The Hospitalist of The Future

Written by Andrew McWilliams

The term “hospital of the future” is used frequently to refer not to a type of building, but rather to a set of emerging trends in hospital care. These trends are likely to have a profound impact, not only on hospitals’ physical facilities, but on the types of medicine practiced in them, as well as the medical practitioners themselves.

As a result, consideration should be given to the “hospitalist of the future” and how these new trends in hospital care could affect hospitalists’ care duties, working conditions and required qualifications.

Emerging Trends in Hospital Care

The average age of U.S. hospitals’ physical plant was 11.9 years in 2021, according to Becker’s Hospital Review. A hospital project may take six or seven years from design to completion, which means that today’s hospital may reflect care needs and a design philosophy that are nearly 20 years old, i.e., a long time in today’s fast-moving health care field.

A number of trends will help to shape the design of future hospitals include:

• Increasing prevalence of chronic diseases. The burden of caring for a growing number of patients with noncommunicable diseases in hospitals is no longer feasible, or even necessary.
• Advances in medical knowledge and technology. Health conditions that used to require prolonged hospital stays now require less time to treat, or can be treated on an outpatient basis. As a result, hospitals are moving from being solely centers of inpatient treatment towards diagnostic and treatment service providers.
• Shift from fee-for-service to value-based healthcare delivery model. Value-based healthcare (VBHC) rewards providers for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives. The shift to VBHC promotes preventive healthcare over reactive, or “sick” care. While providers may need to spend more time on new, prevention-based patient services, they will spend less time on chronic disease management.
• Personalized medicine. Personalized medicine will replace a "one size fits all" approach to hospital care with an individualized approach. Medically, personalized medicine uses advanced sensors and diagnostic technologies, in combination with AI, to select and administer the most appropriate treatment for each individual patient. From a patient perspective, personalized medicine means not being treated like just another case or file number. Patients will increasingly expect personalized, high-quality care on their own terms.
• The lessons of COVID-19. The pandemic, which flooded many hospitals with large numbers of highly contagious patients, demonstrated the advantages of the “hospital without walls” model in which hospitals concentrated on treating extremely sick, highly contagious COVID patients while treating other patients outside the hospital via digital links

The “Hospital of the Future”

While many of the details are not yet clear, the hospital of the future (HoF) will look quite different than the hospital of today. The picture that begins to emerge is that of “a network with flexible capacity, connected by a single digital infrastructure critically ill patients are cared for in (remotely supported) ICUs; regular care takes place in connected health hubs in the community; while the at-risk patient population is monitored remotely and more engaged with their health than ever before.” (Jeroen Tas, Chief Innovation and Strategy Officer, Philips).

To put it differently, the HoF can be conceived as a “digitally connected community rather than a circumscribed physical space electronic health records (EHRs), which allow patient information to be shared across health systems, and telehealth, which allows patients and physicians to communicate at distance.” (Laura Spinney, writing in The Guardian, 2 Jan. 2021)

In the HoF, a growing number of inpatient health care services will be pushed out to home and remote outpatient ambulatory facilities, while complex and very ill patients will continue to receive acute inpatient services. The HoF will have the capability to connect multi-disciplinary teams regardless of their physical location.

The HoF concept is thus a “hospital without walls”, embedded in the community. Hospitals as physical entities will certainly continue to exist, to be sure, but they will probably function as specialist hubs, with each specialty concentrated at one or a few hubs in each region, rather than replicated in a large number of generalist hospitals.

The Role of Hospitalists in the Hospital of the Future

As hospitals change, so will the role of hospitalists. What, then, does the “hospitalist of the future” look like?

The hospitalist of the future, rather than focusing mainly on in-patients, will monitor, plan and oversee the care of patients spread across a spectrum of venues, including mobile health facilities, rehabilitation centers, skilled nursing facilities and, increasingly private homes. In the hospital-without-walls model, the hospitalist may only see a patient once, e.g., in the ER, while subsequent visits are conducted through a combination of telemedicine, digital diagnostics, and in-person visits by medics or registered nurses to administer medicine or draw blood, for example.

In the process, the distinction between in-house hospitalists and telehospitalists will become increasingly blurred, with virtual care, monitoring and guidance becoming the norm. The hospitalist of the future will operate from a digital monitoring and control center that enables them make quicker, sounder clinical and operational decisions. This trend will be facilitated by technologies like mobile health applications, telemedicine and electronic health records, which smooth the way to provide care outside of the traditional inpatient setting.

As remote, telehospitalist care becomes the norm, there will be a growing need to ensure that every care provider has the skills and ability to provide healthcare services through online care delivery channels. Patient-focused care means that the patient’s experience is valued as highly as clinical outcomes, and that healthcare services are provided in a way that is tailored to meet patients’ individual needs. Thus, there will be a growing emphasis on providing hospitalists with training in the needed online and interpersonal skills, including bedside etiquette, tone of voice and facial expression.

The future growth of telehospitalist services will require hospitalists to cultivate close, collaborative working relationships with the nurses, physician assistants and other care providers on whom they will be relying to act as their hands and eyes at the patient’s bedside, as well as dealing with emergencies. This may be a challenge for some hospitalists, as well as bedside staff, who are accustomed to a more hierarchical relationship.

Tags: Telehospitalist ,Services ,Hospital ,Impact ,Recruiting