The hospital of tomorrow will be different from the one we know today. An interdisciplinary consortium led by the ZHAW is researching how the digital transformation can succeed.
Patients will enter the hospital of the future better prepared, their state of health will be recorded more accurately and continuously during their stay, and they will be discharged home earlier while still receiving optimal follow-up care. And all this without any additional workload for staff and without any loss of quality. What sounds almost too good to be true is to be made possible through the consistent use of new forms of organization, digital technologies and the networking of processes and data. The aim is to continuously transform hospitals from an expensive and cumbersome player into an intelligent and agile system.
This future scenario is intended to help combat cost pressure, staff shortages and overcrowding and is currently being researched as part of the ambitious Innosuisse project "Smart Hospital - Integrated Framework, Tools & Solutions", or SHIFT for short. It is backed by a consortium of five research partners, 20 hospitals and 24 industrial partners. The aim of the project, which started in 2022 and will run until 2025, is to create a data and knowledge platform that shows how this transformation can succeed in practice.
After the first phase of the SHIFT project, in which the needs of all those involved were recorded and concepts developed, everything is now being tested in the second phase. In Basel at the University Hospital, among others. Wearables - small portable computers such as smartwatches etc. - are used here, which use mobile sensors to measure vital parameters such as heart rate and respiratory rate. Professor Jens Eckstein, Medical Director of SHIFT and Senior Physician and Chief Medical Information Officer at the University Hospital Basel, has a lot of experience with this. He and his team have been working on this topic for ten years and are therefore predestined to test devices, processes and acceptance. Eckstein uses the sensors as part of SHIFT, for example to improve the quality of sleep for patients and to relieve the night shift: "A night shift nurse is responsible for around 30 patients. Without wearables, the night shift goes from bed to bed with a flashlight." Those who do not sleep well per se due to illness, hospital environment, bed neighbors, etc. are woken up and often have difficulty falling asleep again. A bad night's sleep does not have the best effect on your well-being.
"Integrating new processes into existing structures is more difficult than simply establishing new technologies"
Jens Eckstein, Chief Medical Information Officer at the University Hospital Basel
"If the patients wear wearables and the night service checks their values on a screen, they can concentrate on the people with poor values and let the others sleep," says Eckstein. He emphasizes that this technology is being used in the study in addition to the usual treatment. "We only adopt this routine when we are sure that we are saving resources, increasing safety and not putting additional stress on care while maintaining the same quality." Eckstein clearly denies the question of whether patients do not feel monitored by devices and algorithms when using wearables. "During the Covid-19 pandemic, we used wearables to monitor isolated patients and found that it helps them not to feel alone." Healthy people would rather not have their health constantly monitored and displayed. "The willingness and desire for monitoring increases as soon as a person is unwell."
Another SHIFT project aims to prepare patients better before they are admitted to hospital - experts refer to this as prehabilitation. Eckstein describes what this could look like: "Let's assume that a person with hip problems hardly moves their leg at all. The muscles become weak and the leg is inadequately prepared for the operation." Mobile sensors can detect the lack of movement and use motivating apps and videos to encourage the person to exercise. "If the leg is in a better condition, the length of stay in hospital is usually shorter."
"Hospital at Home" is the name of another project - the most delicate for Jens Eckstein, as the transition from hospitalization to home care is a critical phase in the treatment process. In the SHIFT pilot study, 53 patients are currently being actively supported by the Medgate digital health platform during their early transfer home in close consultation with the responsible GPs. "This requires close communication between everyone involved - many processes had to be set up to ensure the flow of information and data," says Eckstein. This applies in principle to all SHIFT projects: "Integrating new processes into existing structures is more difficult than simply establishing new technologies," explains the medical director. A new process must ensure safer and better care for patients. "They also have to participate and carry the sensors. Positive communication is essential for this." Employees also need to be convinced of the added value of innovations such as wearables. "If the hospital staff have the feeling that they are additionally burdened by the deployment - for example by charging the devices - and not relieved, this is a hindrance."
The decisive factor for the successful establishment of new structures is not whether the institution wants it, but whether everyone involved sees added value in it. "A central point of the current study is therefore also to gain the trust of GPs in these new structures. We are making good progress and are seeing how our project is beginning to bear fruit," says Eckstein.
"The projects add up to a recipe full of transdisciplinary innovations that provides every hospital with the ingredients for digital transformation."
Johanna Stahl, Winterthur Institute of Health Economics at the ZHAW
SHIFT comprises a total of eleven sub-projects. "They add up to a recipe full of transdisciplinary innovations that provides every hospital with the ingredients and procedures for digital transformation," says Johanna Stahl from the Winterthur Institute of Health Economics (WIG) at the ZHAW. Stahl is responsible for the operational management of the project. "In the first phase, we conceptualized the projects and identified the needs of all those involved." In the first phase in particular, it became clear that many technological innovations were being used in hospitals, but often without taking the overall organization into account. "Digital transformation projects are currently treated as IT projects," explains Stahl. The focus on people and on the change process in general is not sufficiently taken into account. "At SHIFT, we work in a needs-oriented way and clarify, for example, how we can create acceptance for artificial intelligence and virtual reality among staff and patients."
Research is also being carried out into how the many processes involved in everyday hospital life can be made more efficient and effective. Stahl illustrates this with an example: "If I enter hospital as a woman of a certain age, I have to answer the question of whether I am pregnant with every new contact person. This information could be recorded once and passed on to all hospital units." Technological support for processes would give medical staff more time for their core tasks. The final and decisive SHIFT phase will start next year, when the results from the pilot projects will be implemented on a sustainable basis - the recipe must prove itself.
SHIFT stands for "Smart Hospital - Integrated Framework, Tools & Solutions". This is an Innosuisse flagship project, which is being led by the ZHAW from January 2022 to June 2025 with four research partners (University Hospital Basel, Universities of Basel and Zurich, University of Applied Sciences Northwestern Switzerland), 20 hospitals and 24 industry partners to investigate how digital transformation can be implemented in hospitals. The results are intended to create a template for the entire healthcare system. The CHF 5.7 million project, led by ZHAW professors Alfred Angerer (Head of Healthcare Management at the Winterthur Institute of Health Economics) and Sven Hirsch (Head of the ZHAW Digital Health Lab), comprises eleven sub-projects that can be divided into three areas:
Innosuisse promotes innovation in system-relevant areas with the Flagship Initiative. SHIFT is one of 15 research projects approved as part of the 2021 flagship call for proposals. At the end of June, the SHIFT project was awarded the Prix d'excellence santeneXt, which honors excellence in the field of healthcare innovation and digital transformation. The contents of all sub-projects developed to date can be viewed on the SHIFT knowledge platform.