High rising costses - hospitals in the fight for their existence

High rising costses for hospitals (openPR) - new concepts are in demand

Karlsruhe, Cologne, Hamburg - January 2007. The hospitals in Germany are at substantial rising costses. With introduction of the drop lump sums and at the latest with the new collective wage agreements it showed up for many houses that it does not continue in such a way with the economic development. Today often already as success one celebrates, if the current operating cost is covered. From the additionally necessary financing, also the urgently necessary investments is frequently still not at all the speech. On this thin economical basis the existence of hundreds of hospitals is endangered in Germany from view of the next three to five years.

In order to manufacture a durably load-carrying total concept

a “offer” is to be developed, which aims at the patient and its needs (“the patient is located in the focus = customer”),
patient-far expirations are to be rationalized and if necessary strange to assigned (Make or Buy),
is to be co-operated with other houses in the group,
an organization of the administration and guidance are to be established, more modern management realizations meet,
and is over a hospital information system (KIS), to create a data basis which all took part necessary transparency for fast, individual decisions gives.

Medical supply, requirement and costs

On the first (statistic) view the current medical supply situation for the population is expressed sumptuous in Germany. With more than 2,100 hospitals, approximately 815,000 persons employed in the health service and on the average 6.5 hospital beds per 1.000 inhabitant Germany is above average well taken off. The other countries in Western Europe come on the average on less than 4 beds per 1.000 inhabitant, would have to supplement thus over over 50%, before they achieve the German supplying degree. Thus the supply of hospital beds, comprehensive prevailing, in Germany and, does not accompany however by any means with a better state of health, as international comparisons likewise show.

From approximately 56 billion euro costs of the German health service result about 70% per cent for personnel and 30% as non-personnel costs. The hospitals with 27% are the largest individual cost block in the health system. At the latest since introduction of the drop lump sums the hospitals are forced based account of the hospital achievements to work over all working processes away, economically and to make thus a contribution to the health reform.

First successes are not enough yet

Despite past, quite already considerable, current studies show reduction of the average Liegedauer, the reduction of the number of beds, the hospitals and the past personnel trunk as well as realized privatisations that still a third of the existing hospitals cannot work in the future economically. The result further privatisations, unions to supraregional hospital groups with increasing specialization or also final locking will be. The last collective wage agreements for the medical profession, with all understanding for their situation, will accelerate this development once again clearly.

The hospitals are now demanded to identify so far still unused Rationalisierungspotenziale to develop economical concepts new administrative and organisational structures to construct and/or to the new concepts adapt and high a claim of quality and achievement at the same time to convert.

Starting points for an economic improvement

Logistics (management)

A much discussed topic is the optimization of hospital logistics. Here the Verbesserungspotenzial is appropriate for the internal and external patient transportation, in addition, in the procurement and inventory management, in the range of the scheduling for medical investigations and OI dates, in the storage logistics, in physical and digital document archiving
(Document management system) and finally in the optimized information logistics, i.e. employment of a hospital information system (KIS).

The scheduling of the medical investigations and/or OI plans should follow organizational operational sequence. A rough planning should go to the planning of the OI dates, the bed capacity, space extent of utilization etc. in front, those through a detailed planning with consideration of date desires, preferences and resources is co-ordinated. The waiting periods of the patients and the idle running times could be reduced thereby clearly. Investigations showed that 10-15% are to be expected saving of time here.

The planning and execution of hospital logistics the inclusive storage and transport of laundry, meals, medicaments, medical special need, administrative and restaurant economics, laboratory samples, beds, instruments, post office, patient documents as well as disposal transport usually offer a substantial Rationalisierungspotenzial.

In order to install an efficient logistics management is the employment of a hospital information system (KIS) recommended, starting from a certain size even compellingly, in order to bundle and steer so the information, material and Werteflüsse optimally. Thus all stations receive necessary transparency over the operational sequences in the hospital. All transportation can be seized and organized in the system.

• The integration of a KIS contains the following aspects:
o administration of patient master data, disease data, laboratory data and radiological investigations
o planning and documentation of the medical treatments, operational interferences and care
o archiving and support with the production of documents (physician letters, OI reports)
o optimization of internal hospital transportation
also short term planning
avoidance of expensive stop in treatment rooms
reduction of the waiting periods around 15 - 20%
feed of orders over mobile terminals (PDA)
o Logistikcontrolling
account opposite health insurance companies, health insurances and self payers
procurement management with supplier management and material planning and - arrangement
inventory management
structure of meaningful key performance of indicator (KPI´s)
documentation of Verbrauchsmaterialen in the hospital for each cost centre (e.g. OI or Roentgen department)
cost objective accounting (inclusive material and work time)
providing from evaluations to the legal and internal reporting
With the introduction of the KIS and thus the creation of necessary information transparency the bases for the later optimization are created. Under the objective to optimize and the economically possible Synergiepotenzial realize the medical strengths, the among other things following tasks are applicable for the restructuring in this phase:

• Goods received, storage and department supply also
- medical and not-medical special need
- Restaurant economics
- Administrative need
• Center controlling of the patient transfers
• Center controlling of the bed transportation
• Center sterilization and supply of instruments
• Center pharmacy and supply of medicines
• Center meal preparation and supply of the stations
• Center controlling of the laundry transportation
• Center controlling of patient document archiving
• Post office internally and externally
• Tasks of disposal for different product/materials groups

The entire logistics organization must be converted and should not perhaps also compellingly by the hospital. The coworkers of the hospitals should focus themselves on patient near tasks, while the logistic functions should be completed by specialists for such tasks. Here a Make is or Buy - decision under qualitative and monetary aspects to examine.

The external Logistikdienstleister is to then seize all goods stream and Informationsprozesse (procurement/storage/distribution/disposal), coordinates and in a central storage depot (within or outside of the area) to bundle if necessary and the individual stations meeting demand to supply.

With optimal completion the hospital has a smaller administrative expenditure, smaller existence and thus smaller reproaching costs, less decrease by the concentration and information transparency by obsolescence. In addition so an improved starting point develops to intersperse in order to reduce the number of suppliers and improves procurement prices. By the concentration of the logistics, which increased transparency and the measures and negotiations which can be derived from it leave themselves the costs within this range around 10-20% to reduce according to experience. In addition maintenance personnel is relieved and can dedicate itself its major tasks more intensively. Further save potenziale lies surely in the standardisation of the products and services, the use of electronic procurement platforms for the material purchase and of services among other things in the logistics range.

Over the possible Einsparpotenzial there are different opinions among the experts. Thus a management consultation of the hospital industry indicates a cost optimization of the procurement processes of 4.5 billion euro. However Professor Wilfried von Eiff, Leiter of the Centrums for hospital management sees - CKM, this statement for unrealistic. Hospitals in Germany have an average operating size of 250 and 450 beds. An optimization in this size would suggest that each hospital can save on the average 2.2 million euro lastingly. The CKM - Centrum for hospital - management proceeds from a reduction of costs with 750 million euro.

Administrative structure

As king way from (coming) the economic crisis in many places the union to a larger, several districts or cities comprehensive hospital group are regarded. It is obvious that the group can create at least conceptionally the possibilities of activating the Potenzial described first. A group of five, six or still more houses can make on the one hand a co-ordinated form for the medical specialization possible and hold thus patients in the region, which otherwise 50 or more kilometers far into the next clinch with appropriate equipment to drive would have. On the other hand the group can prevent double and three-fold storekeeping, obtain a bundling of the procurement activities, create an efficient central supplying center and implement and supervise operational tasks of logistics economically.

In addition, for the group first the suitable organisational structures must be developed, in order not to run the risk that the hoped for Potenziale, due to lengthy, bureaucratic and unprofessioneller decision ways again to seep. A taut organization form with clear Verantwortungen and in addition suitable authority is indispensable. The medical profession will be stopped in the future still more to work in your Entscheidungsrefugium still more economically. Ideally become some positions, which are put on operatingspreading in personnel union of few high-level personnel occupied, in order to avoid foreseeable friction losses. A professional presentation of advice and committee meetings is likewise according to experience helpful.

On the other hand a simple adding of supervisory board mandates for in the long run 5 or 6 times 7 or 9 municipality or circle councillors leads not to a functional advice, but rather to a parliament, since the interest situations are often too different. Similar it can over-on-boardend committees to come. And if then, as in the genuine parliament, first the debates dominate and subs-committee meet, before something is decided, are fast used up the possible synergy advantage of the group.

Result

It is Potenzial available and it must be compellingly lifted. Not despite but because of increased economy by reductions of costs and rationalization of expirations and decision ways the offer can be able to the patients (= customer) increased and physicians and be relieved maintenance personnel by functions of the administration.

Close co-operation up to the fusion of houses is promising success however laboriously and full Stolpersteine. A group should take on the one hand not too many back sighting on old habits and structures, since this aspect brings often nothing. On the other hand one should turn on the intended changes carefully and with the compellingly necessary professionalism, so that by the change process will not smash porcelain already unnecessarily.

LOGO TEAM management consultant for logistics and organization
Emperor route 235-237
D-76133 Karlsruhe
Telephone: +49 (0) 721-912940
Fax: +49 (0) 721-912944
E-Mail: info@logo-team.com
Internet: www.logo-team.com

Contact: Dipl. - engineer /Dipl. - Wirtsch. - Engineer Martin Stoll - Karlsruhe | Cologne | Hamburg

LOGO TEAM is a group of experienced logistics and organizational consultants with locations in Karlsruhe, Hamburg and Cologne since now over 15 years at the market acts.

Due to our activities as advisors and also as a responsible person manager from industrie and logistics service enterprise we could gain experiences in logistics and organisation area over years. For us logistics means the holistic view of the Supply chain with all being, information and Werteflüssen.

Consulting understanding

Our goal is it to promote co-operation in logistics. We concentrate on the feasible and look for each other the holistic, range-spreading solution. We want to realize and look for our concepts therefore long-term co-operation with our customers.

Achievements

With our achievement components we accompany the enterprises from industry, trade and service not only in the analysis, decision and conception phase, but also with the realization.

- Make or Buy decision (outsourcing)
- Planning of logistic systems
- Location/work planning
- Flow of material/camp planning
- Auschreibung for the purchase of logistic services and IT-systems (goods economy, stock management, flow of material/arrangement/route planning systems)
- Procurement optimization
- Process optimization
- Process cost calculation
- Project management
- Traning & Coaching
- Time management
- Personnel consultation

Demand us!
www.logo-team.com

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