Characteristics of an Ideal Hospital

There has been considerable writing about the characteristics of an ideal hospital. While variables like delivering high quality care have achieved a consensus, there are sometimes contradicting recommendations about what a hospital should set out to achieve. Considerations differ drastically depending on the lens one uses to evaluate a hospital system. Because of the high stakes nature of the deliverable that is good patient care, almost anything one can think of becomes a high priority high value outcome to consider. This author has identified 6 dimensions that must be part of every hospital's agenda for it to fulfil a mission of high quality and sustainable patient care: Effective communication, safe and high value care that is in step with accepted standards of care, resilience to stressors, commitment to continuous process improvement are all variables that cannot be ignored when designing or assessing a hospital or hospital system.

Because of the high stakes nature of the deliverable that is good patient care, almost anything one can think of becomes a high priority high value outcome to consider.

?Effective Communication: this high-level variable applies to every aspect of a hospital. When designing a hospital system, one must assess how communication takes place between clinical teams, within a team, across managerial hierarchies and between the hospital and patients and their families. Care and attention to not only whether communication can take place but developing an understanding of barriers to communication as well as how organizational culture creates hidden agendas that may not be apparent from a surface evaluation. Understanding hidden agendas within an organization can help address actual issues that can interfere with effective communication. Independently addressing communication as a dimension can help better delineate if an issue has to do with knowledge, logistics or communication style.

Understanding hidden agendas within an organization can help address actual issues that can interfere with effective communication.

Delivers high quality care: For any hospital to have the trust of the community it serves it needs to be able to deliver care that is perceived as high quality. The challenge in the health care industry is that unlike the manufacturing industry, the output (quality of care) is not always directly related to patient outcomes (recovery, cure, effective disease management, return to baseline function). This uncoupling of output quality to patient outcome adds a layer of complexity where individual patient outcomes require a panel of experts to determine if a negative outcome (morbidity or mortality) was caused or made more probable by an issue in care delivery. Evaluating quality of care then, often becomes an exercise in evaluating processes. Useful clinical outcomes have also been historically evaluated in artificial closed processes such as: appropriate DVT prophylaxis, falls, rate of foley catheter associated infections, central line associated infections, time to initial antibiotics in patients presenting with sepsis and rate of new bedsores in hospitalized patients. While the global standard of care has been dramatically improved by attention to such outcomes, when divorced from the overall patient outcome or experience these variables lose their meaning.

The challenge in the health care industry is that unlike the manufacturing industry, the output (quality of care) is not always directly related to patient outcomes (recovery, cure, effective disease management, return to baseline function).

Resilient to stressors (environmental, medical, labor shortage, structural, supply chain issues): hospitals must deal with a complex array of scenarios. Even with fluctuation in patient volume from season to season held constant, almost any changes in the external environment can impact hospital processes. Hospitals need to continue smooth operations under a variety of environmental conditions and need systems in place to ensure that even natural disasters don’t impact electricity or oxygen supplies to operating theatres or critical care units. Hospitals serve the most vulnerable people and so need much more robust systems in place to deal with natural disasters. International or national drug shortages or laboratory reagents can have a disastrous impact on patient safety in a hospital. The margin for error is so low and the stakes are so high that hospitals need to hold themselves to standards that supersede any manufacturing company while continuing to deliver a much more complex product. A worsening global shortage in highly skilled personnel, especially physicians and nurses, makes labor shortages a real threat to a hospital’s ability to function at all, let alone well. These real-life risks have to be considered when designing any new hospital system or evaluating an existing one. Failure to do so must reflect on a hospital’s overall rating. Other than physical stressors sudden changes in patient flow need to be accounted for such as during pandemics or communicable disease outbreaks. Changing demographics in a society due to an ageing population also require hospitals to plan for high quality geriatric care for larger patient volumes. Geriatric training or at least literacy would be needed for all front-line staff and physical structures might need to be adjusted to accommodate this need over time.

Hospitals need to continue smooth operations under a variety of environmental conditions and need systems in place to ensure that even natural disasters don’t impact electricity or oxygen supplies to operating theatres or critical care units.

Continuous self-improvement: A system that is not improving is worsening. In a sector where the standard of care continues to shift as new research and evidence is produced, failure to put a system in place that evaluates if not contributes to this research would quickly render a hospital’s services obsolete. With “good care” being defined in terms of acceptable patient outcomes for a given presentation, failure to provide what is considered the standard of care is considered a failure. For example, a patient presenting with a myocardial infarction in the 1960’s would have received an Aspirin and then admitted “for monitoring”; in 2022 failing to provide an intervention to break down the thrombosis would be considered malpractice. Hospitals need to have systems that are flexible to change from the level of the individual provider to systematic or even structural improvements. Continuous self-improvement doesn’t only apply to what counts as good care but must also improve a component that examines hospital wide processes for efficacy, efficiency and safety. Employee engagement in this culture of continuous improvement is crucial for the long-term success of a hospital. High staff turnover in a hospital is a serious indication of failing to create an organizational culture that is continuously improving.

A system that is not improving is worsening. ?

Able to incorporate up-to-date standards of care: Despite the overlap with the continuous improvement section, this deserves to be discussed on its own. The highly technical aspect of care delivery requires commitment on a hospital wide level for lifelong learning. Hospital staff need to understand that a certain number of hours weekly need to be devoted to personal improvement. Successful hospitals create a culture of lifelong learning by protecting time during work hours for physicians and nurses to dedicate to personal growth. This not only serves to keep personnel educated and up to date, it also helps create a cohesive culture and the opportunity to build consensus on what the hospital standard of care should be. Giving the most highly skilled professionals the opportunity and time to dedicate to personal improvement has far reaching consequences that include improved staff satisfaction and thus retention, improved quality of care delivery and even reduced cost of care delivery because of the resulting improvement in coordination of care.

?Successful hospitals create a culture of lifelong learning by protecting time during work hours for physicians and nurses to dedicate to personal growth.

Serves unique needs of target community/patient population: It would be remiss to ignore the fact that populations around the world have a unique cultural context as well as potentially unique medical issues. No hospital can be considered to do a good job without considering clearly who the target patient demographic is. A hospital functioning in a region with a high prevalence of tuberculosis (TB) for example must be able to isolate a higher number of patients in a negative pressure room than a hospital that would only see the rare case of TB. Hospitals that serve a much older population would have a design that is completely different to a children’s hospital. The unique dietary requirements of patients, spiritual practices and even access to complimentary therapeutic modalities that might be considered essential are all part of the considerations in building a hospital system. Health and illness do not exist in a silo but are intimately tied to every person’s value system and view of the world. Accommodating the patient’s expectations when it comes to privacy and need to have family or friends stay with the patient are all important factors to consider. A good hospital must have the ability to address this effectively to build trust with its patients.

Accommodating the patient’s expectations when it comes to privacy and need to have family or friends stay with the patient are all important factors to consider.

Community engagement: Given the above hospitals would ideally engage the community to promote wellness and a healthy lifestyle. Investment in home care teams and community cooperation programs can position a hospital to better understand its community’s service requirements as well as engage with it in a healthy way. This bilateral relationship can promote patient advocates that have intimate community ties and can help shape hospital systems in a patient centered way.

Investment in home care teams and community cooperation programs can position a hospital to better understand its community’s service requirements as well as engage with it in a healthy way.

These dimensions can be considered cornerstones of evaluating a hospital or hospital system. Independant care and attention to each of these dimensions can ensure that a hospital has a robust mechanism of self-evaluation. These dimensions can also be considered when evaluating hospital leaders and decision makers in terms of how much attention each of these dimensions receive during their term. As the only self-regulating profession, increased transparency of how health care systems are evaluated and in turn clinicians within them can help establish a culture where the complexity of decision making in hospitals is appreciated and supported by the community at large.