Regardless of attitudes about the ACA, the goals of the federal and private sector healthcare reform efforts – driving down cost and improving quality – are creating a need for healthcare transformation. This is most apparent for hospitals, as they are regarded as the most expensive part of the healthcare delivery system.

As my next door neighbor, a surgeon said to me many times, “Hospitals are dangerous places, people die there”. That is unfortunately all to true. According to Houle and Fleece three times as many people die in hospitals due to medical errors each year than on highways -100,000 compared to 34,000.

How many 747 airplane crashes would it take to equal 100,000 avoidable deaths? Can you imagine the hue and cry of the US public if airlines were crashing on a daily basis? Yet, almost a year ago the major television networks said that one out of three patients admitted to hospitals had some other complication. There was no noticeable reaction. Worse, there are many lessons that could be learned from the airline industry and put into practice that would improve patient outcomes. Some of these practices are slowly making their way into the healthcare field. Team training, crew resource management, and checklist are becoming part of medical education and training programs.

The business model shift from volume to value is the most important and most challenging issue facing hospitals. Hospital CEO’s must guide their organizations in figuring out how to provide more affordable, higher quality care at lower reimbursement rates – probably under a fixed or bundled payment model.

Decreasing federal reimbursement levels are a fundamental issue of concern, with broad implications for the quality of care providers are able to deliver. Despite the challenges there is an air of optimism and hospital administrators see an opportunity to develop a framework to provide more affordable higher quality care.

Our health is our most valuable asset yet people squander it every day. In the US obesity actually accounts for 17 per cent of all medical costs, at approximately $170-190 billion annually. Health consequences of obesity include diabetes, mellitus, asthma, sleep apnea, gall bladder disease and a range of cancers. Among children and adolescents, annual hospital costs related to overweight and obesity more than tripled over the past two decades.

A primary goal of the 2010 health-care overhaul is to reduce hospital readmissions. How are hospitals going to reduce readmissions if patients do not take responsibility for themselves?

Why should patients follow their doctor's instruction and advice? Readmissions culminate in bad outcomes for the patient but they refuse to see just as they refuse to contemplate the effects of their smoking, obesity, and other lifestyle choices that directly affect their health. If the resources are there, it's somebody else's problem. If there is a bad outcome, it's the doctors' fault, not the patient's decision(s). Patients have to be responsible for their health and follow through with the advice and direction they are given.

The vast majority of hospitals are not currently configured to deliver “wellness.” Developing those capabilities will require significant time and capital investments, and new kinds of community partnerships.

Primary prevention of obesity and responsible health choices should be high on the political agenda.