Coevolution of patients and hospitals: How changing epidemiology and technological advances create challenges and drive organizational innovation

Over the last 20 years, hospitals have revised their organizational structures in response to several environmental pressures. Today, recent technological advances and demographic and epidemiologic trends call for new strategies to cope with ultra-elderly frail patients characterised by chronic conditions, high severity health problems, and complex social situations. The main directions of change concern new ways of managing emerging clusters of patients whose needs are not efficiently and/or effectively met within traditional hospital organizations. Following the practitioner and academic literature, we first identify the most relevant clusters of new kinds of patients representing an increasingly larger share of the hospital population in developed countries. Secondly, we propose a framework that synthesises the major organizational innovations, the same innovations toward which we find convergence in successful cases around the world. Finally, we conclude by substantiating the trends of and the reasoning behind the prospective pattern of hospital organizational development