The boundaryless hospital

Everyone in the western world has a clear idea of what a hospital is. People think of a series of large multi‐storeyed buildings filled with highly skilled and professional people (the ‘ologists’) offering sophisticated services amid an impressive array of high technology equipment. Over the past century the development of the hospital has involved cramming more and more services, staff and resources into the one location. Many large hospitals today have a staff of several thousand and are like a small city. But will hospital development continue in this direction? We think not. We believe the hospital has reached an evolutionary branch. The fundamental nature of hospitals is about to change because of the application of information and clinical technology, changing medical practices and economic rationalism. To understand why requires an excursion into a number of disciplines including the history of the hospital, organisation behaviour, medical practice, management and health care policy. And this is no mere epistemological exploration: it is vital for society generally and those who work in health care particularly to understand that the existing structure of the principal organisation which delivers health care is coming to an end. Our principal focus is the teaching hospital, but the analysis applies to a substantial degree to the many kinds of hospitals found throughout the industrialised world .