I believe the biggest challenge will be addressing and overcoming the viciously persistent problem of patient safety in hospitals. In all my years of practicing medicine, the constant vigilance needed to protect patients from errors promulgated by bad processes,non conscientious/unhelpful/incompetent employees, poor staffing, administrative neglect, etc. was the most exhausting part of my (hospital-based) practice.

It's interesting that the word "hospital" in Dictionary.
implies these words

1. repair
2. surgery
3. injury
4. charity for orphans and elderly

Maybe we need a new word or descriptions for care facilities based on type of care, e.g. Eldershire, which now implies cooperative forms of housing for elders who can live in small formed communities that have shown through research to reduce reliance of mediation, emergency hospital services and assured a place for "aging in place," that supports independence and community participation.

This method of caring community is replacing assisted living and nursing homes and helping to define "aging in place."

Bev, thanks for your response. I share your view, althought what you point to is need for a leadership approach that addresses these issues and is not heroic, (relying on one leader to make sure it happens).

Periodically, Tony Chen and I share a phone call and my view that the hospital blog community is information driven rather than organized to encourage and form community driven leadership methods that lead change in health care.

That is why I always enjoy reading Chris and Jeff's contributions here, as wellas Tony. They are seeking something new that has not been done before and is not driven from the top down.

The biggest challenges facing hospitals is the same one that perpetuates the most dysfunctional organization in American business - the fact that their is a dual governance system running hospitals means that the political ramifications of any administrative initiated efficiencies and improvements had better pass muster with the medical staff hierarchy. And that, dear reader is why hospitals are dangerous places to be when you are sick!