WHO and the future of hospitals

Changing priorities for the WHO?

It might be fair to say that the WHO has often been mainly associated with work on Universal Health Coverage (UHC), access to primary care and responses to communicable diseases and global health crises, and less on the activities of hospital organisations.

However, on the evidence of sessions I attended at the 2019 World Hospital Congress, at the invitation of the WHO, this view needs to change.  This development could have far-reaching importance for EuHPN member organisations, given the reach and influence of WHO policy makers and practitioners.

The WHO has had a new Director General, Dr Tedros Adhanom Ghebreyesus, for the past two years.  His mission is to build a strong, effective, transparent WHO in the service of the global Sustainable Development Goals, to address the social, political and economic determinants of health and wellbeing.  Just as the EuHPN has discussed at recent workshops, beginning with the Madrid event in 2017, hospitals are now seen as vital elements in the web of care which supports these ambitions and the WHO is committed to recognising this role.

At IHF 2019 the WHO organised, sponsored and took part in a number of sessions on how hospitals can effectively support primary and community care and play a full part in ensuring UHC.  On 6th November around 80 participants came together to discuss the ‘Fast Forward’ Initiative for community- and person-centered hospitals and health services.  As the conference programme notes: “While, hospital-centric health systems have been blamed for limited development of primary health care; it is now time that hospitals are regarded as an essential part of the solution and that their transformative potential be recognized and unlocked.”

After discussions around existing and future projects which use the embedded expertise and knowledge of hospital organisations to develop the wider health system, WHO technical officers outlined a plan to set up an ‘Incubator’ project: initially, a group of a small number of hospital organisations which can pilot the proposed tools and support WHO will offer to transform hospitals into full partners in the quest for UHC.

On 7th November I attended an invitational seminar on Health services and infrastructure planning in the context of UHC, an essential lever for operationalization of service packages, which explored the links between the governance and structuring of strategic planning of health services, the physical infrastructure of healthcare systems, and the health outcomes for patients and citizens.

Bringing together the discussions on the 6th and 7th, 8th November included an open session titled ‘Rethinking hospital planning for improved population health’.  I gave an outline of EuHPN thinking on this topic, alongside speakers from the USA (Chief Strategy Officer, Gillette Children’s Speciality Healthcare), Portugal (President, Portuguese Association of Hospital Managers) and France (Deputy CEO, Paris Region).  This session was grounded in three principles for the future of hospitals:

“First, hospitals will move away from their traditional definition as physical buildings (bounded by walls and beds) and instead see themselves as flexible organizations that pull together scarce resources for the community. Second, they will leave behind their isolating status as institutions uniquely responsible for individual patients requiring highly specialized acute care, and instead embrace joint responsibility with other care providers for population health. Third, they will broaden their focus from immediate, acute episodes to a wider and ultimately more effective focus on integrated care pathways.”

From an EuHPN perspective, these three principles raise interesting questions.  If ‘hospitals’ come to be defined as collections of resources (people, equipment, technology, data) rather than being ‘bounded by beds and walls’, then who is going to be planning and building this future?  Do we have the competence to do this in the existing workforce?  If hospital organisations are to ‘embrace joint responsibility with other care providers for population health’, how will financing, governance and accountability function?   

These questions are already being raised by health policy makers across Europe, and the answers, and their consequences, are being tested in many jurisdictions.  From a personal and EuHPN perspective, it seems right and helpful that the WHO is taking an active interest in the future of hospitals.  The WHO officers gave assurances that this work stream will continue, and that they will report further in the coming weeks.  I will keep EuHPN members appraised of any news.

Jonathan Erskine

Executive Director, European Health Property Network

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