Table 5.

Hospital Factors — “The Clinical Service”

Very ill patients, highly specialized care Rapid pace, reduced length of stay (LOS), day of procedure admission Absence of many common illnesses No time for reflection Loss of role as “center of doctor's lives” Economically strained, competitive environment Shift to ambulatory care Spread of specialty care to non-AMC's Transparency Safety/Quality/Efficiency (Value) Patient Satisfaction