What If There Were No Hospitals

[Applause]

so what if there were no hospitals

it’s a provocative question and if you

think about it

what would happen to our society if we

didn’t have hospitals

you’ve heard politicians say recently

that

if the hospitals are overloaded if they

exceed their capacity

the economy would shut down

so it made me think about how did

hospitals begin

and what was their function early on

if you go back to antiquity you found

out that hospitals were often

created by religious organizations

and they were put in place to take care

of the sick the poor

feed them sometimes they would take care

of soldiers that came back from war

injured but for the most part hospitals

were created

for places for people to die

and if you look at how hospitals have

evolved over the years

since antiquity till about the 18th

century in europe

they didn’t change much but then that

was about the time

the shift occurred where they went from

more of a practice of art

to practice of science and they

would go back and forth again where

religion would dominate

hospitals for a while and then science

would dominate

and if you fast forward to present day

we now have teaching hospitals

that are part of very complex academic

health centers

and these hospitals now are places where

we teach medical students

nursing students allied health

professionals

we do research all kinds of great things

are discovered and we also take care of

patients

they’re a complex institution with

lots of regulations lots of complex

reimbursement structures and they

probably would not exist in their

present

state if those regulations and those

accreditation requirements

didn’t exist

so what is a modern day hospital like

well it’s like a factory there are

people that pay attention to

supply chains there are people that pay

attention to finance

there’s massive information technology

infrastructure

there’s environmental services there’s

waste management

besides nurses doctors

all kinds of therapists people being

taught

people doing research it’s really really

a complex system

and a little bit different than things

like

the aviation industry or the nuclear

reactor industry

where they have to be high reliability

organizations

very little tolerance for failure

hospitals have been called out in past

years

for creating errors for being unsafe

for being places that people had to go

to

but certainly didn’t want to go to

and so i challenged the model of the

present day hospital

and so what’s the problem what are the

major problems with the modern day

hospital

well i think in the midst of this

pandemic we’ve now

had our warts exposed we’ve seen that

hospitals struggle with their supply

chain

we ran out of protective equipment we

ran out of ventilators

we didn’t have adequate staff

we had some real real significant issues

capacity as i mentioned earlier was a

real problem

if the hospitals get overwhelmed the

economy is going to be shut down

we’ve been shutting down hospitals

because we’ve been told we had too many

hospital beds

for the past few decades and now all of

a sudden

we don’t have enough hospital beds so

hospitals across the united states were

asked

increase your capacity by 50 percent

what other industry could flip a switch

and

increase their capacity by 50 percent so

we

we could create space we could find beds

but where do you get the staff because

at the end of the day

people are taken care of by people

so our strategy failed us and if your

strategy fails you

you shouldn’t repeat the same

methodology

you have to start thinking differently

you have to start thinking

what will the next generation hospital

be and will we need

hospitals in their present form

what kovid 19 did to us is it exposed

the fact that technology

might be something that could really

help us

create the next generation hospital so

what did we learn

we learned that we had to have touchless

surfaces

we had to identify people with certain

technologies

we couldn’t allow visitors to visit

people with covid

in their hospital beds so we started to

use ipads

and our iphones to communicate with

loved ones

as the only way to say goodbye

some people had to die alone and if we

didn’t have the technology they would

have not

been able to communicate with their

loved ones

we learned how to trace people’s hand

washing with technology to make sure

that they were doing what they were

supposed to do

we could trace exposures if somebody

had coveted 19 we could trace who they

were exposed to

so technology really helped us and i

think technology will

continue to be that bridge into the

future

but innovation is messy

people are reluctant to change people

fear change often

because they tend to cling to the status

quo they like

what’s familiar but i think what covid19

did is it forced us to accelerate the

adoption

of technology i consider technology

the connective tissue

of the hospital you know maybe

one day we’ll have drive through brain

surgery

but that’s probably in the future

but we do have drive-through coveted

testing right now

and we do have drive-through

vaccinations

we also have very sophisticated

information technology with analytics

and we also are bringing point of care

testing

to the bedside

so what will the hospital of the future

be

we’ll always need hospitals but

they’re going to be very different

the hospital of the future will have

different technologies to make the room

quieter

it’s been described sometimes in the icu

that it’s like a casino there’s so many

bells and whistles going off it’s not a

very restful place

patients will be able to control the

lighting

and the temperature in their own room

they’ll be able to look out the window

and see nature

which has been proven to accelerate

healing

i also think that hospitals will be like

air traffic control towers

with experts in the hospital overlooking

a continuum of care that goes beyond the

walls of the hospital

hospitals will look at different modes

of transportation

just like amazon and google

are looking to use drones hospitals will

use drones to transport specimens

between laboratories in between

hospitals and to reach out to rural

clinics

to pick up specimens and potentially

even paperwork

so the hospital of the future will be

much different than the hospital of

today

and the hospital of the future is going

to have to understand

what are the future threats we’re likely

to have more infections we’re likely to

have

mass mass casualties and they have to be

able to flex

up and reduce back

during normal operations so we’re going

to have to design our hospitals

differently

and they’re very expensive to design and

they’re very expensive to change

so they have to be well thought through

before they’re constructed

will there be hospitals without beds

there are hospitals now that are being

built without beds

there are hospitals that are being built

with a small number of beds

the objective is not to be in a hospital

but to be in your own healing

environment with the expertise

distributed outside of the walls of the

hospital

maybe we’re going to have futuristic

diagnostic sick bays

because if you think about it there are

very few businesses

that diagnose a problem and then fix

the problem all in the same business

that’s somewhat unique in hospitals

in and innovation in business that

doesn’t always

work well so you have to define the

problem quite clearly

so you don’t throw multiple therapeutics

at the problem and hoping you catch the

right solution

so you need to define the problem with

things like molecular diagnostics

artificial intelligence machine learning

all of that stuff will help refine

the definition of the problem so the

therapeutic can be more

precision like and the word

hospital is much related to the word

hospitality

and so we don’t want our hospitals to be

dark and drab and gray

and unpleasant when you do ultimately

have to come to the hospital

you want it to be a pleasant experience

you want it to be

a first-rate five-star looking hotel

with all of the therapeutics and

diagnostics within

the other responsibility we have with

the futuristic hospital

is to make it sustainable we have to

integrate

green technologies we have to reduce the

waste

we have to reuse and we have to recycle

hospitals generate a disproportionate

amount of waste

we use too much plastic we use too much

paper

we use too much energy and we have to

adopt new technologies to reduce that to

make it sustainable

for the environment and sustainable for

the cost of

health care

and so when i think of a hospital of the

future

i think that it will continue to exist

but it will not be restricted by its

walls

that outside of its walls is where it

can do the most

good provide the greatest help

as we decentralize the expertise

and get it out to places where

patients exist where they want to exist

that’s what the hospital of the future

should be

and so it might end up being in your own

home

so you may come to the hospital for some

care

but then you’ll be equipped with some

vital signs monitors that you can put on

your watch or your finger

or on your ear or a sensor that’s on

your tooth

there’s a number of different biometric

technologies

that could be put on you and you could

ultimately be cared for

in your home because when you see

somebody

coming to a hospital and they’re

restricted from being with the people

they love at the end of their life

it’s a tragedy to see somebody die alone

and if we extend our expertise outside

the walls

i don’t think we’ll have people dying

alone

thank you