1. Future Hospital: from “central role”
to “key role”
Joan Escarrabill MD
Chronic Care Program– Barcelona Esquerra.
Hospital Clínic (Barcelona)
Vic, December 12th 2013
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Master Plan for Respiratory Diseases (PDMAR) & Home
Respiratory Therapies Observatory (ObsTRD). FORES.
Ministry of Health (Catalonia)

2. 1133 – to XVI cent.
Accommodation for
sick priests
XI – XV century
Hospital de St Jaume
Leprousy
1217
Hospital de pelegrins
o St Bartomeu
Hospital of pilgrims
2 buildings
24 beds
1348
Ramon de Terrades
Black Death
2
Hospital de lala Santa Creu
Hospital de Santa Creu

3. The City Council
participates in the
hospital management
2 buildings
24 beds
1408
Guild of
shoemakers
1348
Ramon de Terrades
Black Death
1525
Curch
involvement
1647
Canon Pere Ramis
Improvement works
3 canons
3 civilian representatives
1 councilor
1 nobleman
1 merchant or artist
3
Hospital de lala Santa Creu
Hospital de Santa Creu

4. 1713-1724
Partial use as a
military hospital
1792
1845
Sisters of Charity of
St. Vincent de Paul
1 Physician
1 Surgeon
1 apothecary
1 nurse
(“cabo de vara”)
4 servants
1920
Surgival
Service
1931
Local general
hospital
1845 & 1885: Cholera
1863: Floods
4
Hospital de la Santa Creu

5. • Structural
• Organizational
Dinamic
Flexible
• Local Hospital
• Tailored to the
needs of the
population
Innovative
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Hospital de la Santa Creu

6. J A Muir Gray. Lancet 2013;382:200-1
Better value through population
and personalised medicine.
Effectivity
Presonalised
Population
medicine
Quality
Safety
Value
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Customize evidence
 Biomarkers
 Personal values
 Clinical situation
 Context
Responsibilities to the
population to be served
 Avoid inequalities
 Distribution of resources

7. Hospitals on the edge
1. We must promote dignity and patient-centred care
2. We must redesign services.
3. We must change the way we organize hospital care.
4. We must review medical education and training.
5. We must ensure the right mix of medical skills.
6. We must renegotiate the New Deal.
7. We must improve the availability of primary care.
8. We must revolutionize the way we use information.
9. We must embed quality improvement across the system.
10.We must show national leadership.
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8. 





High quality care sustainable 24 hours a day, 7 days a week
Continuity of care as the norm
Stable medical teams for patient care and education
Optimized relationships with other teams
Appropriate balance between care by specialists and generalists
Discharge arrangements which realistically allocate responsibility
for further action
http://www.rcplondon.ac.uk/projects/futurehospital-commission-background-and-workstreams
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9. Lancet 2013;382:923-4
Increase
(emergency)
admission
Pts > 85 yrs
Multimorbidity
Cognitive
impairement
Balance
Reduction
LOS
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10. To identify the optimum
care pathway for adults
with medical illnesses
Lancet 2013;382:923-4
Increase
(emergency)
admission
Pts > 85 yrs
Multimorbidity
Cognitive
impairement
Balance
Reduction
LOS
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11. Future hospital


No “one size fits all” : Coordinated mangement
of patients with multiple comorbidities

Specialist medical care will not be confined to
inside the hospital walls.





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Hospitals must be designed around the needs
of patients
Continuity of care
Illnes can occur in any time: 24/7/365.
Reorganisation of ‘front door’
Vulnerable patients.
Patient experience is valued as much as clinical
effectiveness

12. Extended roles for physicians
in the community
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13. Three elements
Fast track
Acute care
hub
Ann Intern Med. 2012;157:448-449.
“Hub &
spoke”
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Clinical
coordination
center

14. Disruptive business model
Solution
shop
Value-added
process
Facilitated
network
Intutive Medicine
for unstructured
problems
Hypothesis testing
until diagnosis can
be made
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Empirical medicine
Patient groups with
common needs
Standardization
Long-term care:
adherence

15. Disruptive business model
Precision
medicine
Personalized
medicine
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Care plan:
adherence
Focus on
results

16. Key words to summarize
Concentration
Complexity
Context
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Transparency
Design

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18. Concentration
To be or not to be
To close hospital beds
or to close hospitals ?
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19. Transparency
General
data
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Specific
data

20. Design
The patient room of the future is being designed as a
safe, private, comfortable place conducive to healing.
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22. BMJ 2013;347:f5479 doi: 10.1136/bmj.f5479
“Conventional models of health service
design in which a hospital site is the
sole focus for the delivery of
emergency, acute and elective services
are dated,”
“The expectation that most
physicians will become highly
specialised in a narrow field
must be changed.”
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23. Context
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24. Complexity
What we’re trying
to build is a
learning health
care system
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To gather data
about hospital
users
To run that data
through
predictive models
and
recommendation
systems
Personalized
diagnoses and
treatments

25. To conclude…
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26. Thank you very much for your attention !!!
ESCARRABILL@clinic.ub.es
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