Quality concept

Pillar 1: Classic quality management – focus on best possible result and smooth processes

For each of our patients we strive to achieve the best-possible treatment result. For this reason, the main focus of our efforts in classic quality management is on the quality of medical results. We measure this on a quarterly basis based on 59 Group-wide quality indicators – of which 45 from the method according to Section 137 German Social Insurance Code V (SGB V) (method of the National Quality Assurance Centre – BQS) and 14 from DRG data, i.e. from data gathered for invoicing purposes (e.g. diagnosis, procedures, duration of stay), providing an objective basis for assessing the quality of medical care. That is why we will further expand this basis of our quality assurance and will moreover establish a Group-internal benchmark on the basis of routine data: working closely with the head physicians of our hospitals, we are developing sets of indicators which we will further extend in 2008 by further key ratios on patient safety and from the projects of the Federal Association of Private Hospitals in Germany (Bundesverband Deutscher Privatkliniken e.V., BDPK) and the Association of University Hospitals in Germany (Verband der Universitätsklinika Deutschlands, VUD).

When working with key data, a distinction has to be made between “hard” results data and what are known as “reference indicators”:

The first provide information directly, without any further explanation needed, on the quality of results for a certain area (e.g. mortality rates) – also as part of a ranking or benchmark. As a prerequisite for this, the issue has to be specified as narrowly as possible and/or the risks adjusted to a reasonable extent.

However, such results data are less suited when it comes to improving the results data: after all, an increased mortality rate figure of a department does not say anything about which steps in diagnosis and treatment processes can be improved. For this, a follow-on analysis is required. This is exactly where the “reference indicators” (e.g. duration of operation or complication rates) come in: they indicate cases whose treatment processes might be further improved and therefore should be looked at more closely.

With a view to ensuring the best possible clinical processes at our hospitals, we continuously evaluate the respective hospital- and department-specific results locally. For example, the quality management officer performs joint file reviews with the respective head physician. When necessary, the Group quality management department is available to assist with the reviews. It is not always the case that an evaluation calls for a change in processes. The analysis is just as useful in enabling the meaning of existing indicators to be reviewed on an ongoing basis and to make adjustments where appropriate.

This standardised approach enables us to improve the guidelines for clinical processes systematically, with our special interest being devoted above all to interdisciplinary medical fields having multiple interfaces and therefore requiring an intelligent organisation of processes.

Thanks to additional system audits, we achieve partial or complete certifications of medical specialties, such as oncological centres (breast, prostate or gastrointestinal). Parallel to this, we also have the high medical quality of these performance centres confirmed externally by the relevant specialised organisations (for example based on the guidelines of the Germany Cancer Association (DKG)).

Treatment success is more than the objectively measured quality of diagnosis and therapy. Subjective evaluation of hospital treatment by patients is also an important aspect to be considered, since only satisfied patients are willing to establish a lasting relationship of trust with their treating doctors, something that can be crucial for the success of the treatment.

Since objective medical results quality and subjective patient satisfaction may differ, we put the measurement of patient satisfaction on an equal footing with classic results measurement.

The data measured – like the data on results quality – are included in a regular Group-wide benchmark. In this way we make direct use of the assessment of our patients to improve internal processes.

Pillar 2: Medical controlling – careful documentation and objectively justified coding of medical services

Since the introduction of the DRG system, medical controlling has increasingly developed into an independent field of activity, and its significance has also grown. Originally focused on converting individual medical services into remuneration codes, the range of tasks has expanded, making it an indispensable interface between financial management and medicine and linking up medical expertise to economic performance data. Medical controlling thus not only allows for complete documentation and correct coding of medical services as the basis for correct accounting and reasonable remuneration, but also determines the quality and reliability of many of our Group quality indicators. For this reason we have combined medical controlling and traditional quality management “under one roof”, creating considerable synergies for both sub-areas.

By documenting the patient’s treatment fully and plausibly from a medical viewpoint, the main purpose of this integrative function is not only to ensure correct remuneration of services but also to optimise diagnostic and therapeutic processes and use these as the basis for improving the quality of treatment.

Pillar 3: Hospital hygiene – the paradigm of medical treatment quality

Hospital hygiene is a seal of quality in medical practice. Particularly given the rising incidence of infection rates worldwide, we are especially concerned with protecting our patients and employees effectively against the risks of infection. For this reason we have included the overriding task of ensuring hospital hygiene as a permanent part of our quality concept.

Hospital hygiene makes a vital contribution towards ongoing quality assurance by linking up results measurement (infection epidemiology) with process optimisation (infection prevention). It also plays an important role in ensuring swift and targeted intervention and effective containment of infections in the case of an outbreak (e.g. noroviruses).

With a view to promoting regular Group-wide exchange of knowledge on this important issue, we have set up a project group which, along with the doctor responsible for hygiene at our Group, also includes the staff responsible for hygiene at our hospitals. In this group, both the day-to-day challenges and possible standards for hygiene-relevant measures are discussed and adopted as Group-wide guidelines or for individual hospital rules.

We have thus permanently established hospital hygiene at the Group and hospital level – at a standard well exceeding the statutory requirements (Infection Protection Act and federal state legislation).