Ernst Walther: Efficiency and economy in German hospitals


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In this slideshow, Dr Ernst Walther, Head Physician, Department of Neurology, Schön Klinik Hamburg Eilbek, Germany, describes efficiency and economy in German hospitals, focusing in particular on neurological rehabilitation.
Dr Walther spoke at the Nuffield Trust European Summit 2014, which was supported by KPMG.

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Ernst Walther: Efficiency and economy in German hospitals

  1. 1. European Health Care Summit 2014 Big hospitals versus small hospitals – is either better? Dr. Ernst Walther Schön Klinik Hamburg Eilbek
  2. 2. Origins and history of hospitals in Germany 1285: Foundation of the „Heilig Geist Hospital“ by The city council and citizens of Lübeck 1710: Erection of the „Werk-, Zucht- und Tollhaus“ Celle by Georg I. Ludwig of Hannover (Great-Britain) 1710: Foundation of the „Charité“ by Friederich I. to prevent a spread of the plague
  3. 3. Types of Hospitals in Germany • Health care provision is local, supra-local, supra-regional • Capacities are planned by the "Länder" • Hospitals differ in intensity of health care provision determined following federal state law • There are four care levels 1. Basic Hospital Services Provision 2. Regular Hospital Services Provision 3. Specialised, focused Hospital Services Provision (e.g. Schön Klinik Eilbek in Hamburg) 4. Maximum Hospital Services Provision
  4. 4. Basic Facts Schön Klinik Hamburg Eilbek 2013 Primary care hospital with additional specialized departments . 703 beds. 24h daily emergeny room 17 medical departments / Integrated Practice Units 20.000 inpatients p.a. More than 1.600 employees 50.000 outpatient contacts p.a. Focus on orthopedics, neurology und psychosomatic medicine © 2013 Schön Klinik Seite 4
  5. 5. Neurocentre Schön Klinik Hamburg Eilbek Head Physicians: Daniel Wertheimer und Dr. Ernst Walther Acute Care Neurology 25 beds Cases 2012: 1112 -------------------------------------------------------- Neurology Intensive Care 38 beds Neuro-ICU Neurological Early Rehabilitation 49 beds Cumulative cases 2012: 426 -------------------------------------------------------- Continuative Neurological Rehabilitation (Phases C/D) 15 beds Cases 2012: 139 © 2013 Schön Klinik Seite 5
  6. 6. Neurocentre: Work force Overview: employees Physicians incl. thereof Head Physicians therof Speciality Registrars graduated nurses Therapists Hygiene specialists Tracheal cannula specialists Breathing therapists Social service employee Quality manager for relatives Certified Urologists Incontinence team (nurses) Total © 2013 Schön Klinik Accredication for medical training 45 2 7 220 70 2 2 1 1 1 2 2 Neurology 36 Mon. Neurological intensive care medicine 12 Mon. EEG training centre of the DGKN Nursing specialist in neurological early rehabilitation 346 Seite 6
  7. 7. Employees in German Hospitals (in fte) 840,000 834,585 830,000 825,654 820,000 810,000 800,000 791,914 790,000 780,000 770,000 2000 2002 2004 2006 2008 2010 17% of the employees in German hospitals are physicians 83% are non-physicians, of which 45% are nurses FTE = Full Time Equivalent, Source: Federal Statistics Agency © 2013 Schön Klinik Seite 7
  8. 8. Why is an early onset of rehabilitation important for the course of neurological diseases? • The likelyhood of regeneration is the earlier the better • The kind and dimension of functional deficits is better understood in multi-professional therapy teams • The dynamic and functional dimension of the disease will be better understood • Appropriate therapy strategies can be initiated promptly and focussed on the functional problem Conclusion: Neuro-rehabilitation should start during the ICU stay on the cutting edge when the acuity of the primary disease just allows the first therapeutic approaches. © 2013 Schön Klinik Seite 8
  9. 9. © 2013 Schön Klinik Seite 9
  10. 10. Hospital Planning and Renumeration • The federal state determines an individual health care provision mandate for each hospital i.e. the permitted quantities of health services provision (except for emergency cases) • Since 2004 most of the hospital health services are renumerated on the basis of diagnosis-related groups (DRGs) • Each hospital negotiates with the local representation of the sickness fund to determine the annual budget • The annual budget is calculated by using the individual quantities of the hospital multiplied with the uniform standard price for health services in the respective state ("Landesbasisfallwert") • The deficits or surpluses are balanced in the following year © 2013 Schön Klinik Seite 10
  11. 11. Patient referrals neurological early rehabilitation Hospitals Hamburg 2012 Number of beds early rehabilitation Hamburg 1.1.13 Klinik Betten FR Beatmungs betten FR Schön Klinik Eilbek 53 31 BG Unfallklinik HH 28 16 Allocating hospitals University hospital AK Harburg 28 AK Nord Heidberg 5% 5% Asklepios Kliniken Hamburg 36% 12 AK St. Georg 9% Other hospitals, surroundings 20 Wilhelmsburg Groß Sand 161 © 2013 Schön Klinik Other hospitals, Hamburg University cardiac centre 20 Frührehabetten Gesamt 15% 30% 47 others Datenquelle: Controlling Schön Klinik Hamburg Eilbek Seite 11
  12. 12. Effiency and Economy in German Hospitals "Germany is part of the OECD countries with the most efficient hospitals. The number of cases in relation to the number of employees weighted based on ICD categories shows that the hospitals in Germany have a comparatively low input of personnel per case. The number of cases, though, has been rising more than in other countries. Reasons are not clear yet. (Source: Study, Schreyögg, Insitute for Effciency of International Hospital Systems, Management in Health Care, University of Hamburg, 2013) Prices for health services in German are relatively low as compared to other OECD countries (OECD 2010). Measuring quality across throughout patient pathways needed Project Schön Klinik and WINEG/TK planned: "Development of an intersectoral quality monitoring - starting with health services at the departments of neurology and orthopedics at Schön Klinik Eilbek" © 2013 Schön Klinik Seite 12
  13. 13. Continuous Measuring of Quality and Outcome at Schön Clinics since 2007 • An independent, new institute for quality assurance of hospitals will be implemented in Germany until autumn 2014 • Annual Budget: 16 million EUR • Tasks are e.g. measuring quality, outcomes rather than patient satisfaction, determination of minimum quantities for certain operations like endoprotheses or intervertebral discs © 2013 Schön Klinik Seite 13
  14. 14. Thank you for your attention. Seite 14
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