Hospital & Health Care Challenges in the 21st. Century Challenges Opportunities

1. Hospital & Healthcare
Challenges
in the 21st Century
Prof. S.A. Tabish
FRCP, FACP, FAMS, MHA (AIIMS)
Postdoc Fellowship, Bristol University (England)
Doctorate in Educational Leadership (USA)​

2. • There is a rapidly growing number of
health care innovations on the horizon
that both excite and concern policy-
makers.
• On the other hand, policies that shape
health care are typically considered as
conservative especially in terms of
traditional models of clinical practice
and primary health care provision

3. Societal Pressures
•There is considerable pressure from
societies for providers to become
more accountable, relevant and
responsive while providing greater
and more equitable access to health
care and well-being.
•The response of this pressure varies

4. 21st century healthcare challenges

5. Health Care Predictions

6. Unlocking the opportunity of digital health
• The digital age holds out the promise of innovative
technology & business models.
• Internet & smartphone penetration is growing,
and the technology
• infrastructure is moving to cloud-based services.
• Managing health care has been changing.
• To be part of the competitive industry today,
health care providers need to address the major
changes that are driving patient behavior and
adopt a customer service mindset.

7. EXPECTATIONS OF HEALTH CARE
• Expectations of health care and better
outcomes for themselves are at their
highest
• Patients are true consumers, they
understand they have options & use
information & data about themselves &
providers to get the best treatment at a
time, place and cost convenient to
them

8. Human Touch
Health care practitioners should keep in mind
that medicine must always be patient-centric
treatment, and technology is merely a tool
to improve the patient’s health outcome.
Doing this way, professionals should
also have time to provide the human touch.

9. Telehealth, Telemedicine, eHealth
Telemedicine is defined by the
WHO as “the use of information &
communications technology (ICT)
to deliver health care particularly
in settings where access to
medical services is insufficient”.

10. • The broadest term in comparison is telehealth.
• It incorporates not only technologies that fall
under “telemedicine,” but also direct,
electronic patient-to-provider interactions
and the use of medical devices (e.g.,
smartphone applications (“apps”), activity
trackers, automated reminders, blood
glucose monitors, etc.) to collect and
transmit health information, often with the
intent to monitor or manage chronic

11. ehealth
In the European countries, the term
‘eHealth’ is also used to describe digital
health and technology-driven remote
health care.
Barely in use before 1999; this term now
seems to serve as a general “buzzword,”
used to characterize not only “internet
medicine”, but also virtually everything
related to computers & medicine.

12. eHealth (Contd)
• eHealth is used to describe an even broader
scope of digital information tools, ranging from
electronic health records (EHRs), which
facilitate the exchange of patient data between
health care professionals
• EHealth may include computerized physician
order entry mechanisms, e-prescribing, and
clinical decision support tools, which provide
electronic information about protocols &
standards for use in diagnosing and treating
patients to providers

13. Telehealth Modalties
•In the future of the health care
industry, telehealth almost likely
will involves four distinct domains
of application those are commonly
known as synchronous (live video),
asynchronous ,
Remote Patient Monitoring (RPM)
and mobile health (m-Health)

14. Mobile Health:
• When mobile communication devices
such as cell phones, tablet computers
and PDAs support health care and
public health practice and education.

15. eHealth

16. 21st century Trends
• The changes in our world are having a direct
impact on the medical industry.
• The 21st century has the most advanced
medical technology compared to any previous
century, but it also has unique problems that
make it necessary for healthcare to adapt.
• From nursing shortages to changes in
healthcare technology statistics, hospitals and
clinics are working hard to be prepared for the
changing needs in the medical community.

17. Healthcare for an aging population
• By the year 2030, the number of people over 60
years of age will increase by 56 percent, from 900
million to 1.5 billion. In the US alone, the number
of Americans over the age of 65 is expected to
double from roughly 50 million today to nearly 100
million by 2060.
• What does this aging population mean for
healthcare? Organizations will need to
continuously learn and update their practices and
routines.

18. HC Leadership
• Qualified and trained healthcare
leadership is crucial to ensuring that
hospitals and clinics are able to keep up
with changing needs for the industry. As
more individuals become qualified to
lead in the healthcare field, more minds
will be at work to help tackle challenges
and problems

19. Healthcare in the age of climate change

20. Climate Change
• Climate change is a public health concern that continues
to escalate: UN scientists estimate we have only 12 years
left to keep global temperatures from rising above 1.5
degrees celsius.
• If we don’t hit that goal, we’ll see drought, food scarcity,
and an increase in extreme weather that will cause
injuries and deaths.
• Climate change can bring hotter days and heat-related
injuries.
• It can cause food and water scarcity, which means
hospitals and clinics would need to be prepared for
patients suffering from nutritional deficiency.

21. Healthcare and multimorbidity
• Multimorbidity (multiple Ch Conditions) increases
with age, and as more of the population ages and
lives longer than before, multiple chronic
conditions won’t be far behind.
• Multimorbidity is a health issue as doctors and
nurses work to treat many conditions, at the same
time.
• This requires new levels of skill and technique to
avoid mixing medicines that could be problematic,
and is more difficult on patients physically and
financially.

22. CHRONIC CARE MODEL
• It is also a financial burden on the
healthcare industry, as multiple
conditions prove intricate and expensive
to treat.
• The Chronic Care Model is an important
redesign for chronic disease and
multimorbidity. This model helps care for
and educate patients in the most
effective way possible.

23. HC For Aging Population
• Healthcare leadership needs to make
specific decisions about financial and
medical options for treating those with
chronic conditions.
• As the population continues to age, as
people live longer, and as more chronic
conditions have treatments, the healthcare
industry will have to be prepared to keep up
with the demand to fight multimorbidity.

24. HC for those suffering from mental illness
• Around the world mental illness is causing
injury and death for millions of people.
• It is also costly and difficult to diagnose and
treat.
• The opioid crisis is attributable for the
highest death, suicide, and overdose death
rates in the US. Many individuals with
substance use disorders have co-occurring
mental health conditions that are untreated.

26. MENTAL HEALTH
• Hospitals and health leaders need to work
together to navigate ways to work with
mentally ill patients, and researchers, to
continue to find ways to help provide relief.
• The use of telepsychiatry in an emergency
department can decrease waiting time for
a psychiatric consult, decrease cost of
care, and increase linkage to outpatient
mental health services.

27. Challenges for HC in the 21st. century
• Our world is facing many serious healthcare
challenges.
• The answer to the world's great health care challenges
is primary care.
• Those nations with a greater emphasis on primary care
are able to:
• Lower the cost of care
• Improve health through access to more appropriate
services
• Reduce the inequities in their population's health.
• Our generalist tradition of primary care is the only way
that nations will be able to effectively tackle the diverse
health challenges facing the people of our world.

28. Obesity Epidemic

29. Lifestyle Diseases

30. 21st century health challenges:
• Countries worldwide are facing complex and diverse health
challenges in 21st century, and usually there is one national
health system for individual and population health
outcomes. The COVID-19 pandemic and other emerging
health challenges have exposed gaps and fragmentation in
health systems with limited public health capacities and
governance.
• “Essential Public Health Functions” (EPHFs) have been
revitalized to support an integrated approach to sustainable
health systems strengthening, complementary to primary
health care

31. Concept of the EPHFs
• Public health refers to the science and art of preventing
disease, prolonging life and promoting, protecting and
improving health through organized efforts of society. The
EPHFs are generally regarded as a fundamental and
indispensable set of collective actions under the
responsibility of the State which are needed to meet public
health goals, including the
• Attainment and maintenance of the highest level of population
health possible within given resources. The list of and the way
of operationalizing EPHFs are dependent on societal and
health contexts in a country or region and the EPHFs are
interconnected and interdependent.

32. Four key areas of strategic focus

33. Top Health Challenges of This
Century: Are We Prepared?
• The health industry has continued to make
advancements right from the start of this century.
• From finding cures for different cancers to
developing non-invasive medical technology, there
is always something new emerging in the health
front.
• Our resources and supplies become more and
more scarce, especially seeing how the global
population and poverty levels are rising at
alarming rates.

34. Major Public Health Problems
• AR is on the verge of becoming a rundown of a
global crisis.
• Immunization: Pneumonia and influenza still
continue to be the top 10 causes of deaths among
children and older adults.
• The obesity epidemic is a reality
• Mental Health: Treating the most statistically
rampant mental health illnesses, like depression
and/or anxiety, will continue to be the major focus
• Emerging Pandemics

35. Antibiotic Resistance

36. Confluence of Nature and Neglect
• COVID-19 sparked a global health, economic, and societal
emergency unlike any other in recent history. It killed more than 6.3
million people as of June 2022, with true mortality being possibly
three times higher and numbers continuing to rise.
• The IMF projected the cumulative output loss from the pandemic
through to 2024 to be about $13.8 trillion.
Pandemic Prevention Is the Ultimate Investment for Humanity
• Prevention is a global public good that requires an integrated, risk-
based approach to prioritize spillover hot spots, ensure compliance
with international health standards, and promote country
ownership. The good news is that these investments are highly
effective: actions to prevent disease outbreaks carry an estimated
rate of return of up to 86 percent, and most of these actions will
result in significant co-benefits.

37. Lifestyle Diseases: A snapshot
• According to WHO:
• Tobacco accounts for over 7.2 million deaths every year
(including from the effects of exposure to second-hand
smoke), and is projected to increase markedly over the
coming years.
• 1 million annual deaths have been attributed to excess
salt/sodium intake.
• More than half of the 3.3 million annual deaths attributable
to alcohol use are from NCDs, including cancer.
• 6 million deaths annually can be attributed to insufficient
physical activity.

38. The Human Journey:Current and Future Challenges

39. Future Challenges
• As the identification of global health issues and
public awareness and demand for treatment
and services increase, it will be important to
consider best practices and avoid recreating
processes that we know are insufficient, costly
and, most importantly, not effective or even
counter productive – for example, using
antibiotics for viral infections or being passive
to vaccination opportunities.

40. Hospitals: Changing Role
The modern hospital is a matrix organization, an
amalgam of social, architecture and technology.
The functioning of a hospital has unique
components of its own apart from the elements of
functioning of a business organization, research
laboratory and a departmental store.
The ever increasing demand from the health care
seekers, technology changes and advancements
have to be judiciously balanced with the
constraint of resources

41. MANAGEMENT OF INNOVATION
• Strategy Options :
Flexibility and multiple approaches required (economic
incentives for some, professional satisfaction for
others)
During design phase there should be divergent
thinking, creativity, brainstorming, administrative
flexibility and effective communication.
During implementation phase there should be effective
planning, coordination, control, evaluation,
participative decision making and appropriate
incentives.

42. MANAGEMENT OF CHANGE
• Strategy Options :
“Nothing is more constant than change itself”
“Man by nature resists change”
“Every Group has its own dynamics”.
Key strategies in implementing change are
training, attitudinal reinforcement, participation
and commitment of the maximum.

43. MANAGEMENT OF TECHNOLOGY
• Strategy Options :
Optimization of health care, to which
equipment, appliances and technology
makes a significant contribution, must be
subjected to a critical qualitative appraisal
using scientific methods.

44. MANAGING HUMAN EXPERTISE
• These include super-specialists, specialists, other staff
Strategy Options :
• Participative decision making
• Monetary compensation
• Non monetary packages
. Paid family holidays.
. Appropriate titles - consultants
. Financed National & International conferences
. R & D activities
• Stress management
• HRD . Prevent Brain - Drain

45. MANAGEMENT OF CONSISTENCY
• To achieve TQM
 To achieve Accreditation
 To understand that to get ISO certification

46. MARKETING OF HOSPITALS
• Strategy Options :
 Finding out what the customer wants and analysis of
the needs.
 Fulfillment of those needs better than anyone else.
 Meeting financial objectives.
 Target Marketing / Identifying Potential Markets.

47. The Fifth Estate
 Witnessing the rapid rise of wikis, blogs, and
many other online social networks (such as
FaceBook, YouTube, LinkedIn, MySpace,
Twitter), we are already in the Fifth Estate,
,
enabled by the growing use of the internet,
mobile phones, and related information and
communication technologies.

48. Management of Legislative Issues
 Organ Transplant Act
 Consumer Protection Act
 Bio-Medical Waste (Management & Handling) Rules
 Right to Information
Strategy Options
–Know the provisions of the Acts
–Disseminate it to the concerned
–Adhere to the provisions

49. EMERGING
ISSUES
Enhanced patients
expectations
Epidemiological
and demographic
changes
Emphasis on
ambulatory /
daycare
Enhanced standards
Changing function
of hospitals
Health Insurance
Advancement in
Medical Sciences

50. HOSPITALS: STRETEGIC ESSENTIALS
Design for flexibility and expandability
Anticipate Change in Demand Functions
Assisted living
Healthcare Hotels
Emphasize on Patient focused hospitals
Focus on Energy conservation
Create a Healing Architecture
Aesthetics-An Essential Requisite
Go for Green Hospitals
Visualize the Hospital of the Future
Analyse the Strategic Options

51. Indian Healthcare : The Changing Scenario
Current Healthcare Landscape

52. Over 60,000 cardiac surgeries
done per year with out comes
at par with international
standards
Multi organ transplants like
Renal, Liver, Heart, Bone
Marrow Transplants, are
successfully performed at one
tenth the cost.
Patients from over 55
countries treated at Indian
Hospitals.
INDIAN HEALTHCARE CAPABILITY
FACT#1: Proven Indian healthcare system

53. “Physicians, Nurses, Medical Technicians and Other
Scientific Occupations will Become Growth Industries to
Rival the IT Sector within the Next Decade”
- India Vision 2020 Report
HEALTHCARE….THE SUNRISE INDUSTRY

54. THE HOSPITAL OF THE FUTURE
A number of smaller facilities will be
required at several locations to
accommodate the dispersed
function and larger facilities at an
early accessible location to
accommodate the concentrated
functions.

55. The different buildings may be a diagnostic buildings, a
building for pre-clinical services, a building for daycare
surgery and daycare, a building for special medical
treatment and intensive care, a logistic center, an
office building and an education / scientific building.
The patients would only be moved around in the
hospital in exceptional cases when there is a need for
highly specialized diagnostic equipment or treatment.

56. One Health for Our Future
• One Health is an integrated approach that supports a
wide range of sustainable development objectives
with significant co-benefits in areas such as
agriculture, food production, and environmental
protection. For example, a One Health approach to
prevention by reducing deforestation would generate
ancillary benefits of $4.3 billion from lower carbon
dioxide emissions.
• Diseases know no boundary; the next pandemic may
already be on the horizon.

57. ONE HEALTH
• The World Bank’s global estimate of prevention
costs guided by One Health principles ranges
from $10.3 billion to $11.5 billion per year,
compared to the cost of managing pandemics
which, according to the recent estimate by the
G20 Joint Finance and Health Taskforce, amounts
to about $30.1 billion per year.
• There has never been a better time to adopt One
Health as an investment in humanity’s future.

58. 21st century healthcare challenges:
Medical Trends
• Health Care Excellence
ThroughAdministration & Leadership
• “Change will not come if we wait for
some other person or some other time.
We are the ones we’ve been waiting for.
We are the change that we seek.” [Barack
Obama]

60. • Waqt se din aur raat
• Waqt se kal aur aaj
• Waqt ki har shai ghulam
• Waqt ka har shai pe raj
• Waqt ki gardish se hai
• Chaand taaron ka
nizaam
• Waqt ki thokar mein hai
• Kya hukumat ka samaj
• Waqt ki paband hain
• Aati jaati raunakein
• Waqt ki paband hain
• Aati jaati raunakein
• Waqt hai phoolon ki sej
• Waqt hai kaanton ka taj
• Aadmi ko chahiye
• Waqt se dar kar rahe
• Kaun jaane kis ghadi
• Waqt ka badle mizaaj
• Waqt ka badle mizaaj

71. THANK YOU