HISTORY

1
HISTORY

• Medieval
• Medical care an afterthought in jails or alms
  houses
• People inmates not patients
• Renaissance
• Institution developed for medical care
• People inmates, indigent, dependent sick
• Social pressures and norms dictated activities
• Medicine offered little

2
HISTORY

• 18th Mid 19th Century (U.S.A.)
• Hospitals evolved
• a) From alms houses socially disadvantaged
• b) Community responsibility worthy poor
• Trustees, not doctors, controlled hospitals
• Education
• Late 19th Mid 20th Century
• Drivers anesthesia, antisepsis, microbiology,
  x-ray, laboratories
• Science comes to medicine professional nursing
  arrives
• The Youngest Science shifts control to doctors
  and fuels hospitals expansion lt 200 in mid 19th
  Century to gt 6000 by the 1930s
• Education and research

3
HISTORY

• Mid 20th Century 21st Century
• Specialization in medicine drives and is driven
  by the expansion of hospitals
• WWII creates a sense of the value of science and
  technology
• Desire for sophisticated hospital services
  fuels insurance which fuels technology
• Hospitals develop as critical social structures
  in many communities and academic health centers
  develop as the greatest concentrations of
  technology, knowledge and innovation
• Hospitals the center of health care
  organization

4
HISTORY

• Drivers of evolution
• Demography, globalization
• Innovation in biology genomics proteomics
• Drug development
• Innovation in technology CT scan, MRI,
  robotics, fiberoptics, energy sources,
  miniaturization
• The age of information technology
• Result
• Expanded predictive and diagnostic power
• More precise, less traumatic, more effective
• Prevention treatment rehabilitation
• Technology and skills diffuse more rapidly
• ?place of the hospital in more distributed and
  integrated system of care

5
HOSPITAL ORGANIZATION

• Location
• Rural
• Suburban
• Urban
• Academic center
• Level of Care
• Primary
• Secondary
• Tertiary
• Tertiary and experimental

• Acuity of Care
• Acute Care
• Rehabilitation
• Chronic
• Long term care
• Content of Care
• General
• Specialized (e.g. Childrens, Cancer,
  Orthopaedics)

6
FUTURE HOSPITAL

• Choices
• Autonomy vs. integration (cost)
• Level of care i.e, 2o 3o
• Content general vs. focus vs. combination

7
FUTURE HOSPITAL

• Community and Rural
• Relation to larger hospital or system
• Access to most advanced skills and technology
• Facilitated dissemination of technology and
  skills
• -Quality Assurance
• Role of information and telecommunications
• Place of student, Resident, Fellow education
• Research clinical, care, organization,
  management
• Staffing - traditional

8
FUTURE HOSPITAL

• Academic/Urban
• Concentration of skills and technology
• Responsibility
• -Innovation
• -Dissemination of technology and skills
• -Quality Assurance
• Role of information and telecommunications
• With medical schools, responsible for education
  of students, residents, fellows (direct
  oversight)
• Research center of translational population
  dependent (genomics-proteomics), organization
  finance
• Staffing programmatic vs. traditional

9
CONCLUSION

• Hospitals of the Future
• Less autonomous - part of broader delivery system
• Technology - advanced, less traumatic,
  rationalized
• Skills - distributed to maximize innovation and
  dissemination
• Education - system or regionally based
• Research - translational particularly genomics
• Critical need better, more sophisticated
  information systems