Thursday, March 26, 2009

[EQ] Investing in hospitals of the future

Investing in hospitals of the future

 

Bernd Rechel, Stephen Wright, Nigel Edwards, Barrie Dowdeswell, Martin McKee

World Health Organization 2009, on behalf of the European Observatory on Health Systems and Policies

 

Available online as PDF file [304p.] at: http://www.euro.who.int/Document/E92354.pdf

 

“……..Over the years, the hospital has evolved into the institution and buildings that we know and trust, through the advance of scientifi c medicine. Th ere have been revolutions in surgery (anaesthesia and asepsis), imaging (X-rays and magnetic resonance imaging (MRI)) and laboratory medicine (bacteriology and haematology), among many other fields. The locus of all these developments was the hospital, leading to its enormous significance today, although some activities are increasingly able to be carried out in other settings.


Hospitals are not only sites to provide health care: they carry out extensive programmes relating to research and development, education and training, and in their own right they are critical components of the urban fabric. Thus, although there are sure to be major evolutions in the nature and role of hospitals, the institutions themselves are unlikely to be displaced soon.


If only as a result of its importance as the place where scientific health care is focused, the hospital sector typically absorbs up to 50% of national expenditure on the health care system. This highlights the critical nature of the decision to invest capital in the construction of a hospital, given that this action commits society to a stream of future running costs which dwarf the original – already considerable – capital cost…..”

 

“…..Running through this book is the leitmotif of the critical nature of the model of care, explicit or perhaps even implicit, as a structure for the role of the hospital. “Form follows function”, and thus the shape and size of the hospital are determined by the services it tries to deliver. In planning a hospital, it is naturally the future demands that are most important, futures that are always uncertain because of unpredictable trends and technological developments.

Decision-makers should be aware that capacity is not usefully indexed simply by the number of beds, and space should be as “loose-fit” and flexible as can be designed and built. We can surmise that the more the underlying care processes can be systematized, the more efficiently and effectively flows of patients can be managed.

Perhaps inevitably, this volume raises more questions than it answers, and thus indicates a research agenda to come. ….”Philippe Maystadt President European Investment Bank

 

 

CONTENT

 

Part one: The changing context of capital investment

Chapter 1 Introduction: hospitals within a changing context  Bernd Rechel, Stephen Wright, Nigel Edwards, Barrie Dowdeswell, Martin McKee

Chapter 2 New models of long-term care and implications for service redesign Pieter Degeling, Jonathan Erskine

 

Part two: Influencing capital investment

Chapter 3 Planning health care capacity: whose responsibility?  Stefanie Ettelt, Martin McKee, Ellen Nolte, Nicholas Mays, Sarah Thomson

Chapter 4 Concept planning: getting capital investment right  Knut Samset, Barrie Dowdeswell

Chapter 5 Capital investment and the health care workforce  Bernd Rechel, James Buchan, Martin McKee

 

Part three: Economic aspects of capital investment

Chapter 6 Market competition in European hospital care  Hans Maarse, Charles Normand

Chapter 7 Capital financing models, procurement strategies and  decision-making Geert Dewulf, Stephen Wright

Chapter 8 Life-cycle economics: cost, functionality and adaptability  Svein Bjørberg, Marinus Verweij

Chapter 9 Facility management of hospitals  Kunibert Lennerts

Chapter 10 The economic and community impact of health capital investment  Jonathan Watson, Simona Agger

 

Part four: Design issues

Chapter 11 Translating hospital services into capital asset solutions  Bernd Rechel, Stephen Wright, Martin McKee

Chapter 12 Sustainable design for health  Rosemary Glanville, Phil Nedin

 

Part five: Conclusions

Chapter 13 Conclusions and critical success factors  Bernd Rechel, Stephen Wright, Nigel Edwards, Barrie Dowdeswell,Martin McKee

 

 

The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Offi ce for Europe, the Governments of Belgium, Finland, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the World Bank, the London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine.

 

 

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