Rebecca Rosen: Trends in the organisation of hospital services


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In this slideshow Dr Rebecca Rosen, Senior Fellow, Nuffield Trust, explores recent trends and strategic choices in the organisation of hospital services in Europe.
Dr Rosen spoke at the Nuffield Trust European Summit 2014, supported by KPMG.

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  • Comment that disability services and long term care are wrapped into healht care/hospital systems
  • Re networks and integation , comment on links to disability services and long term care
  • Link strategic funding to Carolines’
  • Three key sets of interests –
    Governments and funders managing national health budgets trying to manage the amount of money swallowed up by the hospital sector
    Then there are patients and the public with their health care needs. THese are becoming increasingly complex as the populations of Europe age and develop more chronic conditions and co-morbidities. But patient demands are also changing - with growing expectations about timeliness, convenience and Courtesy and a growing knoweldge and about sense of entitlement to the lates high tech treatments
    Then there are the hospitals themselves – trying to balance their books; ensure quality and safety; grow their market share and build their reputation in order to attract patienst
    So during the course of the day, we want to think about how the strategic development of the hospital will be shaped by these other stakeholder interests.
  • Increasingly difficult to solve hospital problems just by addressing the needs of the hospital just by focusing on the hospital alone.
    We’re seeing lots of responses.
  • Rebecca Rosen: Trends in the organisation of hospital services

    1. 1. The organisation of hospital services in Europe: Recent trends and strategic choices Dr Rebecca Rosen Senior Fellow The Nuffield Trust 20th-21st Jan 2014 © Nuffield Trust
    2. 2. Hospital services across Europe HOSPITAL: ‘an institution providing medical and surgical treatment and nursing care for sick or injured people’. (OED) Diverse range of institutions with varied roles in different countries © Nuffield Trust
    3. 3. Historic variations in hospital policy & funding Central and Eastern Europe • Centrally planned, hospital dominated health tradition in all countries • Concentration of diagnostics, treatments and technology in hospitals • Financial pressures underlie recent national strategies to rationalise hospital care using a mix of market forces and national planning © Nuffield Trust
    4. 4. Historic variations in hospital policy & funding Western and Northern Europe • Wide variation in role of hospitals in delivering specialist care • Community based specialist care in some countries • Growing separation of functions between hospitals (emergency care and acute procedures) and community services (diagnostics, office based procedures, chronic disease management, rehabilitation etc) • Small, physician owned single speciality hospitals in some countries • More regional and local planning of hospital services including local government control of health & social care in Scandinavian systems © Nuffield Trust
    5. 5. Recent trends • Fewer acute hospital serving larger populations • Increase in day case activity – though rates still vary widely between countries • Reductions in length of stay • Growing number of ‘specialist’ hospitals • Growing recognition of volume/outcome relationship with concentration of some services into larger centres (eg trauma, hyper-acute stroke) (Edwards et al 2012: Changes in health provision in Europe: Major trends) © Nuffield Trust
    6. 6. Variation in current funding and supply Total per capita healthcare spending, US$PPP, 2011 Based on (OECD, 2013). © Nuffield Trust
    7. 7. Variation in current funding and supply Acute Care Beds per 100,000 population: EU15+Switzerland, 1998-2008 (EHHF, 2011) © Nuffield Trust
    8. 8. Variation in current utilisation Average length of stay and percentage of day cases: malignant neoplasms of trachea bronchus and lung, 2008 (EHHF, 2011 © Nuffield Trust
    9. 9. Multiple drivers of change in hospital care Constrained resources and new payment systems Growth in use of markets and competition Aging population with multi morbidity New medical and communications technologies Hospital organisation and delivery Quality and safety National policy/ regulation of hospital sector Patient and public expectation © Nuffield Trust
    10. 10. Concepts of strategic change in hospital care • Intra-institutional change • Efficiency • Quality and safety • Sustainability • Culture • Extra-institutional change • ‘Connectivity’ • Networks • Integration • Growth, mergers and acquisition • Re-configuration of hospital sector © Nuffield Trust
    11. 11. Mechanisms for change: Intra-hospital mechanisms • • Redesign • Environment (eg buildings, hospitality…) • Service line redesign (including tools such as lean) • Organisational structure and culture Specialisation Externally driven mechanisms • • • • • Central planning and payment reform Ownership, management and market reforms Strategic purchasing by payers Connectivity /networks Integration © Nuffield Trust
    12. 12. Defining the ‘space’ for Eurosummit discussions How are individual hospital strategies adapting in response to national & regional policy, funding & regulation How are hospitals adapting in response to frailty, complexity and changing patient expectations Is national/regional policy responding appropriately to changing demography epidemiology/growing public expectation © Nuffield Trust
    13. 13. Challenge for the Euro-Summit • Can we reach consensus about how hospital strategy should respond to the changing interface between hospital, political, payer, and public interests? Aims of the Euro-Summit • To examine the strategic choices available to hospitals, payers and policy makers • To explore how these choices are being made, and the factors underlying decisions • To learn about promising new organisational models for hospital services emerging in Europe, in the context of wider changes to health and society • To identify the options for policymakers, payers and providers to influence the future strategic development of hospitals © Nuffield Trust
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