Abstract
All health systems have been profoundly affected by COVID-19 crisis. The significant volumes of services that was postponed during first wave and again and again during current crisis have generated serious consequences for the management of chronic and high-risk patients.
Returning to full capacity in care activities, as well as recovering gaps left behind, requires clear strategies and innovative actions, using all opportunities provided by modern technologies and envisioning new paradigmatic operational changes and cultural shifts.
Yet, this is not the only challenge, or a new challenge.
Health organizations and systems were already facing disruptive changes well before the advent of COVID. Not just transitional, but structural changes redefining the normality of healthcare. A new normality.
There are two clusters of challenges taking place in the health sector that are reshaping the context for the management of service delivery: Firstly, evolutions in progress, and secondly the VUCA environment (Volatile, Uncertain, Complex and Ambiguous).
The first cluster of issues are evolutions in progress, includes that health organizations are currently facing several challenges:
Varying patient epidemiology
Ageing populations create the need for a new type of care Increasing patient frailty requiring an integrated continuum of care (chronic, frequent-user, not self-sufficient) Increasing high dependency or critical patients, but not so unstable as to require intensive care post-acute surgical patients needing a medical tutor (i.e. orthogeriatric patients) a higher number of elderly patients with cognitive impairments and complex social backgrounds an increasing number of informed patients seeking active involvement in their own health management and prevention Technical and technological innovation in service delivery
New treatment opportunities due to new skills and science Operations with quick recovery (day-surgery, one-day surgery, week surgery, etc.) Freestanding surgery, mini-invasive, robotics, remote technologies etc. Increasing risks of “turf wars”, due to the overlapping of ‘catchment’ areas between medical, surgical and interventional diagnostics (i.e. cardiovascular, neuroscience, oncology, etc.) Expectations of improved flow and quality of care:
Building patient-centred hospitals, with care settings designed around the needs of the patient Increased efficiency and productivity Specific pathways designing for urgent verses elective care Multidisciplinary production platforms (wards, operating theatres, intensive care, outpatient rooms etc.) designed with flexible allocations such as pool beds and OT jollies. Accountability on outcomes
Showing a track of attention to evidence-based medicine and clinical governance Taking PREMS and PROMS into account.
As if all the above challenges were not enough - and they are certainly only a subset of what health managers face daily – there is the second cluster of issues.
The second cluster of issues concerns the disruptive innovation landing on health systems: artificial intelligence, robots, precision medicine, regenerative medicine. Technology and algorithms are set to run healthcare. Financial struggles are common to all countries, even the richest. In many places, health care professionals are experiencing a loss in status and role and there is a widespread shortage of doctors in many developed and developing countries.
Therefore, managers and clinical leaders face a paradigmatic revolution requiring new paradigms this new normality. New business models are emerging and spreading across health systems: low cost or low price healthcare, focused hospitals, and medical tourism. Henceforth, there are vast opportunities to develop new strategic directions.
In this view, new designs for the internal organization of the hospital are emerging, along principles of patient-centred care, valued-based healthcare and clinical service lines built around multi-professional and multispecialty teams. Furthermore, new challenges and opportunities are generated by new models for the delivery of healthcare including remote care, concierge medicine, retailization, and consumer empowerment, and by skill mix and operations management.
It is in this light, having in mind the above challenges, that this issue of HSMR includes works presented at the he EHMA 2019 Annual Conference on Health Management 2.0, that was held on 17th–19th June 2019 at Aalto University, Espoo, Finland and hosted by the Helsinki University Hospital (HUS) and the National Institute for Health and Welfare (THL).
The conference gathered more than 350 international healthcare managers, professionals, researchers and policy makers. The delegates came together from across the world to learn new skills, share ideas and acquire effective practices on health management.
As you can see from the articles selected for this issue, there is a lot of food for thought on the reconfiguring and transformation of health systems and organizations toward value-based logics and on the necessary developments for leaders and managers.
So, welcome to the HSMR special issue on EHMA 2019 conference.
Hope you enjoy it as much as I did in the building of its contents.
Finally, let me thank my guest co-editor of this issue, prof. Rocco Palumbo from University of Tor Vergata, Rome, for the amazing work he did in coordinating the authors and supervising the final editorship.
Milan, 21/01/2021
Prof. Federico Lega