European Health Care Summit 2014

Big hospitals versus small hospitals –

is either better?

Dr. Ernst Walther

Schön Klinik Hamburg Eilbek

Origins and history of hospitals in Germany

1285: Foundation of the „Heilig Geist Hospital“ by

The city council and citizens of Lübeck

1710: Foundation of the „Charité“ by

Friederich I. to prevent a spread of the plague 1710: Erection of the „Werk-, Zucht- und

Tollhaus“ Celle by Georg I. Ludwig of Hannover

(Great-Britain)

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

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Basic Facts Schön Klinik Hamburg Eilbek 2013

More than 1.600 employees

Primary care hospital with

additional specialized

departments . 703 beds.

50.000 outpatient contacts p.a.

17 medical departments /

Integrated Practice Units 20.000 inpatients p.a.

24h daily emergeny room

Focus on orthopedics,

neurology und

psychosomatic medicine

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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

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Neurocentre: Work force

Physicians incl. 45 thereof Head Physicians 2

therof Speciality Registrars 7

graduated nurses 220

Therapists 70

Hygiene specialists 2

Tracheal cannula specialists 2

Breathing therapists 1

Social service employee 1

Quality manager for relatives 1

Certified Urologists 2

Incontinence team (nurses) 2

Total 346

Overview: employees Accredication for medical training

Neurology 36 Mon.

Neurological intensive care

medicine 12 Mon.

EEG training centre of the DGKN

Nursing specialist in neurological

early rehabilitation

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Employees in German Hospitals (in fte)

834,585

791,914

825,654

770,000

780,000

790,000

800,000

810,000

820,000

830,000

840,000

2000 2002 2004 2006 2008 2010

FTE = Full Time Equivalent, Source: Federal Statistics Agency

17% of the employees in German hospitals are physicians

83% are non-physicians, of which 45% are nurses

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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.

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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

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Patient referrals neurological early rehabilitation

Hospitals Hamburg 2012

Datenquelle: Controlling Schön Klinik Hamburg Eilbek

9%

5%

15%

5%

30%

36%

Other hospitals,

Hamburg

Asklepios

Kliniken

Hamburg

University cardiac

centre

others

University hospital

Other hospitals,

surroundings

Allocating hospitals Klinik Betten

FR

Beatmungs

betten FR

Schön Klinik Eilbek 53 31

BG Unfallklinik HH 28 16

AK Harburg 12

AK St. Georg 28

AK Nord Heidberg 20

Wilhelmsburg Groß Sand 20

Frührehabetten Gesamt 161 47

Number of beds early rehabilitation Hamburg 1.1.13

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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"

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• 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

Continuous Measuring of Quality and

Outcome at Schön Clinics since 2007

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Thank you for your attention.