A series of new media reports and consultant commentary on industry evolution highlight the increasing pressure on health system boards to fully engage in sophisticated strategic planning—and thus may be useful reading for the strategic planning committee.

In a February 25 op-ed piece in The New York Times, Dr. Ezekiel Emanuel offers a provocative perspective on the future of hospitals. His view is that the importance of hospitals in the delivery system is declining for a series of reasons: e.g., the increasing risk of hospital-acquired infection; the ability to perform more complex care safely and effectively in other settings; and the possibility of more rapid recovery in "hospital at home" programs. As a result, he predicts, "many of today's hospitals will downsize, merge or close. Others will convert to doctors' offices or outpatient clinics. Those that remain will be devoted to emergency rooms, high-tech services for premature babies, patients requiring brain surgery and organ transplants, and the like."

A somewhat similar perspective was offered by The Wall Street Journal in its February 26 "special report" on health. The Journal's view focused on the shift away from traditional inpatient facilities and the increasing investment by providers in outpatient clinics, same day surgery centers, free standing emergency rooms and microhospitals. Those experts interviewed for the article described a future in which there would be a need for fewer "full service" hospitals, and a major change in the scope of treatment provided at other hospitals. Like the Times piece, the emphasis of the Journal is on the fading of the "full service hospital, the fewer number of inpatient stays and the steady increase in outpatient visits."

Yet a different and interesting perspective is offered by Ryan Gish of Kaufman Hall in his new commentary, Freight Trains and the Core Business of Healthcare. Mr. Gish points to America's freight rail transportation system as an example of how one industry successfully improved its core business in a rapidly changing environment. He suggests that those strategies and results carry important lessons for America's hospitals and health systems, and may help them as they rethink the approach to their core business. Among the relevant "railroad" lessons cited by Mr. Gish are the following: rethink basic structures and processes; aggressively manage cost, price, and efficiency; and apply innovative technology.

These three articles, and others like them, relate directly to the fundamental issue of the long term sustainability of the inpatient health care mission of the  hospital. This can be very useful fodder for hospital and health system board members who are involved in strategic planning or who are otherwise working to be suitably informed in order to react to management proposals relating to strategic initiatives, and to provide oversight of initiatives that have been implemented.

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