A new study co-published by the European Observatory on Health Systems and Policies and Cambridge University Press, provides a timely analysis of the changing role of the hospital across Europe. The hospital is one of the most recognizable and central parts of a health system. Yet, its fundamental design has changed little in decades, even though the burden of diseases it must respond to is constantly evolving – most recently with the emergence of COVID-19 and, less dramatically, with the growth of multimorbidity and frailty. Also evolving are the things that can be done in hospital, or in some cases, things that would once have been done there but are now better done elsewhere. For these reasons it is time to look again at the role of the modern hospital, not as a building filled with beds but rather as a concept, as a care deliverer and as a workplace. This study is the second volume in a series on the transformation of health systems in Europe. It seeks to challenge existing models of hospital care, review best practice from different countries and give pointers to the future.
Hospitals through the centuries
Hospitals emerged in the 18th century and developed on the back of scientific and technological advances, such as microscopes, X-rays, anaesthetics and germ theory. They became the setting in which resources and training were centralized. Further developments in the treatment of pain, trauma and disease expanded the scope of acute hospitals throughout the 20th century. As the quality of life of the public improved over time and people’s lives were extended through cures and treatment of infectious and chronic diseases, the typical patient became older but also frailer and often with multiple chronic conditions.
Challenging traditional ideas of the role of the hospital
The hospital is currently where most specialist health care is provided. Hospitals are employers and are financially and symbolically important to local communities. Currently, hospitals account for the majority of national health-care spending and therefore represent a significant opportunity cost. If we are serious about delivering patient-centred care, is the hospital the best place to provide it?
This study looks at many developments that challenge traditional ideas of the role of the hospital. They include:
- changes in technology for diagnostics and treatments
- changes in patients, who have become older, frailer and often more socially isolated
- changes in models of care, involving multidisciplinary teams, networks and integrated care pathways
- changes in staffing and concepts of specialists and generalists.
This study, written by and for clinicians, hospital managers and those who design and operate hospitals, argues that hospitals need to change as the patients they treat change and as the technology to treat them advances. They also show why hospitals need to be planned as part of the wider system in which they sit, with specialists developing new collaborative ways of working with primary care.