The future of hospital Nuclear Medicine is triggered by the hospital
organisation itself. In general, the hospital organisation of
the present requires substantial changes in order to be competitive,
economical, and abreast of the rapid progresses in
medical developments and patient management. It also must
be flexible to changes in health politics. In this special report an
organisational hospital structure is outlined which may help
encounter the challenging hospital future. Some hospitals have
already implemented convincing changes, whereas others are
far behind

Dierckx, Rudi A.

Otte, Andreas

Otte, Karina

English

Via Medica Journals

103
Nuclear Medicine Review 2004
 Vol. 7, No. 2, pp. 103–105
Copyright © 2004 Via Medica
ISSN 1506–9680
www.nmr.viamedica.pl
Editorial
The hospital organisation of the future
Andreas Otte1, Rudi A. Dierckx1, Karina Otte2
1Division of Nuclear Medicine, Ghent University Hospital, Gent, Belgium,
2Legal Department, University Hospital, Freiburg, Germany
[Received 8 IV 2004; Accepted 9 IV 2004]
Abstract
The future of hospital Nuclear Medicine is triggered by the hos-
pital organisation itself. In general, the hospital organisation of
the present requires substantial changes in order to be com-
petitive, economical, and abreast of the rapid progresses in
medical developments and patient management. It also must
be flexible to changes in health politics. In this special report an
organisational hospital structure is outlined which may help
encounter the challenging hospital future. Some hospitals have
already implemented convincing changes, whereas others are
far behind.
Key words: hospital organisation, hospital of the future,
patient management, patient focus, controller unit
Introduction
Whether there can be an „ideal” organisational hospital struc-
ture in view of the increasing legal and economical pressure on the
hospitals remains open. The fact is, however, that the strained
financial situation of the hospitals makes innovations of their organ-
isation essential. Physicians, including Nuclear Medicine physicians,
working in hospitals must be aware of the changes the hospital
organisation may face to remain competitive. In the following, there-
fore, we would briefly like to outline our opinion of an „ideal” orga-
nisational hospital structure, which is in line with current opinions in
health economics [1–23], but certainly will be subject to the legal,
political and financial framework and may need adaptation from
country to country. Also, some countries may be more progressive
in the installation of such or similar structures than others. Further-
more, within a country implementation may vary from hospital to
hospital depending on the chosen legal form of the hospital.
„Ideal” hospital organisation
At present in most hospitals the existing rigid hierarchical struc-
tures should be overcome by flatter hierarchies considering in-
creasing delegation of decisions, increasing responsibilities for
the delegates, and implementing task forces and project team
structures. The old rigid hierarchical organisation with its trial sep-
aration into medical director and staff, administrative director and
staff and hospital service director and staff mainly reduces flexi-
bility in decision making and, albeit created to best possible
ensure the interests of the patients, frequently ends up in compe-
tition between the three lines on existing resources, which are un-
stoppably becoming rare. Where possible, matrix management
should replace line management structures. One approach to le-
verage the hospital organisation could be to integrate the heads
of the various medical departments and the hospital services unit
in the financial processes and financial management. This, how-
ever, would probably not have the expected success, given the
different business languages of the involved parties and the het-
erogeneous attitudes of the medical group compared to the non-
medical group. Another approach may be to appoint a full-time
and fully dedicated Senior Medical Director, who on the one hand
is board-certified in a medical discipline, ideally, but not essential-
ly, with leadership experience in a clinical staff position, and on
the other hand has an additional qualification in Business Admi-
nistration. Without doubt, finding such candidate may be challeng-
ing, but as we think worthwhile, as the Senior Medical Director
could help coordinate the balance between best practices in me-
dicine (being an expert in the medical field) and economical con-
siderations (being an expert in Business Administration). A further
approach could be decentralisation in decision-making from the
aforementioned top management to the strategic business unit
or even departmental level, allowing for autonomous definitions
of the strategic business unit or departmental clinical and research
outputs and directions, their quality and funding. This does not
necessarily mean that the top management is to be abandoned;
it only focuses on the more integrative concept of management in
general. Decentralization in decision-making would, as we think,
indeed be a motivating factor for the employees. This could be
enhanced by provision of supporting structures such as control-
ler units and a well organised and networked Information Tech-
nology division. Former “pure” personnel departments should be
replaced by “true” human resources departments including trai-
ning, motivation and incentive programme units. Only well-motiva-
ted and trained employees will contribute to the successful eco-
nomy and quality of their hospital. Employees in the medical field,
apart from similarities to industry employees, also have special
Correspondence to: Andreas Otte
Division of Nuclear Medicine, Ghent University Hospital,
De Pintelaan 185, B-9000 Gent, Belgium
e-mail: Andreas.Otte@Ugent.be
104
Nuclear Medicine Review 2004, Vol. 7, No. 2
www.nmr.viamedica.pl
Editorial
needs characteristic for the medical field, which must be addressed
appropriately. Besides, the choice of the legal form of the hospital
plays a key role in the opportunities the employees actively have.
In Germany, for example, more and more public or state hospitals
are being transformed into limited companies, which have already
been proven successful in private hospitals, in terms of quality in
decision-making, medical output, short response times and flat
hierarchical structures. In addition, as in industry, mergers and
take-overs between hospitals are playing an increasingly impor-
tant role in order to address competitiveness.
The general processes and sequences in the special organi-
sation “hospital” should also be revisited, as medical progress in
diagnostics as well as therapeutics is rapidly developing, new in-
dications are evolving, patient structure and frequency is dynam-
ic and the health-political framework is continuously changing.
Patient services should primarily be patient-focused offering di-
fferent levels of care such as emergency rooms, intensive care
units, intermediate care units, normal wards, and low-care units,
allowing for adequate stratification of the patients, which results in
an optimisation of the time patients are staying in hospitals and at
the end helps saving funds. A short-term therapy unit would add
up here, allowing for optimisation in planning, staffing, motivation
of the employees, patient contentedness, and last but not least
marketing of the hospital. Also, an interdisciplinary admission unit
could optimise the sequences in the hospital, as by this the pa-
tient is first screened for the following transfer to the correct unit.
This would help reduce ineffective admissions and potential diag-
nostic duplications; it would also shorten patients’ stays in hospi-
tal and, therefore, be more economical. It could furthermore be
motivating for the employees to work in interdisciplinary teams.
Commencing with the interdisciplinary admission units, the mod-
ern hospital organisation may reconsider changing the classical
separation of medical departments in general. For this, a dedicat-
ed allocation (patient) management tool would be essential, en-
abling the timely planning and accurate organisation of all neces-
sary and avoidable steps during the stay of a patient according to
his/her individual needs.
The introduction of diagnosis related groups (DRGs) as a basis
for hospital funding is another topic, which — as we think — should
be treated separately. In our opinion, at least speaking for Germa-
ny, the introduction of DRGs into the existing hospital environ-
ment is still challenging.
The aforementioned suggestions are, of course, a personal
view of the authors and may be subject to limitations due to poli-
tical, financial, capacity or other reasons. However, we want to
draw a picture which may help the reader to become aware of the
complexity of this certainly intriguing field.
The “hospital of the future”
Of course, the „hospital of the future” already in part exists. As
one example the new clinical centre Barmbek in Hamburg/Ger-
many may be mentioned [24]. This hospital, which is entitled by
its flyer „hospital of the future”, developed a model with a new
management and organisational structure, with modern patient-
-focused sequences and a future-oriented service offer. This hos-
pital has been consulted by the internationally experienced man-
agement consultant Andersen Consulting/Accenture and, as we
think, presents an excellent example of a new hospital era. It com-
prises the formation of new leadership and organisational struc-
tures with modern patient-focused processes and a future-orien-
ted offer of medical services. It includes interdisciplinary medical
centres, the focus on key medical tasks, new reporting structures
in medicine, care and management, new functions such as multi-
professional treatment teams, centre managers, team partners
etc, individual admission and dismissal planning, or an allocation
management.
Andersen Consulting/Accenture has also consulted other hos-
pitals, e.g., in the USA. In fact, many ideas which are about to be
implemented in European hospitals, as for example the aforemen-
tioned Barmbek clinical centre in Germany, result from the Ame-
rican experience of organizing and managing hospitals. Of course,
there are differences in the hospital organization and Nuclear
Medicine between the United States and most European centres
(e.g., the integration of Nuclear Medicine into Radiological de-
partments, different board certification procedures, state versus
private University organization, radioprotection requirements with
influence on patient care times). Nevertheless, implementation of
key items from the American organization and management of
hospitals in general and Nuclear Medicine in special and learning
from its (much longer) experience could help make the European
centres more effective.
Conclusion
The changes of the mostly decrepit hospital organisation are
first of all provocative for all involved parties. The changes are
affecting all professional groups in the hospital, medical and non-
medical. Changes often provoke emotions. Changes are, how-
ever, necessary. Team work and team playing are essential in the
implementation of changes. The challenges to the hospital of the
future are coming, and we can only address them if we face them
unemotionally and constructively, seeing also the opportunities.
We think that this general health economics topic is of increasing
interest also to the Nuclear Medicine physician readership.
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