[Turnover of Non-medical Staff in Outpatient Oncology Practices: Is Building Social Capital a Solution?]. / Fluktuation bei nicht-ärztlichem Personal in onkologischen Schwerpunktpraxen: Sozialkapitalaufbau als Lösungsansatz?

STUDY AIM: While a lot is known about potential and actual turnover of non-medical hospital staff, only few data exist for the outpatient setting. In addition, little is known about actual instruments which leaders can use to influence staff turnover in physician practices. In the literature, the social capital of an organisation, which means the amount of trust, common values and reciprocal behaviour in the organisation, has been discussed as a possible field of action. In the present study, staff turnover as perceived by outpatient haematologists and oncologists is presented and analysed as to whether social capital is associated with that staff turnover. In conclusion, measures to increase the social capital of a practice are presented. METHODS: The present study is based on data gathered in a questionnaire-based survey with members of the Professional Organisation of -Office-Based Haematologists and Oncologists (N=551). The social capital of the practice was captured from the haematologists and oncologists using an existing and validated scale. To analyse the impact of the practice's social capital on staff turnover, as perceived by the physicians, bivariate correlations and linear regression analyses were calculated. RESULTS: In total, 152 haematologists and oncologists participated in the study which represents a response rate of 28%. In the regression analyses, social capital appears as a significant and strong predictor of staff turnover (beta=-0.34; p<0.001). CONCLUSIONS: Building social capital within the practice may be an important contribution to reducing staff turnover although the underlying study design does not allow for drawing causal conclusions regarding this relationship. To create social capital in their practice, outpatient physicians may apply measures that facilitate social interaction among staff, foster trust and facilitate cooperation. Such measures may already be applied when hiring and training new staff, but also continuously when leading employees and when organising work tasks, e.g., by establishing regular team meetings.

[The homo patiens as an outsider of society : on the cultural and psychological exclusion of those who are different]. / Der homo patiens als Outsider der Gemeinde : Zur kulturellen und seelischen Grammatik der Ausgrenzung des Dämonischen.

The paper analyzes the problems of social inclusion of the homo patiens as a result of cultural patterns of deeply anchored personal dispositions of social exclusion of the alterity of the otherness. The processes of deinstitutionalization are therefore not only structured by path dependencies resulting from institutions and from the interests of the actors; cultural stigmatization is at work, which has a deep impact on the affectivity of the person in social interactions.

[The future of medical rehabilitation in accordance with SGB V and SGB XI in the context of changes in the German Medical Care System]. / Die Zukunft der medizinischen Rehabilitation gemäss SGB V und SGB XI im Kontext des Wandels des bundesdeutschen medizinischen Versorgungssystems.

During recent years the German federal social welfare system has been subject to several changes due to structural reforms. The hospital sector--as an element of this system--has also been affected. Based on various legislation the financial framework has been reduced which has led to tendencies of economic limitation and rationalization. From this background considerable risk selection and changes in emphasis might result. Cost intensive patients with a high need for treatment are referred as quickly as possible and discharged to outpatient services despite unknown domestic follow-up care. Mostly the elderly are affected. Medical rehabilitation can be found in this system at the cut between SGB V and SGB XI. However, this division raises problems and discussions concerning benefit payment (rehabilitation before nursing, priority of home, etc.). Right in rehabilitation the most important thing is an overlap of sectors. Various medical, nursing and other social supplies have to be put into a network to achieve an integral treatment of patients that focuses on the individual situation.

[The future of public health]. / Zur Zukunft des Gesundheitswesens.

As the results of the structural reform policy regulating the health care sector, the paper presents the possible path of increasing intrasectoral risk selection and intersectoral risk externalization (especially between the law of health care insurance, the law of statutory nursing insurance, and the German poverty law). Particularly the new developments in the hospital sector will be analyzed regarding the dynamics of risk selection and risk externalization. The new economic ways of financing the hospital sector are inducing the need of systematic integration of the different branches of social law, especially more developed networks of the health care, the nursing system, and the social care services.