Special article
The Hospital of the Future in 10 points
El hospital del futuro en 10 puntos
R. Gómez Huelgasa, J. Díez Manglanob, J. Carretero Gómezc, R. Barbad, X. Corbellae, J. García Alegríaf, M.T. Herranzg, I. Vallejoh, F.J. Elola Somozai,
Corresponding author
a Sociedad Española de Medicina Interna, Hospital Regional Universitario de Málaga, Spain
b Sociedad Española de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
c Sociedad Española de Medicina Interna, Hospital de Zafra, Badajoz, Spain
d Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
e Hospital Universitario de Bellvitge, Secretaría General de la European Federation of Internal Medicine, Spain
f Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
g Hospital General Universitario Morales Meseguer, Murcia, Spain
h Hospital San Juan de Dios del Aljarafe, Grupo de Trabajo «Paciente pluripatológico y edad avanzada» de la SEMI, Spain
i Fundación Instituto para la Mejora de la Asistencia Sanitaria, Spain
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"apellidos" => "Elola Somoza" "email" => array:2 [ 0 => "fjelola@movistar.es" 1 => "javier.elola@imasfundacion.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Sociedad Española de Medicina Interna, Hospital Regional Universitario de Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sociedad Española de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sociedad Española de Medicina Interna, Hospital de Zafra, Badajoz, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Universitario de Bellvitge, Secretaría General de la European Federation of Internal Medicine, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Hospital General Universitario Morales Meseguer, Murcia, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Hospital San Juan de Dios del Aljarafe, Grupo de Trabajo «Paciente pluripatológico y edad avanzada» de la SEMI, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Fundación Instituto para la Mejora de la Asistencia Sanitaria, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El hospital del futuro en 10 puntos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 761 "Ancho" => 2091 "Tamanyo" => 113060 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Matrix organization of a hospital with care networks of a regional nature.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Spanish Society of Internal Medicine (SEMI, for its initials in Spanish), with the collaboration of the Fundación Instituto para la Mejora de la Asistencia Sanitaria [Institute for Healthcare Improvement Foundation], carried out the “Future Hospital” project over the course of 2018 and 2019.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Based on knowledge on the Spanish National Health System (SNHS, for its initals in Spanish),<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> this project seeks to adapt the analysis performed by the Royal College of Physicians (United Kingdom)<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> on the organization of care in future hospitals (Future Hospital Programme) to the context of the Spanish healthcare system. Numerous scientific and medical societies, professional associations in the health sector, and patient associations participated in this project.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this article is to highlight, in 10 points, the predictions from this project that we consider to be the most relevant. The last point is devoted to analyzing the challenges for internal medicine that can be surmised from these proposals. Although some considerations contained in this article may be applicable to private entities, the framework for this reflection is the SNHS.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Hospitals will be configured as high-technology hubs at the service of care networks. Towards “health maintenance organizations”?</span><p id="par0015" class="elsevierStylePara elsevierViewall">Care networks will be configured around healthcare processes and the departments and clinical units will be reorganized based on their contribution to these processes. The planning and design of the hospital as well as its organizational and management structure will be at the service of the care networks to which they provide support. In <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> (a hospital with regional referral services), the hospital is linked to regional healthcare networks (for instance, cardiovascular, neurosciences, or cancer areas).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A significant part of these networks’ activities will not be carried out in the hospital that serves as a basis for the regional or supraregional reference departments and units, but rather in other settings, such as general acute hospitals of “health area” (district hospitals), the primary healthcare centers, the patient's home, or nursing homes. In other words, the concept of a hospital as a “closed institution” will disappear in the future hospital so that it may be conceived of as a hub for the activity of the units and networks that provide healthcare for a specific geographical zone as well as the rest of the units that provide support to them.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To have a sufficient reference population, the integration of the aforementioned care networks must be carried out on the regional level and “health area” (district) level. To add value,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> the networks must be oriented towards: (1) improving health outcomes, seeking the best possible ratio between the resources (costs) and the outcomes obtained, and (2) developing population health policies, which should entail regional configurations similar to the <span class="elsevierStyleItalic">Health Maintenance Organization.</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">The hospital will be organized by healthcare processes and must modify its organization</span><p id="par0030" class="elsevierStylePara elsevierViewall">The hospital will act as support for the care networks, which in turn will be organized based on processes. Therefore, the organization of care in the hospital will integrate and organize all the healthcare resources that operate within it, adopting a matrix-like configuration focused on processes that will replace the current pyramidal, hierarchical organization of the SNHS’ hospitals (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Hospitals’ healthcare areas will incorporate the units, departments, and clinical and non-clinical professionals that generally work together on the processes that correspond to areas of shared scientific and technical knowledge. The organization of the division of care into areas must be tailored to the acute care hospital in question (with regional or supraregional reference units, district or local hospital).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">The intensity of both the use of technology and the level of care will increase, the length of stay will decrease, and the hospital must ensure quality 24 h a day, 365 days a year</span><p id="par0040" class="elsevierStylePara elsevierViewall">Outpatient care for acute illnesses will be the default option. Admission to the hospital will only be indicated when the intensity of the technology and/or monitoring and the level of care require it. Discharge will be granted as early as possible, when quality patient care in a less intense setting can be assured (from intermediate care centers to the patient's home). Early mobilization of the patient<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a> and attention to their physical and psychological needs—including nutrition, hydration, pain relief, respect for sleep, personal hygiene, and anxiety—will not only contribute to reducing the length of stay but also to improving their quality of life and preventing readmissions.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The space devoted to hospitalization will be reduced in size and will involve a much more intensive use of resources, shifting the level of care in hospitalization units from the Intensive Care Society level 0 (traditional conventional hospitalization) towards levels 1 and higher.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">An acute care coordination area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) must be present in all acute general hospitals. Its fundamental mission will be to establish continuity of care among the emergency, critical care, hospitalization, and hospital-home transition units, guaranteeing the standards of care for acutely ill patients (including chronic patients with acute illness/decompensation) who require admission to the hospital.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The acute care coordination area will be responsible for implementing a shared care system with other hospital units, especially surgical units, and guaranteeing appropriate standards of care for these patients. The “Future Hospital” report proposes standards that must be met by all hospitalization units for the care of adult patients with an acute condition. Furthermore, it must guarantee the quality of care in the hospital 24 h a day, 365 days a year.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Systematic care for complex chronic patients will blur the lines between specialized care, primary care, and social services</span><p id="par0060" class="elsevierStylePara elsevierViewall">Continuity of care is one of the main challenges in healthcare, especially for complex chronic patients.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Continuity as the norm should be one of the principles of the future hospital.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The community coordination center (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>) will have the mission of guaranteeing the continuity of care; minimizing the risk in healthcare transitions; ensuring compliance with standards of care for complex chronic patients; establishing systems for coordinating/integrating healthcare services with social services to provide comprehensive care; and developing new healthcare management systems in collaboration with primary care, social services, patient organizations, social volunteers, etc. for complex chronic patients. This must be done from a perspective of shared work between primary and specialized care.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The “Future Hospital” report proposes standards that must be met in the care of adult patients with chronic conditions.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">When hospital admission is necessary, the identification of frail people and care of their needs are critical aspects for decreasing readmissions and increasing the probability of the patient living at home after hospital discharge.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">All acute general hospitals, including local hospitals, must develop a coordination area for complex chronic patients’ healthcare. It must collaborate with primary care and the various community and social resources on providing systematic care focused on self-management, decrease of dependence, prevention of frailty, and maintaining the community setting of the patients in order to avoid hospital admission or admission to the emergency department, to the extent this is possible.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">The patient will not be a passive subject, becoming actively integrated into the health team</span><p id="par0080" class="elsevierStylePara elsevierViewall">The integration of the patient in the management of his or her health problems is an important aim in the strategy to add value.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a> Shared decision-making will be incorporated into regular practice.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Digitalization will be a powerful tool for involving patients and citizens in the management of their health.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,22</span></a> The incorporation of the ill person on the same level as the professional will lead to redesigning processes and settings that are more friendly than the current ones. The incorporation of the patient’s experience in the framework of a direct relationship with institutions’ governance can be an effective, formal way of integrating their vision with the aim of improving healthcare.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Hospitals’ outcomes and standards of care will include those arising from the patient’s experience.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Healthcare areas and units will substitute hospitals’ current structure of departments and specialties</span><p id="par0095" class="elsevierStylePara elsevierViewall">Placing the patient at the center of healthcare and articulating healthcare based on care processes will require a hospital organization in which a structure based on specialized departments will give way to an organization in which large care areas will gain prominence. These areas will integrate knowledge areas and disciplines linked to sets of processes, such as heart, cancer, or neurosciences areas, among others (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) as well as the development of multidisciplinary units centered on the management of complex conditions.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Current medical specialties will undergo significant modifications driven by knowledge and technological innovation and will tend towards subspecialization and the creation of interdisciplinary knowledge areas. However, this trend will not necessarily entail medical specialties becoming independent organizational structures, as they will be integrated into multidisciplinary teams organized around care processes.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Digitalization will radically modify the organization and provision of services both within and outside of the hospital, facilitating outpatient and at-home care</span><p id="par0105" class="elsevierStylePara elsevierViewall">Digitalization encompasses advancements in information and communications technology. The incorporation of these technologies into healthcare will be, as it has been in other sectors, disruptive in nature; it will radically modify the manner of organizing and providing healthcare services. Its incorporation and intelligent use will contribute to adding value (improving outcomes and reducing costs) in healthcare.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Big Data and data analytics will be especially relevant in the development of population health policies and precision medicine. Telemedicine will notably reduce the need for patients and healthcare workers to travel for consultations, follow-up, and more, and in particular, will facilitate the care of complex chronic, frail, and dependent patients in their social setting. Wearables will also contribute to achieving this objective.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The precision of diagnoses will increase with the help of artificial intelligence. Robotics and virtual reality will increase safety and reduce times of procedures, which will become less and less invasive. In large part, robotics will substitute personnel resources in carrying out activities of a physical nature (patient transfers and mobilization, cleaning, medication dispensing, food distribution, etc.).</p><p id="par0120" class="elsevierStylePara elsevierViewall">The development of information and communications technology will allow for establishing new, more agile, and personal forms of communication with the patient, reducing the healthcare system’s response time to citizens’ needs and demands.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Information technology systems for management, image storage, and other clinical data systems will be easily integrated into the electronic medical record. In this manner, the interoperability of electronic medical records and their usability by professionals will improve. Blockchain technology will allow for complete traceability of all interactions with the patient and their record.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Information technology systems will facilitate collaborative research and networked hyperspecialization.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Hospital governance will establish a balance between managers and clinicians, incorporate patients through their organizations, and transfer management capacity to care networks and units</span><p id="par0130" class="elsevierStylePara elsevierViewall">The change in focus from activity to outcomes (added value) will entail significant changes in the governance of healthcare institutions, including that of hospitals. At present, the “managerialist” focus in the organization and management of hospitals has limited efficiency.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> There is growing evidence that the involvement of physicians in management increases the quality and efficiency of healthcare management.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">“The future hospital” proposes a healthcare division of care focused on health outcomes at the same level of responsibility as the managerial level. The management will direct its focus towards improving efficiency and providing services (information technology, communications, management control, auxiliary services, etc.) to support the healthcare division. Above the two, there will be a council with representation from all relevant actors (politicians, unions, healthcare professionals, etc.), including patients through their organizations.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Hospitals must be publicly accountable for the outcomes achieved with the available resources. These hospital outcomes will incorporate health outcomes, including those regarding the patient experience, and the costs of the resources used. This will radically modify the scorecards, which currently focus on resources used (structure, expense) and activity.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The involvement of physicians in management will require a transfer of responsibility for the organization and management of healthcare networks and units to healthcare professionals (clinical management), providing the necessary support as well as managerial control from the direction of the center.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Organizational variability, homogeneity in quality, and dual organizations</span><p id="par0150" class="elsevierStylePara elsevierViewall">To tailor care to the population's needs, healthcare services must be redesigned so that they provide different care models that better meet the needs of all citizens, incorporate scientific and technological advancements, and overcome barriers between healthcare and social services organizations and settings that make comprehensive care difficult. It is not possible to meet this challenge through top-down actions, which up until now have been driven by the SNHS. On the contrary, the development of local, bottom-up solutions led by professionals or community initiatives must be encouraged.</p><p id="par0155" class="elsevierStylePara elsevierViewall">There is no single solution for a problem as complex as how to organize healthcare that is able to adjust to different realities with the available resources and achieving the greatest possible levels of quality and efficiency. Therefore, the proposed lines of development for the “future hospital” must be adapted to each setting. Organizational variability will not entail inequality in the quality of care, given that quality standards as well as health outcome indicators must be homogeneous.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The organizational structures of institutions as well as hospitals are focused on achieving objectives, the use of resources, and the evaluation of day-to-day management. They pay little attention and devote few resources to analyzing the setting, promoting and evaluating new models, and introducing precise changes for improving the quality and efficiency of their services.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Pyramidal, hierarchical organizations, which are typical of industrial organizations, are poorly suited to healthcare services in which the knowledge does not lie in a technocratic leadership, but rather in the professionals.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The matrix organization proposed in the “future hospital,” with a dual figure in the organization's leadership (the care division and the management division) does not completely solve its adaptation to change. However, the concept of a dual organization with two structures: one which is hierarchical (in the “future hospital” proposal) focused on meeting aims, and another which is a network (netarchy), focused on promoting collaboration, self-management, and innovation<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> could achieve a dual aim: 1) not lose focus on achieving the aims established by the SNHS and 2) increase innovation and accelerate change.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Internal medicine and the internist: key agents in the “future hospital”</span><p id="par0170" class="elsevierStylePara elsevierViewall">If continuity as a norm is one of the principals of the new model,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> the related dimensions of comprehensiveness and continuity are most frequently recognized as the scope of action of internal medicine.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The European Federation of Internal Medicine underlines that “Internal medicine is a holistic medical specialty <span class="elsevierStyleItalic">par excellence</span>, and for this reason it should be at the forefront of patient-centred care.”<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> For this to occur, it is necessary for the internal medicine specialist to internalize this as the most important challenge at present. A central aspect is this focus on the guarantee of continuity of care, both for acute and chronic patients.</p><p id="par0180" class="elsevierStylePara elsevierViewall">The guarantee of continuity in acute patient care requires the integration of emergency, hospitalization, and critical care units in the same care process. In regard to coordinating acute care, internal medicine must tackle the challenges of leading the development of the acute healthcare coordination area; implementing evidence-based, systematic, quality care for patients hospitalized in its wards;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> collaborating with other units and services to guarantee continuity and standards (“comanagement”) integration of internal medicine physicians in certain departments, especially surgical departments), and guaranteeing optimal quality care 24 h a day, 7 days a week.</p><p id="par0185" class="elsevierStylePara elsevierViewall">The guarantee of healthcare continuity for complex chronic patients will involve internal medicine in the development of the “community coordination center,” collaborating with primary care and the various community and social resources in the provision of systematic care to complex chronic patients and developing structured relationship systems with primary care teams in the hospital's area of influence, sharing the clinical management of these patients.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The new challenges will require internal medicine physicians to have new professional skills in clinical management, digitalization, interaction with patients and their associations, and more. Therefore, training programs must be redesigned.</p><p id="par0195" class="elsevierStylePara elsevierViewall">The “Future Hospital” report foresees an increase in the demand for internal medicine physicians with these new professional skills and, especially, physicians who are dedicated to guaranteeing continuity of care.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres1394515" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1278090" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1394514" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1278089" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Hospitals will be configured as high-technology hubs at the service of care networks. Towards “health maintenance organizations”?" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "The hospital will be organized by healthcare processes and must modify its organization" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "The intensity of both the use of technology and the level of care will increase, the length of stay will decrease, and the hospital must ensure quality 24 h a day, 365 days a year" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Systematic care for complex chronic patients will blur the lines between specialized care, primary care, and social services" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "The patient will not be a passive subject, becoming actively integrated into the health team" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Healthcare areas and units will substitute hospitals’ current structure of departments and specialties" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Digitalization will radically modify the organization and provision of services both within and outside of the hospital, facilitating outpatient and at-home care" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Hospital governance will establish a balance between managers and clinicians, incorporate patients through their organizations, and transfer management capacity to care networks and units" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Organizational variability, homogeneity in quality, and dual organizations" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Internal medicine and the internist: key agents in the “future hospital”" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 15 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-13" "fechaAceptado" => "2020-04-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1278090" "palabras" => array:3 [ 0 => "Hospital" 1 => "Future" 2 => "Reforms" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1278089" "palabras" => array:3 [ 0 => "Hospital" 1 => "Futuro" 2 => "Reforma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called “The Future Hospital.” Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La Sociedad Española de Medicina Interna (SEMI) ha desarrollado a lo largo de 2018–2019 el proyecto “El hospital del futuro”. El Hospital del Futuro pretende trasladar al contexto del sistema sanitario español la reflexión que abordó el Royal College of Physicians en el Reino Unido sobre la organización de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud (SNS). En el proyecto participaron asimismo numerosas sociedades científico-médicas y entidades profesionales del sector salud y asociaciones de pacientes. Este artículo tiene por objeto destacar en 10 puntos las previsiones que consideramos más relevantes derivadas de este proyecto, dedicando el último a los retos que para la Medicina Interna se deducen de estas propuestas.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez Huelgas R, Díez Manglano J, Carretero Gómez J, Barba R, Corbella X, García Alegría J, et al. El hospital de futuro en 10 puntos. Rev Clin Esp. 2020;220:444–449.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1739 "Ancho" => 2512 "Tamanyo" => 256762 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The hospital within the care network.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 761 "Ancho" => 2091 "Tamanyo" => 113060 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Matrix organization of a hospital with care networks of a regional nature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El Hospital del Futuro" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "R. 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| 2023 April | 1 | 0 | 1 |
| 2023 March | 4 | 3 | 7 |
| 2020 October | 1 | 2 | 3 |
| 2020 September | 4 | 2 | 6 |
