Good Example Of Changes In Hospital Management In The Past Two Decades Essay

Introduction

The marvels of medical science in its quickly advancing state will likely never cease to amaze us. In fact, it appears every day there is a new procedure, preventative measure, technological protocol, or design that allows medical professionals to deliver a higher standard of care to patients. Medical professionals are finding new ways to deliver scans, keep patients healthy, make care accessible, and even grant damage control surgery, as they never have before. There was a time when babies were delivered into unwashed hands on dirty floors, patients were not scanned routinely for health, and the infrastructure of hospitals in general was a disaster. Today, all of that is changing. In the past two decades, hospitals have changed radically in terms of types of services offered, as well as the infrastructure and design of the hospital. The changes have allowed hospitals are now ready to offer medical care in the 21st century.

Services

Many believe that twenty years is not long enough to change a hospital’s services in a notable way. However, hospital management understands that some of the services rendered in hospitals today, however small, have great impact on patients. For example, in America, the long withstanding segregation experienced during the Civil Rights Movement caused patient segregation in many facilities. According to Kristian Siverbo and associates, “Attitudes Toward Quality Improvement Among Healthcare Professionals: Lessons From A Hospital-Wide Quality Initiative,” the segregation ended primarily in the 1960’s, but the facilities used to only treat certain minorities were vastly under-funded and left without proper equipment . In the last decade, these facilities began receiving necessary tools needed to provide the same preventative healthcare as facilities that only treated white people during the segregation era . Quality healthcare was, for the first time, a reality in these facilities. While segregation declined entire facilities the right to grant proper healthcare to the populations of some countries, this does not speak to services granted on a smaller scale. For example, twenty years ago, mental health services were not as prominent in hospital setting as they are today. While psychology was a respected profession, some of the more violent or less understood mental illnesses were not understood in a hospital setting, and if an individual admitted himself or herself, they may be turned away. Fortunately, as stated in David While and associates’, “Implementation of Mental Health Recommendation Services in England and Wales and Suicide Rates, 1997-2006: A Cross-Sectional Study and Before and After Observational Study,” many of these stigmas have been changed . It was recommended to hospital management across England and Wales, as early as 1997 that more should be done in a medical setting for the mentally ill. However, some hospital management teams were reluctant, having thought they would look, “as batty as their patients,” if they admitted people who were not physically ill . The study shows that prior to the implementation of services catering to the mentally ill, i.e. intervention, counseling, medication, suicide watch, etc., suicide rates in the area were 42% higher than 2006. They had dropped another 10% when checked again in 2010 . When hospitals began to realize their services went outside fixing the physical abnormalities of the brain, but also remedying its chemical imbalances, there was also a dramatic impact to the services offered. The services staffs are able to offer have also changed in the past twenty years. It has been documented, for example, twenty years ago one did not need as much educational accreditation as they do now to become a nurse, primarily in America and Europe . Nurses were not always required to have an Associate’s degree or a Bachelor’s degree from a university when attempting to practice medicine; there were instances when they were able to begin at lower positions at a hospital, and work their way up to being a nurse. While nurses are technically unable to administer life-saving drugs or operations to patients, but they are still in charge of their care and, twenty years ago, were sometimes ignorant to some of the basic life-saving measures that nurses today are very knowledgeable about. Today, it is mandatory for nurses to obtain a standard amount of schooling before administering care to a patient. This change of delivery in services has not only ensured a difference in the quality of life for patients, but also in how nurses feel about themselves and their work . Preparing for the 21st century means hospital management must also usher its patients into a new era of thinking when attempting to offer new services. The entire point of offering new services is to help ensure that patients will leave the facility healthier than before, and in some countries that have relied on holistic remedies, this can be a difficult task. Essentially the local population may be resistant to change. However, Yonghong Xioa and associates’ article, “Changes in Chinese Policies to Promote the Rational Use of Antibiotics,” outlines how local hospitals are attempting to change the stigmas and offer a safer a brand of healthcare . It is a common misconception the the whole of China is adverse to antibiotics; this is not the case. Many are open to taking them; more aptly, most cannot afford them. There still are, however, many individuals who believe that through the use of oils, acupuncture, and other holistic remedies, that they can circumvent very serious illnesses such as measles, TB, and even cancer . Many Chinese citizens also abused antiobiotics, using them as drugs. Hospital management is now working with the Chinese government to pss policies in order to promote rational use of antibiotics in an effort to change the minds of citizens, as well as save their lives. As mentioned previously, hospital sanitation is perhaps one of the services that has made the most progress. There was a time when many babies born died soon after due simple to unsterile hands. The power of soap and antibacterial handlotion has been invaluable to hospital staff in terms of saving lives. Unfortunately, this is not the case in every country; some still suffer greatly at the hands of germs, especially the young. Songul S. Yalcin and associates’ article, “Changes and Determinants in Under-Five Mortality Rate in Turkey Since 1988,” for example, shows that many deaths occuring in children under five-years-old happen in infancy, and still because of unsterile conditions . There were many other factors to the under-five mortality rate, such as low-birth weights, as well as rural residence and inaccessibility to hospital facilities. Forunately the country’s hospitals have done their part through outreach programs, as well as services on site, to teach mothers how to better care for infants and children. Cleanliness has also been a bigger issue in Turkey, and they were able to lower their under-five mortality rate by two-thirds when last assessed in 2010.

Infrastructure

Quality services and constant improvement is important to a hospital manager’s day-to-day busines. A crucial part of that, though, is the infrastructure of the hospital. While new services are being offered each day to people around the world, it would not always be possible without changes to the infrastructure, or inner-workings of hospitals. Many things have changed in the past two decades to allow such grand improvements to take place. Hospitals, for example, became bigger, according to Zack Cooper and associates’, “Does Hospital Competition Save Lives? Evidence From the English NHS Patient Choice Reforms .” The article states that forcing hospitals to compete within a market of fixed prices demanded that they stay on a budget. This was forseen as a bad move because it was thought many people would be too poor to seek care from the hospitals but, in fact, more people were able to afford healthcare than ever before, allowing hospitals to expand. This allotted for new wings of hospitals which granted new space for equipment and also allowed more patients to be treated . The decision to work on a fixed budget and compete within this market did save lives because it ultimately brought in more money, allowing hospitals to grow and serve more patients than ever before. This, of course, was only documented in Europe. Germany experienced similar positivity during a privatization, according to Oliver Tiemann and Jonas Schreyogg . This leaves many wondering whether working on a fixed budget competition truly is the answer for a hospital’s infrastructure. While hospitals across Europe that resorted to working on an open, fixed budget competition saw larger profits and were able to expand, it waas found that the infrastructure of privatized German hospitals became more efficient in the past twenty years by a margin of 2% . It appears that after hospitals convert to private, for-profit status, they experience a regulated three year period of elevated efficiency which either stabalizes or tapers off. This observations allows us to assume that, while efficiency is key, it will not last in a privatized, for-profit environment. Hospital managers, therefore, should attempt to nagivate toward a fixed-budget competitive market. Larger spaces and more money have allowed for many things to happen in hospitals around the world. While the space is obviously used to house more patients, many hospital managers have also used the extra space and money to implement new procedures in their facilities in an effort to change the infrastrcture. There has been an evolution in damage control surgery, according to Brett H. Waibell and Michael Rotondo, one which hospital managers have wanted to take advantage of . Once the patient is assessed and has been cleared to undergo the procedure, it is understood that damage control surgery can help correct or control problems pertaining to issues with the bowels to orthopedic problems . Without the higher income and larger space granted by fixed budget income, this infrastucture change would not have been possible. These surgeries are also offered in other countries, such as the United States, however they are often more expensive than most can afford nd are not considered as part of such a grand infrastructure change, but rather a scheme to get rich.

Design

Unsurprisngly, the design of many hospital programs typically leaves something to be desired. Safety issues, for instance, often become a matter of great concern, especially when transporting the elderly. David Sandvik and associates’, stated in, “A Hospital-to-Nursing Home Transfer Process Associated With Low Hospital Readmission Rates While Targeting Quality of Care, Patient Safety, and Convenience: A 20-Year Perspective,” that twenty years ago, many elderly individuals were either injured upon transport, or quickly readmitted to the hospital after transport . Eventually it was assumed that two reasons were the cause: th haste of the transport, as well as the design of the program for the elderly once admitted to the hospital. The past twenty years has seen hospital management, globally, changing programs for the elderly once admitted to the hospital. Safer and more effective trolleys upon transport have also been implemented in many countries in an effort to ensure safety upon transport to nursing homes . It has allowed for the readmission rate of the elderly to decrease by 14%, and has been considered a design success.

Conclusion

In sum, there have been many changes throughout the last twenty years that have impacted the services, infrastructure, and design of hospitals. Hospital managers have attempted to do what is best for patients in terms of keeping them safe and healthy, while delivering the best and newest available methods of care. They have demanded the best out of their employees, changed the policies in their countries, changed the way their hospitals operated, and even changed the design of many programs in order to ensure the safety of patients, all in an effort ready their facilities for the 21st century. While they have gained a lot of ground in twenty short years, and many lives have been saved because of it, there is still a long way to go. We are fifteen years into the 21st century, and I believe that we are not as prepared as we could be to help the population medically. Essentially, there is still work to be done.

References

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Cooper, Z., Gibbons, S., Jones, S. & McGuire, A., 2011. Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms. The Economic Journal, 121(554), pp. 228-260.
Norman, D. A. & Verganti, R., 2013. Incremental and Radical Innovation: Design Research vs. Technology and Meaning Change. Desing Issues, 30(1), pp. 78-96.
Sandvik, D., Bade, P., Dunham, A. & Hendrickson, S., 2013. A Hospital-to-Nursing Home Transfer Process Associated With Low Hospital Readmission Rates While Targeting Quality of Care, Patient Safety, and Convenience: A 20-Year Perspective. The Journal of Post Acute and Long Term Medicine, 14(5), pp. 367-374.
Siverbo, K., Eriksson, H., Roharjo, H. & Moonen, M., 2010. Attitudes toward quality improvement among healthcare professionals: Lessons from a hospital-wide quality initiative. International Journal of Quality and Service Sciences, 6(2/3), pp. 203-212.
Tiemann, O. & Schreyögg, J., 2012. Changes in hospital efficiency after privatization. Health Care Management Science, 15(4), pp. 310-326.
Waibel, B. H. & Rotondo, M., 2012. Damage control surgery: it's evolution over the last 20 years. Revised Medicine, 30(4), pp. 314-321.
While, D. B. H. et al., 2012. Implementation of mental health service recommendations in England and Wales and suicide rates, 1997–2006: a cross-sectional and before-and-after observational study. The Lancet, 379(9820), pp. 17-23.
Xioa, Y. et al., 2013. Changes in Chinese Policies to Promote the Rational Use of Antibiotics. Journal of Public Medication, 10(11), pp. 16-19.
Yalcin, S. S. et al., 2013. Changes and Determinants in Under-Five Mortality Rate in Turkey Since 1988. Central European Journal of Public Health, 21(2), pp. 80-87.