researchers gained an insight into the challenges in healthcare, as well as the national and international trends in tackling those challenges. A large-scale survey among the Belgian population shed light on the opinion of all stakeholders on those trends. Which aspects should policy-makers focus on more and which ones are less important? We refer to the green paper for more information on the literature review and the analysis of the survey. Below you will find an overview of the main challenges and recommendations.

Technology: a blessing or a curse?

Digital and technological developments are occurring increasingly fast throughout the entire healthcare process, from research to diagnosis, treatment and aftercare. The focus is no longer merely on tablets and data mining. Robots, artificial intelligence, and virtual and augmented reality are not science fiction anymore. However, opportunities and risks are two sides of the same coin. New technologies are often expensive. How do we avoid a two-speed healthcare system? And how do we guarantee data privacy? Technology is everywhere and anyone who is keeping abreast of the latest developments expects the healthcare sector to make use of it too. However, we need to ensure that technology does not hinder access to healthcare for users who are not tech-savvy. Moreover, new technologies have a major impact on the job descriptions of healthcare professionals. Therefore, a good framework is a must.

Changing healthcare demands due to the ageing population

The ageing population has resulted in more chronically ill patients and persons with multiple pathologies (co- and multi-morbidity) and/or mental health problems. Thanks to progress in medicine, degenerative diseases no longer lead to a rapid death, but they do still affect patients’ quality of life. How can the healthcare sector respond to the ageing population and the changing demand for healthcare services through an integrated offering of prevention, education, care and well-being?

How can we put patients centre stage?

Patients want to play an increasingly active role. They now also demand to be involved in their treatment and they expect personalised care. A good information exchange between hospitals on the one hand, and between hospitals and other healthcare providers on the other is essential. However, for patients to become fully-fledged partners in the healthcare process, we need more than a well-thought-out development of electronic patient case files. We actually need a significant cultural and organisational shift. How do we deal with empowered and well-informed patients, and offer a low-threshold, nurturing environment to more vulnerable patients? The keys to success are highly flexible healthcare professionals.

Financial capacity under pressure

Lastly, the ageing population and the increasing demand for chronic care have put pressure on the financial capacity of the healthcare system. Smaller hospitals are no longer financially viable, so collaboration through networks has become a must. Hospital admissions are becoming increasingly short and there is a growing trend towards outpatient care.

A smaller role in the healthcare continuum

Both the literature review and the survey show that the role of hospitals in healthcare has become smaller and more targeted. The increasing professionalism in healthcare and technological progress have allowed different players to take on parts of the healthcare package. The result? Specialisation, more efficiency and higher quality levels in all links of the healthcare chain. Hospitals are no longer the integrated healthcare providers they used to be, but rather high-tech specialist or standard technological (possibly specialised) knowledge hubs for the healthcare process, in collaboration with other healthcare providers and patients.

Information exchange must be stimulated

Hospitals can only take on their responsibilities in the healthcare process if the different stakeholders are connected virtually and the patients’ care process is transparent. Nowadays, there are various information platforms in Belgium for the exchange of medical data, but they are not used efficiently. Sumehr, for example, is not systematically integrated. Vitalink is insufficiently completed and the electronic patient case file has only recently been extensively introduced and rolled out in all hospital wards. The government must stimulate the interconnectivity and use of these platforms for the benefit of patients. This would also meet one of the major issues pointed out by the respondents to the survey: for patients to be able to freely choose their physician, the latter needs to have access to their file, which is currently not the case.

From a triple to a quadruple aim

Changes in healthcare also bring about changes for staff. The reorganisation of hospitals in networks will require healthcare professionals to serve different players. How this exchange between players will concretely be set up is unclear at this stage. This uncertainty definitely does not benefit the well-being of healthcare professionals. Yet respondents ranked attention to the well-being of healthcare professionals high in terms of importance. To avoid these stakeholders suffering, policy-makers should focus on four dimensions rather than three: public health, patient experience, healthcare costs and the well-being of healthcare professionals. The white paper ‘Flexible working in hospitals’ (Dutch only) explains how this can be achieved.

Evolving healthcare infrastructure

The changing role of hospitals will have an impact on the required infrastructure. Given the evolution ahead, a division into healthcare components seems the most logical option. Moreover, not all healthcare activities should take place within the hospital walls.

• Wards
  The wards include the traditional hospital rooms with one or more beds, as well as the technical equipment, such as sanitary facilities, compressed air and oxygen installations. The size and set-up of the rooms should be adapted to the duration of the admission and the type of patient. A rehabilitation ward, for example, requires more space for wheelchairs to manoeuvre, while rooms for a one-night stay could easily become smaller. 
• Transitional care facility
  A transitional care facility hosts patients who are not healthy enough to return home or head to an assisted living facility following their hospital stay. These facilities free up beds in hospital wards and temporarily relieve caregivers. In Flanders, several ‘care hotels’ are now operational. They profile themselves as hotels that also offer care services. The difference between these ‘care hotels’ and ‘transitional care facilities’ abroad is that they facilitate these patients’ return to their homes or their move into an assisted living facility through patient education and by actively involving social services and the patients’ relatives in the process. However, the precise role of these entities merits further analysis.
• Centres for chronic care
  This includes rehabilitation hospitals, assisted living centres and psychiatric institutions. The architectural infrastructure of these three types of facilities may be similar, but rehabilitation hospitals require more extensive rehabilitation facilities than the other two, which focus more on accommodation and care services.
• Outpatient centres
  Outpatient hospitals specialising in surgery and internal medicine, polyclinics and local clinics provide outpatient care. Whether or not they are part of a hospital depends on the technical and medical support required. Although we are noticing a shift to more outpatient care, specialised medical care would still benefit from being offered within the hospital walls in the future.

Technological platforms

Operating theatres, medical imaging, laboratories, radiotherapy, intensive care and emergency services require complex and often expensive technology. Currently, these services are integrated into the hospital infrastructure. However, in the future we will not be able to head to just any hospital for all treatments. Therefore, it would be more useful and more affordable to make a distinction between two types of technological platforms: (1) a standard platform that must be available in all hospitals, consisting of operating theatres and standard imaging technology, such as CT and MRI scans, and (2) an advanced platform that also offers PET scans, radiotherapy and intensive care. Those advanced technological platforms would then be shared by various hospitals within one and the same network.

What about logistics and other services?

At the moment, most hospitals organise their logistics and support services themselves, while some outsource them in part. However, for these services, collaboration could result in considerable savings. Despite several joint purchasing initiatives, to date purchases are stored in a decentralised way, which leads to larger safety stocks than actually required. Centralised stocks could bring about additional savings. Logistics platforms could offer their services to technological platforms, wards, transitional care facilities, as well as centres for chronic and outpatient care. Ideally, hospitals in one and the same network would also have a centralised sterilisation unit, laboratory and hospital pharmacy to optimally benefit from economies of scale.

Focused factories

Gathering expertise by centralising operating theatres, surgical outpatient clinics and wards focusing on a specific pathology would be beneficial both in terms of quality and cost efficiency. The question is whether such ‘focused factories’ are best set up at a local and/or regional level, or at a supraregional level. Their optimal scale still needs to be analysed.

Financing and legislation: time for change

The organisation of hospitals is currently determined by the Royal Decree of 30 January 19891. However, the accreditation standards in this decree are not in line with future developments in the sector. We need a separate accreditation for each care component or function (wards, transitional care facilities, surgical outpatient hospitals, focused factories, technological platforms etc.). Technological platforms, a gathering of expertise and collaboration in terms of logistics and other services call for shared investments between different hospitals and/or networks, and for a review of certain accreditation conditions. As for investments in infrastructure, it is probably worthwhile to look into public-private partnerships and new subsidy schemes based on surface area, types of activities and the required equipment to replace the current VIPA fund (Flemish Infrastructure Fund for Matters relating to Individuals (VIPA). Moreover, we need to consider the financing of hospital activities through the Financial Resources Budget and physician fees. If we want to keep part of the outpatient services intra muros, public funds need to be made available to ensure the costs are not at the expense of the fees.

Networks: the state of affairs

There have been a number of developments since the publication of this green paper. On 14 February 2019 the House of Representatives approved the draft law on local and regional hospitals2. As a result, from 1 January 2020 onwards, Belgian hospitals will be grouped in a maximum of 25 networks: 13 in Flanders, 8 in Wallonia and 4 in Brussels.

Keen to find out more?
Download the full green paper ‘Hospital of the future – the future of hospitals’ (only available in Dutch).

1 Royal Decree of 30 January 1989 laying down additional standards for the accreditation of hospitals and hospital services, together with a detailed description of the hospital groupings and of the particular standards.
2 Draft law amending the coordinated law of 10 July 2008 on hospitals and other care institutions, regarding the clinical networking between hospitals (Doc 54 3275/013).