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