Healthcare – Page 2 – Geoffrey Silvera, PhD MHA

This week, health information leaders are gathering at HIMSS, discussing the role of technology in healthcare. And it has me wondering: What role has technology played in shaping the American patient? More importantly, how will it continue to reshape the way we deliver care?

Hospitals have long been the backbone of healthcare delivery, but history shows that no model is permanent. With each technological advance, patient expectations have shifted—and healthcare has had to adapt.

But are we adapting fast enough? Or are we at risk of becoming the next obsolete institution, much like another once-thriving American staple: the shopping mall?

From House Calls to the “Doc in the Box”

Technology has always reshaped healthcare delivery.

When phones became widely available, we transitioned from house calls to traveling doctors who would use a patient’s phone to call prescriptions into their office. As care centralized, patients called to book appointments instead of waiting for doctors to come to them. At the turn of the century, urgent care centers (the “doc in the box”) emerged—some people raved about the convenience, others resisted… and then many of those resisters opened their own. Today, freestanding emergency rooms are the latest iteration of convenience-based care, giving patients hospital-level services without the traditional hospital setting.

Each of these shifts was driven by technology and consumer demand. But what happens when demand shifts again?

A Walk Through the Empty Mall

Not long ago, I found myself walking through a mall—a place that once defined my youth.

Growing up in the 80s and 90s, the mall was everything.

It was where you shopped, where you socialized, where you spent hours just existing with friends.

If I had $10 in my pocket, I was a king—whether I spent it on an arcade game, an ice cream, or a movie ticket.

But today? Malls are ghost towns.

Sure, they see crowds around the holidays, but the average visit now is a pit stop at the return counter. Online shopping has rendered them nearly obsolete.

Why browse for what I need when I can order in seconds and have it delivered tomorrow or even within hours in some cities.

And it’s not just Amazon anymore. TikTok Shop is the new flea market, where influencers convince us we need everything from collapsible blenders to cat vacuums. (I’m not judging, but I’m totally judging.)

The point is: We moved on.

Why do we assume hospitals are immune to the same fate?

Could Hospitals Become the Next Mega Mall?

Every semester, I ask my students:
Will hospitals soon go the way of the mega mall?

Their answer is always an emphatic NO.

But, why not?

Hospitals, in their current form, haven’t always existed. Most of the freestanding hospitals we know today were built thanks to the Hill-Burton Act in the mid-20th century. Before that, care was delivered in homes, small clinics, and charity institutions.

Today, we assume hospitals are too essential to disappear. Or dare, I say it, too big to fail.

But retail stores were once essential, too. So were travel agencies. So were Blockbuster stores. And yet, we moved on when a better option became available.

The better option is already emerging in healthcare. Patients are signaling their preference for alternatives—and some health systems are paying attention:

Many patients today prefer to take an Uber to the ER instead of an ambulance. Some hospitals have evolved, adding rideshare zones and partnering with Uber Health and Lyft Med to support patient transport.
Telemedicine and home-based care are growing—not just because they’re cost-effective, but because patients and providers prefer them.
Amazon and Walmart are entering healthcare, exploring ways to deliver primary care directly to patients and gaining efficiencies in pharmaceutical management as well.

The healthcare mall is already changing. The only question is: Will we adapt fast enough?

Technology Has Always Changed Healthcare—And It Always Will

Hospitals will never disappear entirely. Just like malls still exist. But they will not always be the dominant model in health care delivery as they once were. Interestingly, even while searching for images for this post, the terms “futuristic medicine” almost always centers on an inpatient setting and often doesn’t include an image of patient. And, if I had to paint my version of a dystopian future, that is exactly what it would looks like, a group of clinicians staring at a holographic image and absent a patient or concern for the human behind the images.

We can’t expect technology to change every other industry while leaving healthcare untouched. And, we must take patients lead on how technology will or won’t change our industry. Otherwise we’ll end up just like the kiosk salespeople in the mall today desperately hawking cat vacuums to anyone we can convince needs them. (I told you I was judging).

Recently, I had the opportunity to tour a local hospital that has the distinction of being both academic medical center and safety-net hospital. We spent a lot of time examining patient flow and emergency department overcrowding—and I couldn’t help but think about Disney World.

“Wheelchair Person” by Direct Media/ CC0 1.0

Disney is a master of movement—orchestrating guest flow through its parks so that everyone gets to the right ride, restaurant, or show with minimal frustration. For many years, patient experience gurus lauded this model for its highlighting the experience while waiting. The waiting room is an experience, the exam room is another, and then the interactions with the care providers, all of them contributing to the overall experience especially in doctor’s offices. But, lets get real— no one enjoys the TVs playing HGTV non-stop for hours on end. I could go on forever on my distaste for doctor’s office waiting rooms, but it seems hospitals are doing much of the same.

On my visit, I learned of several patient flow innovations:

A patient flow coordination room, what they called an “air traffic control room” that tracks every patient—incoming, outgoing, and waiting.
Overflow areas designed to help absorb surges in emergency visits, with plans for even more capacity.
A discharge lounge which holds patients who are medically ready to leave but waiting for transportation.

"Air traffic control" Patient Command Central — “Air traffic control” Patient Command Central photo by G. Silvera

There’s an entire logistics operation designed to move patients efficiently. The ethos, if I understand it correctly, is sound and perhaps even noble. Patients who need care should be able to access care and if there is a patient that no longer needs care or can be better taken care of at another level, we need to move them along to open up space for the next patient. But here’s the thing: everywhere is full at every level.

We have pioneered systems to improve intake, and still, patient overflow is an issue. Every innovation that I have seen to address patient flow ends up butting up against the same reality, at some point, there is nowhere else to send the patient. We have organized too many of our systems in this country for the next patient, and, far too often, we have done so at the expense of the patient in front of us.

And I’ll say it again, because it is worth repeating, the queue is not the patient.

Disney Wants to Keep People Moving. Healthcare Shouldn’t.

Crowds line the way to Cinderella Castle at the Magic Kingdom.Credit...Joe Burbank/Orlando Sentinel, via Associated Press — Crowds line the way to Cinderella Castle at the Magic Kingdom. Credit…Joe Burbank/Orlando Sentinel, via Associated Press

Disney’s goal is to keep you flowing through different experiences—moving from ride to ride, maximizing time in the park. Hospitals should have the opposite goal:

🚫 Minimize unnecessary patient movement
🚫 Keep care as close to the patient as possible
🚫 Ensure every transfer serves a real purpose

What Healthcare Can Learn from Disney+

Think about how Disney changed retail strategies.

Disney Stores once brought the magic to malls
Now, Disney+ brings the magic directly to homes

Healthcare is undergoing a similar transformation:
✔ Telehealth eliminates the need for travel
✔ Home-based care brings services to patients
✔ Hospital-at-home models provide inpatient-level care outside traditional walls

Yet, inside hospitals, we still shuffle patients around— transferring them between rooms, waiting areas, departments, and even hospitals. To what end? What is the meaning behind the movement? Is it for patient’s needs or someone else’s?

What If We Built Minimally Disruptive Hospitals?

There’s a concept called “Minimally Disruptive Medicine” that focuses on reducing the disruption of medical visits—especially for elderly patients who rely on caregivers for transportation and support.

What if we applied this thinking inside hospitals?

Fewer unnecessary transfers
More bedside diagnostics and treatment
Care moving to patients, instead of patients moving to care

I am not sure what it would look like exactly, but I have an image of care providers moving through a patient room rather than patients moving through the hospital. For the clinically inclined, what if instead of being the blood that pumps through the hospital, patients were the heart. I encourage us all to think more critically about how disruptively care is currently modeled. Because in the end, patients are not guests in our hospitals.

We are guests in their lives.

“Caregiver Nurse” by Direct Media/ CC0 1.0

What Do You Think?

Are we designing hospitals for operational efficiency instead of patient dignity? How can we make hospital care less disruptive and more patient-centered?

Drop your thoughts in the comments—I’d love to hear your perspective.

#PatientExperience #HealthcareLeadership #MinimallyInvasiveCare #HospitalFlow #PatientFirst #Disney #HealthcareInnovation

Tag: Healthcare

Will Hospitals Go the Way of the Mega Mall?