For centuries, hospitals have been the cornerstone of the US healthcare system. Most Americans come into this world in a hospital — and many leave this world while in a hospital. Throughout their lives, Americans may also connect with a hospital under extraordinary or traumatic circumstances.

In communities where hospitals represent the largest employer, they are strong economic drivers. In fact, hospitals are responsible for more than $750 billion of total annual American health care dollars spent. Despite a history of strength and stature, the American hospital as an institution is in the midst of massive and disruptive change.

Over the next decade, we will see many of our nation’s hospitals reorganizing into an entirely different type of healthcare service provider. Several significant forces and factors are driving this historical — and inevitable — shift.

1. America must lower its crippling healthcare costs. Hospitals are vulnerable because they are generally regarded as the most expensive healthcare delivery system in America.

2. Statistically speaking, US hospitals can be dangerous places. The Journal of the American Medical Association reports that nearly 100,000 people die in hospitals from medical errors every year. The majority — if not all of these cases — are highly preventable, such as preventing hospital-acquired infections.

3. Customer care at some hospitals is a real stumbling block. Recent studies reveal that the average wait time in US hospital emergency rooms is approximately four hours. Can you name another US business where people tolerate such a low level of value and service?

4. Healthcare reform will make connectivity, electronic medical records, and transparency commonplace in the near future. This means that Americans considering a hospital stay will be able to go online and compare hospitals relative to infection rates, degrees of surgical success, and other important metrics. It will allow Americans to do what they love to do: comparison shop. Our health is our most important asset. Why wouldn’t we want to compare performance relative to medical care, just like we compare roofers or carpet installers? Once this occurs, hospitals will be driven by quality, service, and cost. All will be necessary for them to compete.

5. Patient satisfaction is becoming a key ingredient in the reimbursement realm. The Hospital Consumer Assessment of Healthcare Providers and Systems Hospital Survey is a national standardized survey used by the Centers for Medicare & Medicaid Services (CMS) to measure patients’ perspectives on hospital care. It is ultimately utilized to dictate reimbursement at risk. Inevitably, patient satisfaction will directly impact CMS reimbursement or lack thereof.

Being in the hospital business has always been fraught with many challenges. But now it’s truly a matter of life and death — for the hospital, not the patients. Unless a hospital is prepared to adapt and change, it may not survive.