Hospitals complement and amplify the effectiveness of many other parts of the health system, providing continuous availability of services for acute and complex conditions. They concentrate scarce resources within well-planned referral networks to respond efficiently to population health needs. They are an essential element of Universal Health Coverage (UHC) and will be critical to meeting the Sustainable Development Goals (SDG).
Hospitals are also an essential part of health system development. Currently, external pressures, health systems shortcomings and hospital sector deficiencies are driving a new vision for hospitals in many parts of the world. In this vision, they have a key role to play to support other healthcare providers and for community outreach and home-based services and are essential in a well-functioning referral network.
Hospitals matter to people and often mark central points in their lives. They also matter to health systems by being instrumental for care coordination and integration. They often provide a setting for education of doctors, nurses and other health-care professionals and are a critical base for clinical research.
Hospitals should reflect the needs and values of the communities in and around them, while also being resilient and able to maintain and scale up services in emergency situations. Effective hospitals are designed for their users, with attention to the needs of special populations, such as children and the elderly. A well-designed hospital environment maximizes the effectiveness of clinical care delivery and enhances the well-being of patients and hospital staff.
Adequate and reliable infrastructure, technologies and supplies form the backbone of the hospital. Key infrastructure (such as well-planned spaces, water and energy, telecommunications) must support daily functioning, and be designed with redundancy to ensure continued safe and effective operation, even during a disaster or crisis. Appropriate and good quality medical and ICT technologies and supplies should be available for specialized health workforce to meet the population needs.
Hospital functions and organization vary according to health-care delivery organizations and each hospital’s unique position in the system. Good management structures ensure coordination among staff, services, infrastructure and supply chains to deliver high-quality care. Clinical registries and structured data audits facilitate rapid identification of high-yield areas for improvement. Regular monitoring of service quality with targeted intervention to address gaps drives ongoing improvement.
Hospitals are reservoirs of critical resources and knowledge. They can be classified according to the interventions they provide, the roles they play in the health system and the health and educational services they offer to the communities in and around them. They are often the focal point for health care in a community and lead by example for sustainable development, the strengthening of health systems and in building healthy communities. Effective hospitals seek new ways to support care outside their walls to ensure people can be cared for closer to their home, within their community and at a sustainable cost.
Decision-makers at the national and sub-national level create conditions to drive, enable and sustain the paradigm shift in what hospitals do and how they perform. As system architects, they need to maintain oversight of all ongoing health and health system reforms and ensure policies and incentives are coherent and aligned. Major structural reforms outside the health sector, such as decentralization, civil service, privatization and trade, greatly impact the hospital sector and need to be taken into consideration at the macro level when assessing possibilities for hospital sector transformations.