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How and why will hospitals have changed in Portugal by 2029?
em 2020-03-30 Ano: 2020

Prof. Carlos Pereira Alves

How and why will hospitals have changed in Portugal by 2029?*

It’s about time for hospital changes

1. Can you think of three major challenges that will transform hospitals in your country in the ten coming years? Please elaborate for each of these challenges, by thinking for instance to which kind of change it would be and how it would affect the hospital, the level of readiness in the hospitals, etc.

I believe that the three major challenges will transform hospitals in the ten coming years are:

  • Changing conventional hospitalization into either outpatient surgery or home hospitalization
Both alternatives to conventional hospitalizations, already running, will increase in the future, due to clinical studies proving they reduce hospital complications and infections and allow a faster post-operative recovery (earlier onset of daily activities, family life and working activity) and smaller changes in patients’ daily lives. Besides, they have a direct impact on hospitals as well, by allowing better bed management for acute patients’ treatment, reducing surgical waiting lists and allowing a significant increase in hospital efficiency. Finally, they allow a strong rationalization of health expenditure.

  • Implementing integrated and patient-centered health care
Establishing integrated health care services, reflecting the patients´ pathways in the system, is becoming the main key. Due to factors like aging population, increasing chronic diseases and multimorbidity among patients, there is a need for integrated health care services (primary, specialized and continuing) that will allow a global – patient-centered care, instead of a fragmented one with unnecessary appointments, especially on emergency departments.

On one hand, it is important to give patients a warranty of a smart referral, and to offer them timely access to health services and, where necessary, an easy communication or transport between services without obstacles, delays or losses of information. On the other hand, it is necessary to improve health literacy through prevention and promotion, and therefore improve patients’ ability to make informed decisions about their health, throughout their life span.

  • Implementing Value-based health care
Start implementing the “Value-Based Health Care” methodology at the hospital level and thereby adopting the payment mechanisms based on value, will promote the general health improvement, strengthen patient-centered health care, as well as contribute to a higher quality and a more efficient access to health services.

2. What are the opportunities or solutions to address these challenges? Please elaborate on what it would take to address these challenges, what should be done on the short and long term, etc.

There are many opportunities and solutions to address all three challenges that are already being implemented. The very basis of all is a digital transformation that will connect health care providers, increase patient´s interactive use with up-to-date information and therefore an active participation in its own care process and also shift medical services out of hospital. To this end, it is necessary to provide multiple digital service platforms which allow information’s access and sharing, introduce cutting-edge technology and devices.

Another key solution, common to all challenges, is to involve all NHS stakeholders (health professionals, managers, technology and pharmaceutical partners, decision makers and patients) and to ensure their effective participation in all the processes.

This involvement will only be possible through the following solutions: qualitative and effective promotion of new projects and implementations in order to convince and motivate people, developing new instruments and tools for managing, informing and communicating and introducing incentive mechanisms. These could be achieved in a different way. Regarding outpatient surgery or home hospitalization, it’s very important to first encourage payment mechanisms, or at least not to discourage them. Concerning “Value-Based Health Care” methodology, strengthening the incentive mechanisms is essential to encourage hospital performance, based on this methodology and benchmarking, hence demonstrating the added value, sharing good practices and reaching better efficiency.

3. While there might be opportunities or solutions to tackle these challenges, what uncertainties remain regarding the hospitals’ response?

The integration of new processes is usually difficult due to different technical, cultural, behavioural and managerial aspects of the involved parts, and due to the complexity of changes. So, I see three main uncertainties regarding the hospitals’ response:

  • Resisting changes
Since by rule health professionals, patients and hospitals have a tendency to resist big changes, it is very important to do implementations slowly and in phases, taking actions in order to involve all and promote the importance of new ideas, as I already mentioned. It’s also very important to demonstrate the gain, and measure results. To this end, the best way would be to develop pilot projects first.

  • Financial limitations
Hospitals and NHS itself face financial limitations, so – once again – the implementation of all solutions should be done in phases.

Regarding “Value-Based Health Care” methodology in specific, we face the problem of how and who measures the costs and – essentially – who measures the results and health gains. It’s not enough just a “disease free” approach, but a broader approach of health and wellbeing of the population.

  • Regional inequalities
As there are some regional differences and specific problems, it’s significant to involve local authorities and health organizations, not only governmental, but also non-governmental.

About the Portuguese Association of Hospital Development (APDH)

The mission of the Portuguese Association of Hospital Development (APDH) is to have an active participation in all activities that may promote hospitals and contribute to their development.

To fulfill its mission, APDH participates actively in all the reflections, working groups and actions that are inserted in this context, independently of political or commercial interests. In addition, it establishes cooperation protocols with public and private institutions deemed necessary and convenient, aiming to promote and organize the activities that will meet the interest of its members, whether individual or collective.

*A Federação Internacional dos Hospitais (IHF) celebrou, em 2019, o seu 90.º aniversário e neste âmbito convidou todos os Membros de Pleno direito, entre os quais a APDH, a expressar a sua opinião sobre como serão os hospitais em 2029, ano em que a IHF comemorará o seu centenário. O artigo foi lançado numa publicação especial "A Bold Vision for Future of Hospitals and Health Services in the 21st Century", sobre os desafios e oportunidades que os hospitais enfrentarão nos próximos 10 anos.