To Modernize the Hospital - It Has to Get Medieval
Given the close relationship between technology and medicine, you would think that the hospital is a relatively recent institution, but its history actually stretches back into classical civilization. Of course, during these early incarnations (up through medieval Europe), the hospital wasn’t really a place where a lot of medicine was being administered, as they didn’t really have much. What they did accomplish instead was community outreach. Hospitals often worked in conjunction or under the auspices of the church and therefore aimed to care for and educate the unwashed masses as well as clothe and feed all people. Compared to what a hospital looks like today, they are quite different. But I am here to advocate for a return to this ancient purpose. To redesign the very modern, very complex, and very expensive issues facing healthcare and the US economy, we need to reorient the hospital to look outside its sliding doors at the community around it. The hospital needs to get medieval.
One of the biggest drains on the American economy comes from the impact of chronic disease. Chronic diseases such as diabetes, cancer and heart disease are responsible for 7 out of every 10 deaths in the US, and account for 75% of healthcare spending. Every year, 69 million US workers miss work or die early due to illness, a loss of productivity that amounts to roughly $260 billion. Now, some of this needs to be addressed by federal, state and local policy, which some Innovative advocacy groups, like PHAdvocates are working to resolve. Decades-old organizations like The Rippel Foundation are now using innovative data solutions to tackle regional problems, but administrators should see the writing on the wall. The more their hospital can offer in the way of free or affordable screenings for the most preventable diseases, the less their medical professionals will be inundated later on by truly sick patients. This isn’t charity, this is bottom line common sense.
St. Anthony’s of London, founded in the early 14th century, became London’s first free grammar school by the 15thcentury. St. Anthony’s wasn’t a prestigious boarding school, but a hospital. While there is no record of their understanding of preventative policy, this initiative clearly has that motive in mind. The more your community knows, the more likely it is to take care of itself. The modern hospital is full of extremely smart and gifted professionals who have spent years educating themselves and minutes educating their patients, often by simply handing them a pamphlet or showing them a short video.
St. Leonard’s in York, also founded in the 14th century, instituted outreach programs to neighboring institutions, like the leper colony. It is important to frame the hospital not as a single building or set of buildings on a campus. A hospital should be a source of ideation on healing that can be carried out to the far corners of the world, or, at the very least, the neighborhood. Today, paramedicine programs are being implemented in some forward-thinking regions and delivering amazing results. Taking the treatment to the streets not only creates a more connected chain of communication between patient and provider, but it saves money, lots of it.
Imagine the hospital of the future. It’s doctors and nurses see fewer patients each day, but spend longer with each one. This increase in time forges a deeper trust (also a proven factor in faster recoveries), and ensures the patient has every tool necessary to make sure they don’t have to go back to the hospital for a very long time. In between patients, these medical professionals are meeting with paramedics to go over program notes and feedback, inputting the data into analysis metrics to find out how they can be more effective in future rounds. A few days each month, the doctors and nurses go out into the community themselves, delivering talks at schools, offices and public forums to update people on preventative measures they can take to stay healthy.
The thing is, this doesn’t cost that much, especially when you consider how much the alternative is saddling the system with. People today are obviously a whole lot healthier than their medieval counterparts, but their relationship to their care providers is actually less healthy, especially in underserved neighborhoods. The more we can bring this bit of history back into the community and current healthcare delivery systems, the better our future will be.
Joe Wilkins, FACHE
jdw@jwhealth.org