[REDIA--impacts of DRG introduction in the acute sector on medical rehabilitation]. / REDIA - Auswirkungen der DRG-Einführung auf die Rehabilitation.

The REDIA study is the only long-term (2003-2009), prospective, multicentre study analyzing the impact of the DRG system on quality and costs in rehabilitation facilities. In 2004, Diagnosis Related Groups (DRG) were implemented on a mandatory basis in the German healthcare system as a reimbursement scheme for hospitals based on administered prices for procedures. Experiences from other countries revealed that introduction of DRG does not only have a significant impact on hospitals but also on rehabilitation facilities. The study approach ensures a comprehensive analysis as it considers major clinical, therapeutic, psychological and economic aspects. The REDIA study is the only nationwide empirical study that includes all stages of the implementation process: before DRG implementation, during the convergence phase and following implementation. An indication-specific comparison of the phases showed significantly shorter stays in the acute sector as well as shorter transition times between the sectors, resulting in admission of patients into rehabilitative care at an earlier stage of their recovery process. Significant diversions of treatment efforts from the acute sector to the rehabilitative sector have been proven in terms of increased nursing efforts and potential changes in the therapeutic and medical treatments to be provided.

[Rehabilitation and Diagnosis Related Groups (REDIA Study): impact of DRG introduction in the acute sector on medical rehabilitation in Germany]. / Rehabilitation und Diagnosis Related Groups (REDIA-Studie): Auswirkungen der DRG-Einführung im Akutbereich auf die medizinische Rehabilitation.

As experiences from other countries show, introduction and use of Diagnosis Related Groups (DRG), as of January 2004 now also mandatory in Germany, may have a significant impact on associated rehabilitation. The Institute of Hospital Management (IKM) in a multi-centre study promoted by Deutsche Rentenversicherung Bund and Deutsche Rentenversicherung Westfalen is conducting a study regarding potential diversion of healthcare expenditures from acute care towards rehabilitation as a result of DRG introduction in Germany. For documentation of potential short-term changes in patient populations and patient streams, extensive data have been collected in the first two phases in 2003/04 and 2005/06 for a total of 1342 cardiologic and orthopaedic patients. Indication-specific comparison of the two phases showed significantly shorter stays in the acute sector as well as shorter transition times between the sectors, resulting in an intake of patients into rehabilitative care at an earlier stage of their recovery process. Significant diversion of treatment efforts from the acute to the rehabilitative sector, regarding increased nursing effort and potential changes in the therapeutic and medical treatment to be provided, has not been proven as yet. The increase in wound problems expected by practitioners was confirmed in the orthopaedic area by an increasing number of wound healing disturbances and haematomas; in bypass-patients, an increasing number of pericardium and pleura bruises was found. The analyses performed on the data collected revealed no limitations in the patients' ability to participate in rehabilitative measures when the first and the second phase of the study are compared. To be able to depict the further course and interdependencies of changes, continuous systematic observation of developments would be desirable. To ascertain a lasting impact of DRG implementation at least a third study-phase will be necessary, which should be placed at the end of 2008, at the time when the DRG convergence phase will end.

Medical savings accounts: a core feature of Singapore's health care system.

In 1984 Singapore adopted a system of Medisave accounts, individually owned accounts used to pay for many of the health care expenditures that in Germany would normally be covered by the obligatory or private health insurance. The fact that people are spending their own money rather than that of a third-party insurer has helped to curtail Singapore's health care costs, which were about 2.6% of gross domestic product in 1999 (Germany: 10.5%). Even with these low expenditures, the income of Singapore physicians is about the same in relation to average wages as physician income in Germany or the United States, and patients have easy access to such technology as computerised axial tomography, organ transplants and bypass surgery.

[Laparoscopic single patient use instruments: expensive outsourcing of product quality?]. / Laparoskopische Einweg-Instrumente: Kostspieliges Outsourcing von Produktqualität?

The supply of medical goods is an important critical success factor in German hospitals. One major managerial area in the procurement concerns the decision between single patient use (SPU) and multiple patient use (MPU) products. Especially laparoscopic instruments which are generally expensive are a field of interest for decision makers. Due to a lack of quantifiable factors describing the two different forms of supply alternatives with their effects on effectivity and efficiency of the procurement process and the final use are often not taken into account. Since it is expected that in the future more and more laparoscopic instruments will be needed there is a necessity for finding a concept allowing the identification of the "right" product. The Center for Hospital Management (CKM) has the aim to develop a corresponding approach but needs the help of the reader.

[Interpersonal communication as a factor in successful development of a decision-oriented information systems model in the hospital]. / Kommunikation als Erfolgsfaktor für die Entwicklung einer entscheidungsorientierten Informationsverarbeitung im Krankenhaus.

The success of a decision-oriented hospital information system is primarily depending on the way of integration of the involved professionals in the development. The technical realisation of those systems is already supported by several tools. Interpersonal interactions on the other hand which take about 40 percent of the time of development are still methodically ignored. The medVista method promotes the active integration of all persons involved and supports the realisation of a technological model simultaneously. Substantial corrections usually arising after implementation are no longer necessary and the system will be accepted by users.

[Virtual workshop for hospital management]. / Virtueller Workshop zum Krankenhaus-Management.

Due to a survey of the CKM insufficient communication among different professional groups is one of the main causes for unused quality reserves and neglected potentials of efficiency in German hospitals. An essential reason for this insufficiency lies in the traditional concepts of education which are designed for the specialties of the different professional groups. With this these concepts only impart key qualifications such as social authority, ability for communication and ability for problem-solving in a small amount. The goal of the virtual workshop is to train students and trainees in communication and interdisciplinary problem-solving early by working together on a practical case in a Virtual Workshop team. On the other hand all relevant persons to talk to are involved in order to support a qualified preparation of decisions: employees of the project hospital, partners from industry and members of universities.

[Hospital management: quality and economy as management challenges for the physicians]. / Krankenhaus-Management: Qualität und Wirtschaftlichkeit als Managementherausforderung des Arztes.

As a consequence of the Gesundheitsstrukturgesetz (GSG-Health Structure Act) hospitals are called upon to organize the processes of medical, nursing care and administrative services more economically, without there being any reduction in either the social quality or the quality of the process or result of the task of caring for patients. Fulfilling the task of caring for patients professionally entails providing medical efficiency and economy (section 109 SGB V). The hospital management is called upon to harmonize supposedly conflicting objectives such as "increasing the quality whilst reducing the costs" through intelligent organization and leadership concepts. The maxims up to now were: "quality costs money", "innovations need time and money", "a shorter stay can only be guaranteed with additional capacity" etc. The new management paradigm demands: "higher quality and patient-effective innovations (e.g. minimally invasive procedures, out-patient operations) can be realized in a shorter time with a tendency towards falling costs" and "a shorter stay is achieved with less capacity through better organization". To guarantee these standards the doctor in particular is required to be a high performer because the responsibility for medical quality cannot be separated from the responsibility for economical work processes to achieve this quality. Every senior doctor when making his decision about the type and intensity of diagnosis and treatment automatically also makes a decision about executing these processes of medical services in a way which is tailored to suit the needs and economical requests. This management challenge for the doctor presents itself in several areas: --as a manager of the care cascade --as a manager of the services in the regional health network --as a manager of standardization in the field of logistics (e.g. steering of medical products like heart catheters from the point of manufacturing to the point of use) --as a manager who knows how to mobilize the problem-solving knowledge of his employees through delegation-orientated leadership; the concept of the management of wastefulness as an organization and management approach is particularly suitable for hospitals.