Healthcare Prepares for the Future

by Tom Redding and Fred Crans

A hundred years ago, much of the healthcare people received was tendered by the Family Doctor via a methodology known as a “house call” in which the doctor would come directly to the patient’s home, little black bag in hand, sit down by the patient’s bed, have a conversation, take some vital signs, open his black bag, pull out some medication appropriate for addressing their findings, write a prescription, bow politely at the door, put their black fedora on, hop into their Buick sedan and drive to the next patient’s house.

It wasn’t fancy, but the patients loved it. Hospitals were reserved for serious issues. The home sufficed for most things.

In the ensuing decades, a model evolved that featured the hospital as the focal point of a system that also supported physician offices and clinics. People drove to the care they were to receive (as demonstrated by the left half of the graphic pictured above).

Over the past twenty years, systems have grown more and more complex- offering a broad range of services across a plethora of sites in any given service area. Mergers and acquisitions have become commonplace and have done much more than simply add more buildings and more “covered lives” to a system. They have often added redundancy of services offered and buildings and equipment in need of repair or renovation. The result is de-centralization of care, and those changes are fraught with issues that will need to be addressed as systems try to successfully plan their movement into the future.

De-centralization, as well as other Issues, Disruptions and Constraints +have forced systems to scrutinize what assets and resources they have, identify where they want to go in the short, medium and long run and develop plans to address the issues and opportunities they have identified. As they conduct that scrutiny, many health systems are taking a hard look at how to successfully navigate their way into a landscape rife with technological advances such as Telemedicine, Artificial Intelligence (AI), Machine Learning (ML), Robotics, Drones and who knows what is just around the corner.

Let’s take a look at the Issues, Disruptions and Constraints facing today’s Health Systems.

Issues, Disruptions, Constraints and Questions to Answer

Issues- Here are some issues that face every health system as it moves forward:

·?????? Logistics and Transportation. For the next ten years, healthcare delivery will be all about the mastery of Logistics and Transportation. As you can see in the right-hand side of the opening graphic, systems continue to get more and more complicated and diverse in both location and services offered. It’s no longer enough to know how to unload the distributor’s truck at the dock, sign the paperwork, restock inventory in the storeroom and take the rest directly to the patient’s bedside or ancillary department. Today, multiple types of facilities rendering multiple services exist across ever-expanding geographies. Getting supplies and patients successfully to care sites becomes a never-ending challenge. Keeping up is difficult; getting ahead, even more so. Resources will have to be dedicated toward developing, implementing and revising strategies that can serve the system as it changes. The issue is further exacerbated by a growing shortage of Over the Road Drivers and continuing back-ups at major ports of entry.

·?????? Real Estate Optimization. Most Health Systems are formed when previous stand-alone or competing systems join together to create a larger organization with the hopes of providing better or additional care or services to their patient community. Unfortunately, the resulting aggregation of real estate and buildings brings both opportunity and challenges as systems work to find ways to put the right kinds of services in the right place to serve its patients. Another issue that aggregation brings is the physical state of the buildings in the system. Some may be usable, some may need renovation and some may need to be demolished and possibly replaced. And some buildings may need to be built from scratch.

·?????? Need to provide for a flexible workforce as well as fluid patient movement. As care continues to migrate away from the acute-centric setting, Systems will continue to be challenged to build a workforce designed to support flexibility and fluidity of movement of both staff and patients as they render and receive care within the system.

·?????? Support Services Areas. Movement of supplies and people throughout the future care delivery system will require those involved in the process to become “air traffic controllers”. With increased movement of goods and services to more and more locations, dock capacity and management becomes a critical asset to operate a highly effective and efficient facility.

·?????? Adoption of New and Emerging technologies. In the past few years, new and rapidly-evolving technologies seem to be entering the world at warp speed. Health systems, saddled by perpetually scarce resources for investment in things such as Robots, AI, ML and Process Automation, must be disciplined, thoughtful and focused as they match the needs of their operations with the technologies available.

Disruptions: The climate is also rife with disruptions- the ones we know and the ones we don’t know, but should be preparing for. These include:

·?????? Home Health and Telemedicine: Two concepts that have gained momentum since the Pandemic are Telemedicine and Home Health care. In some respects, they herald back to the “house calls” of yesteryear. In other respects, they represent a deep infusion of technology to the patient’s home. Both concepts are extremely appealing to patients, but they require planning and resources to implement and support. Infrastructure, web availability and quality, staffing and logistics issues are involved.

·?????? Value-based care model: Value-based care is a model in which the goal is to improve outcomes (quality) while reducing costs. The model forces organizations to take a look at everything they do and find ways to do them all better and at a lower cost. Organizations that perform well are rewarded with improved reimbursements, while those who don’t are penalized. The model impacts how facilities are designed and how care is delivered.

·?????? Competition from non-traditional sources: Healthcare is an extremely attractive plum. Over $2 trillion is spent annually in the U.S. and that makes the movement of care from hospital-centric to patient-centric a huge opportunity for companies like Amazon, Walmart, CVS and Walgreens, whose expertise lies in excellence of fulfillment. As long as the opportunity remains attractive, non-traditional competitors will continue to enter the market.

·?????? Labor availability challenges: The COVID-19 pandemic had a disastrous impact on the healthcare workforce, causing many people to become burned out and leave the industry altogether. Add to that the need for many new specialty employees in areas such as IT, Technology and Supply Chain Operations and healthcare organizations are faced with a constant dearth of open positions.

·?????? Geo-political, natural disaster and future pandemics disruptions: One thing is certain: if it happened before, it will happen again, only next time it will be worse. The lesson of the pandemic should be: There will always be something unexpected to deal with, and healthcare organizations need to incorporate contingency planning into their cadence.

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Constraints: What issues constrain moving forward successfully? Here are some.

·?????? Fragmentation of Industry Partners: Healthcare is a fragmented industry. It is often not easy to locate, vet and select prospective partners in designing and implementing change.

·?????? Most facilities have been built on an outdated mindset: The older the facility, the less prepared it is to support the present, let alone the future. Assessing the state of a system’s physical infrastructure is often a dreaded and disappointing exercise, yet it is absolutely necessary that it be done so a proper plan can be developed. For some sites, only minor revisions may be necessary. Others may require major work and yet others may need to be replaced or shut down.

·?????? Relationships with needed collaborators have not been built: Once again, history has worked against healthcare when it comes to collaboration. Most systems are comprised of former competitors and for certain, relationships with suppliers have traditionally been adversarial. Building collaborative relationships are paramount, but they take time to develop>

·?????? Many systems are hesitant to invest in new technology and infrastructure improvement: Last and far from least- money. Year after year, the fight for scarce resources is never-ending. Historically, clinical, revenue-producing projects and equipment took precedence. In recent years, IT has become the beast that has to be fed. Supply chain leaders who want to move their system into the future need to know how to build their case.

Here are some questions you should ask as you plan for the future:

1.???? Do we have the right infrastructure in place to support the Decentralized Care Model?

2.???? Are we leveraging the scale of our organization (clinically and in Support Services)?

3.???? Do we have an automation and robotics strategy (clinically and in Support Services)?

4.???? How will Home Health and Telemedicine disrupt our organization and make our existing facilities obsolete?

5.???? Are we investing in the right aspects of our Real Estate strategy to enable the future?

Let us help. For over forty years, St. Onge has been helping organizations across all industries Plan, Design and Implement strategies that will take them successfully into the future. We would like to help you. For more information, contact us.

Tom Redding, Senior Managing Director, Healthcare [email protected]?

Fred Crans, Business Development Executive, Healthcare [email protected]

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