[Adjustment of the German DRG system in 2009]

Management strategies in hospitals: scenario planning

Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to.

Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces.

These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”.

Results: Two key uncertainties were identified and considered in this study:

the development of workload for the medical staff

the profit oriented performance of the medical staff.

According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment.

Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

Complementary education for healthcare personnel: a strategy to increase hospital performance

Introduction: The German healthcare system is facing ongoing radical change and development. The increasing tendency to urge hospitals and medical staff to work in a profit-oriented way constitute among other factors clear present and future challenges. Physicians and surgeons in particular increasingly complain of increasing stress attributed to measures aiming at cost reduction in hospitals. The highest priority must always be patient satisfaction and the delivery of good medical and human service.

Problem description: The health care market in Germany has become an increasingly complex business with uncertain and unpredictable future events. Strategic planning has to enable hospitals to quickly and flexibly adapt strategies to changes in the environment that become essential to their success. The most important task is to develop a strategy that can be applied with success in all possible future scenarios. This is known as the core strategy.

Discussion: The core strategy for hospitals in Germany is complementary education of the medical staff as well as top management. Accordingly, courses, workshops or even part-time graduate or postgraduate education in business and economics are recommended for the medical staff. As far as non-medical hospital executives are concerned, there is no better way than to host them in a hospital department for a period of 6–12 months. This paves the way for understanding and accepting each others’ opinion which increases hospital performance.

Conclusion: Proper and complementary education of the medical staff as well as of non-medical top executives and managers of hospitals is recommended as the core strategy. This harmonizes both professional medical and managerial efforts with a synergy effect that allows soundly facing the increasingly challenging environment of the health care sector in general and in hospitals in particular.

[Complexity level simulation in the German diagnosis-related groups system: the financial effect of coding of comorbidity diagnostics in urology]

BACKGROUND

Precise and complete coding of diagnoses and procedures is of value for optimizing revenues within the German diagnosis-related groups (G-DRG) system. The implementation of effective structures for coding is cost-intensive. The aim of this study was to prove whether higher costs can be refunded by complete acquisition of comorbidities and complications.

METHODS

Calculations were based on DRG data of the Department of Urology, University Hospital of Münster, Germany, covering all patients treated in 2009. The data were regrouped and subjected to a process of simulation (increase and decrease of patient clinical complexity levels, PCCL) with the help of recently developed software.

RESULTS

In urology a strong dependency of quantity and quality of coding of secondary diagnoses on PCCL and subsequent profits was found. Departmental budgetary procedures can be optimized when coding is effective. The new simulation tool can be a valuable aid to improve profits available for distribution. Nevertheless, calculation of time use and financial needs by this procedure are subject to specific departmental terms and conditions.

CONCLUSIONS

Completeness of coding of (secondary) diagnoses must be the ultimate administrative goal of patient case documentation in urology.