4 March 2010
We expect high quality healthcare and value innovation. This has put increased demands on hospitals, which continue to be central to all healthcare systems. Despite considerable reform of healthcare over the years, the hospital itself is in many cases an institution that remains largely unreformed. ?1
This is not to say hospitals have not been the focus of attention. There is the Health Promoting Hospital, the Healthy Hospital, the Green Hospital Movement, and other initiatives. What is missing is an integrated review of progress and a need to address the fundamental structure of the hospital itself.
These many strands can be brought together under the umbrella of “The innovative and sustainable hospital for the 21st century” in which the future role of hospitals can be understood in terms of their ability to anchor care, embrace good management, work with new knowledge and research, and adopt innovative changes, in effect to act as a model for others by demonstrating the effective use of public money, sustainable development while contributing to regional advantage.
It is worth adding that investing in hospital innovation is also compatible with the approach that “Health is Wealth”:2
- health needs of people are defined in terms of their localities; therefore, healthcare delivery is necessarily best understood locally/regionally;
- healthcare is a driver of innovation, research, development and commercialisation;
- healthcare costs rise independently of general increases in economic wealth and it is imperative to explore innovations to bend the healthcare cost curve down;
- healthcare delivery systems are complex in nature and require a steady stream of innovation to meet evolving healthcare needs and deliver improved standards of care;
- healthcare is often the largest employer in regional economies, and has considerable economic impact;
- it is probably a waste of public money to continue to support unreforming institutions that act in the public interest.
Why healthcare and hospitals are important
Healthcare matters for many reasons, including:
Healthcare consumes about 9% of the EU-15’s collective GDP,3 while the whole health sector (including research, biotech/pharma, industry, etc.) comprises perhaps 12-15% of EU GDP;
Healthcare employs around 10% of the European workforce4 yet healthcare organisation have a work-related accident rate 30% higher than the EU average5, so it is one of the sectors in Europe with the most work related accidents and stress related sickness. Specific healthcare risks are biological (e.g. from viruses), chemical, ergonomic (e.g. patient handling, design of workspaces), organisational (e.g. shift work) and psychosocial (e.g. workplace violence).6 Most of the risk is from ergonomic and psychosocial sources, mainly owing to the high levels of musculoskeletal activity, stress, depression and anxiety.7
Hospitals have a major impact in our societies:
Hospitals are by far are the largest areas of direct costs for payers, with about 80% of their costs consisting of two items of expenditure: staffing and building/infrastructure; research hospitals, teaching hospitals, academic health science centres are even more expensive.
Hospitals face the significant environmental challenge of dangerous waste. While about 70% of hospital waste is normal municipal waste (e.g. paper, plastic, glass and cardboard), it can become contaminated and hazardous if it comes in contact with other hospital waste streams, of which 8.5% is from patients, 17.5% is infectious waste, 2.0 is classified as hazardous and 0.3% as radioactive.8
Hospitals are large users of energy (compressed air, heating, lighting, ventilation, steam and hot water), consuming around 6% of total energy consumption in the ‘utility’ buildings sector (including schools, etc.).9 It is estimated that healthcare, and hospitals in particular, may account for 3% of a country’s total carbon emissions.10
Hence, the hospital has some serious challenges ahead.
Therefore, it makes sense to develop the hospital into a “model” of good practice, because public money should – with respect to tax payers and the well being of our society – be used efficiently and effectively. An organisation that has as main objective to take care of citizen’s health should go forward in terms of being a “healthy organisation” in all aspects; be it health promotion, healthy work environment, empowerment that often leads to better health, healthy environmental management and innovation to ensure better health within our society.
Given this scale of expenditure, the managerial challenges, and the rising demands for care, healthcare should be fertile ground for innovation across a broad spectrum from the use of new medical technologies to organisational methods and the use information technologies.
Biomedical, pharmaceutical and medical device research are high value sources of innovation, and are exceeded in terms of scale of research expenditure by only the aerospace/defence sector. Regretfully, much beneficial research fails to be commercialised, and many beneficial commercial products fail to reach the patients to deliver improved care. 11?
Despite the scientific and technological progress, healthcare is often a late or slow adopter of new management tools and innovations. This is partly explained by the inherent risk-aversion of public payers, and the slow uptake of e-health technologies. 12 13 This caution may be understandable, but it does not excuse the need for innovation, as hospitals do need to pursue institutional and organisational reform, respond to changes from new technologies, and realign clinical workflow across patient care pathways. Indeed, hospitals may be the best placed as innovators as they are both producers of new knowledge and researchers, and major users of new knowledge.
Briefing paper prepared by Michael Tremblay PhD, Tremblay Consulting, for ERRIN, European Regions Research and Innovation Network.
1Federico Lega and Carlo DePietro, “Converging patterns in hospital organization: beyond the professional bureaucracy,” Health policy 74, no. 3 (November 1, 2005): 261-281
2 F Unger, Health is Wealth: report to the European Parliament, Springer, 2004.
4European Agency for Safety and Health at Work, Factsheet 29: Safety and health good practice online for the healthcare sector, 2002.
5 European Agency for Safety and Health at Work, Factsheet 29: Safety and health good practice online for the healthcare sector, 2002.
6Risk Assessment in Healthcare, e-facts #18, European Agency for Safety and Health at Work, 2007.
7UK Health and Safety Executive, 2007, http://www.hse.gov.uk/statistics/industry/healthservices/index.htm
8Study conducted by the Waste Prevention Association, Bethesta Hospital, University Hospital Freiburg and Ecodas, cited in Waste reduction in health-care services, Health Care Without Harm. www.noharm.org
11Pascale Lehoux et al., “What leads to better health care innovation? Arguments for an integrated policy-oriented research agenda,” J Health Serv Res Policy 13, no. 4 (October 1, 2008): 251-254, doi:10.1258/jhsrp.2008.007173
12 European Commission, Public procurement for research and innovation: developing procurement practices favourable to R&D and innovation, September 2005
13 European Commission, Accelerating the development of the ehealth market in Europe, 2007, page 25