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Challenges and the Future

Hospitals have evolved from cots in monasteries and almshouses with patients being tended by members of religious orders to vast bastions of technology. They have gone from places where the only comfort to be offered was food and relief of pain and discomfort to places of hope and the reality of being cured of disease. The journey has not been an easy one, and hospitals will continue to face many challenges in the future. Decreased reimbursement and the Affordable Care Act, an aging population and aging workforce, consumer-driven health care plans, and competition for physicians are just a few of these challenges. The health care industry faces pressure to increase efficiency, improve quality and overall performance, and remain compliant with government mandates. Many hospitals are looking toward increased automation and electronic systems to aid in this endeavor; others are streamlining services as ways to work smarter. Where will it all lead? What will hospitals look like ten or twenty years from now?

They will probably be very different from the hospitals we know today. Regardless, the goals will always be the same: to continue to improve patient outcomes and provide the best care possible.

From the convents and monasteries of early religious communities in Europe to the ultramodern, state-of-the-art bastions of technology we know today, hospitals have undergone enormous change. Once a place where only the poor and infirm were treated, hospitals are now the place where all seek care and treatment. Early hospitals were not-for-profit organizations and were financed primarily through charitable contributions. The advent of modern medicine and technology and an increased demand for services have made health care one of the largest industries in the United States and also one of the most highly regulated. The introduction of the federal Medicare program in the 1960s has been a major factor in the increase in government oversight. In addition to government oversight many private organizations, such as The Joint Commission and the Leapfrog Group, have arisen to ensure public safety and monitor quality outcomes.

Finances and reimbursement are currently, and will be for the foreseeable future, the major concern for health care organizations. Reductions in Medicare reimbursement and changes included in the Affordable Care Act will influence how health care is delivered and paid for in years to come. In this rapidly changing industry one thing never changes–the need for competent and accessible quality care.



Centers for Medicare & Medicaid Services (CMS)

committee of the whole

conditions for coverage (CfCs)

conditions of participation (CoPs)

continuum of care

councilor model

culture of safety

diagnosis related group (DRG)

Forces of Magnetism

governing board

Hill-Burton Act

horizontal integration

The Joint Commission (TJC)

Journey to Magnet

Magnet Recognition Program®

mandatory staffing ratios


medical executive committee (MEC)

medical staff bylaws


Medicare Payment Advisory Commission (MedPAC)

never event

not-for-profit organizations

nursing hours per patient day (NHPPD)

patient acuity

patient care department managers

root cause analysis (RCA)

shared governance

vertical integration

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