Institut für Health Care & Public Management

Permanent URI for this collectionhttps://hohpublica.uni-hohenheim.de/handle/123456789/25

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Arbeitszeitmodelle im Schweizer Gesundheitswesen : qualitative Untersuchung in der Maximalversorgung
(2023) Linggi, Michael; Ernst, Christian
Research into the working time models of physicians is of great importance to ensure the health and safety of patients, to improve the well-being and satisfaction of medical staff, to increase the efficiency of work processes and to counteract the shortage of labor. The dissertation discusses the different working time models in the Swiss health care system, especially in the field of maximum care. It shows the working time models applied in practice as well as the challenges arising from their implemen-tation. It concentrates on the field of surgery (cutting discipline), but is not limited to specific surgical specialties, but follows a generalist approach. The aim of the re-search is to show which working time models function in the complex daily work of physicians in the Swiss model of maximum care and to what extent they can be transferred to other levels of care and countries. Due to the complexity of the topic, the research question was answered with the help of qualitative interviews. Both phy-sicians and administrative staff were interviewed. By means of qualitative content analysis, the various categories were then formed in order to be able to classify the transcribed text passages. The dissertation is based on the results of current research, for which primarily the contributions of generalist research were used. It has been shown that the organiza-tion of working time has a considerable influence on the satisfaction and health of employees. In particular, 24-hour operations and the associated shift patterns play an important role. Theoretical approaches to human, social and psychological capital al-so illustrate why employees are one of a companys most important resources. This forms the basis for the presentation of different working time models and the identifi-cation of influencing factors. Future-oriented aspects are also taken into account, such as the possibility of using robots in surgery to perform various procedures, which opens up additional options for designing new working time models. The findings of the dissertation can be summarized as follows: It is important to con-sider working time models in a global context, as the topic is very complex and multi-factorial. Basically, three levels can be identified that have to be considered when de-veloping innovative working time models: Society, institution and individual. In order to make new working time models possible, structural, societal prerequisites such as the Working Time Act and family-friendly framework conditions are needed. In addition, the institution, i.e. the hospital, must have the courage to break new ground and give employees the opportunity to work in new working time models. Finally, it is also up to the physicians to take personal responsibility and not take advantage of the employer. In addition to this overall approach with the three levels, the following focal points could be derived: Everyday work, work-life balance, research, education and training, career, work content, digitalization and other focal points. These focal points show which topics must be taken into account when developing new working time models. Finally, four working time models were identified as the most common: Part-time, Protected Time, Job Sharing and Home Office. In addition, labor legislation must cre-ate the framework conditions to enable these models to be used in a meaningful way. The findings are transferable to clinics and hospitals in other countries with a competi-tive health insurance system, such as Germany or Austria. This means that the find-ings and recommendations for improving working time models should also be appli-cable in similar legal and organizational contexts. This dissertation on the study of working time models among physicians at the high-est level of care provides an important basis for the further development of such models. The holistic view of the topic and the identification of challenges and focal points contribute to the improvement of future working time models. Hospital and clin-ic management should take these results into account when planning and implement-ing working time models. For future research, similar studies could be conducted in other countries.
Mathematische Optimierung der Sterilgutversorgung in medizinischen Einrichtungen unter Berücksichtigung von Einweg- und Mehrweginstrumenten
(2021) Hummel, Rebecca Madeleine; Ernst, Christian
Due to demographic change, healthcare systems in industrialized countries are confronted with increases in service volumes and costs combined with high quality and care demands. Increased efficiency is an important - if not the most important - means of meeting this challenge. Logistics processes, which account for up to 30% of total costs, offer a starting point for efficiency improvements in hospitals. Cost savings of up to 50% can be achieved by optimizing logistics processes. In particular, optimization in the area of hospital logistics offers the opportunity to reduce costs while maintaining quality assurance. This thesis considers the logistical process of sterile supply, which has the task of providing and preparing sterile surgical instruments. As an sub-process of the surgical process, it is of essential importance both from the point of view of economy and quality. The aim of this work is to develop an optimization approach for the sterile supply process which, with the aid of a mathematical model, combines the decision on the grouping of reusable instruments in trays and the decision between the use of a disposable or a reusable instrument. The combination is intended to unlock optimization potential from synergies of the interdependent decisions. The research contribution of the thesis consists, on the one hand, in a systematic literature review on the state of the art of sieve optimization and the disposable-reusable decision, and, on the other hand, in the development of a new problem, which has not been addressed in the literature before, but is highly relevant in practice. The problem is represented in the form of a mathematical model and a mathematical optimization approach is developed to solve the problem. The optimization model is implemented in the optimization software GAMS and applied to a practical case study using the solver CLPEX. For the purpose of an efficient implementation, an algorithm for the linearization of model variables is also designed. Based on the case study, the savings potential of the optimization approach for the gynecological clinic of a maximum care provider can be estimated at almost 80,000 euros per year.
Selektivverträge in der medizinischen Versorgung
(2017) Arnegger, Silke; Ernst, Christian
In the past fifteen years, Germany has introduced several types of medical care and cooperation opportunities between actors in the healthcare market. The gatekeeper model known as Hausarztzentrierte Versorgung (HZV) is a primary physician model and is an example of selective or individual contracting that is now possible between physicians in private practice and health insurance companies. It is also an example of new policy instruments intended to increase competition in the healthcare system (e.g. between insurance companies, amongst physicians in private practice). Increased competition should lead to improvements in the quality of patient care and economic efficiencies in the provision of that care. The latter is an especially important goal in light of the fact that there are a growing number of patients with chronic diseases. Selective medical care contracts like the HZV are situated at this pivot point. Going forward, German health insurance companies and other healthcare market actors – in particular, physicians in private practice – are allowed to enter into individual contracts for the provision of medical care to a group of patients. For this purpose, physicians specializing in a particular field mandate their professional associations to negotiate contracts. Thereafter physicians who want to participate in these contracts can offer the applicable provisions to their patients. Previously, all insurance companies and all registered doctors in private practice were required to enter into collective agreements. Contracts like the HZV mean it should now be possible to study the individual patient care models of different health insurance companies and offer medical care that is better tailored to patients. Additionally, these contracts should encourage communication amongst different actors in the healthcare system and incentivize their behaviour to generate efficiencies. This empirical study aims to explain whether the HZV, namely the selective contracts for primary care physicians in the state of Baden-Württemberg, contain the right incentives for participating doctors (agents) to produce efficient results for the insurance companies with which they have contracted (principals). Data on the quality and efficiency of care provided under these contracts is compared to data on their financial impact on participating doctors. New Institutional Economics inform the theoretical framework used in this study. Its theories of social contract, especially agency, and transaction costs play a central role in interpreting and analysing the data collected. Many studies of selective contracting in the field of healthcare economics focus on legal issues arising from actual and proposed changes to the law. By providing an empirical healthcare oriented economic account of such contracts for primary care physicians in Germany, this study supplements that literature with data and analysis that has been lacking on this important development.

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