Discontented patients, carers overworked: the situation in hospitals nationwide is reflected in the Ludwigsburg Klinikum. Managing Director Jörg Martin does not exclude individual cases. He sees health care in transition.
Ludwigsburg – Patients and relatives have announced their bad experiences at the Ludwigsburg hospital, others have joined them. Interview with the general director of the clinic about treatment errors, economic constraints, the idea of service in care and the actor.
Mr. Martin, patients in Ludwigsburg reported a lack of hygiene, unkind caregivers, treatment errors. You are not just a hospital director, you are also a doctor. How can you allow this?
Of course, every case is close. We have a good system for dealing with cases. Particularly serious diseases and deaths are discussed in an interdisciplinary manner. He is not looking for a culprit, but is trying to find out if and how to change the process. But we must not close isolated cases on the whole. It is necessary that a doctor be at the head of a large health care company because of his expertise.
As an executive, you owe it to the shareholders and you must present a balanced business result at the end of the year. It does not bother the doctor in you?
I continue to believe that hospitals can be managed economically even today. We have the privilege that a large part of the eligible investment costs will be borne by the county and the land. Private homes do not have that. We need a black zero to continue investing in modern staff and big equipment.
Does economic thinking come first?
They talk to shareholders the word. This can not be your claim as a doctor. Do not you want to be able to use the medicine in this country?
We do that! I must be able to do a medicine based on needs. As health care costs increase, insurance premiums will need to increase, at least for those insured under the law. We pay on average 15.5%, then we would have to deduct a little more from the salary. You can also make very good medicines in the current conditions. The economy follows the quality – not the opposite. If the quality is good, you can also work economically. If you register a house, it will not offer more quality, but no one will come.
From the point of view of the badly treated patient, in Ludwigsburg, the economy comes first.
You must analyze each case, but you can not deduce it from everyone. In patient surveys, we are not great, but better than average. These show that there is a majority satisfaction. Very often, a communication problem is to blame. I often do experience it urgently. Patients must wait three to four hours on Sunday. But if you tell them to wait, because the others need to be treated more quickly, they can handle it better than sitting for four hours and ensuring that those who came later are treated first. We are not far enough yet, but we must also understand our profession as a service. This requires good communication.
Does everything in the hospital not serve the man?
You must differentiate two groups of patients. One is the emergency group that comes because it is the nearest hospital or because the ambulance has driven them there. The other group – half or more patients – is the one who can choose where to go. They are not just patients, they are also clients. Of course, as doctors and caregivers, we are committed to all. But a friendly thank you, please or good day is important. We had someone from the hotel compartment, who trained our doctors and our nursing staff.
How is it that you need to increase usability in a hospital?
Through the daily routine.
So there is not enough time to engage with the patient. Time is money. And staff costs account for about 70% in the hospital.
In Germany, we spend 11% of our gross domestic product on health. This places us in the highest category in the OECD area, with Spain at 9%. But we must ask ourselves if the distribution is correct.
The great difficulty lies in the clear boundaries between ambulatory and hospital care. We need to significantly reduce these sectoral boundaries through networking and working with colleagues on the ground.
More ambulatory instead of hospitalization?
Yes, it will come. We treat much more stationary in Germany than in an international comparison. In Denmark, the length of stay of a hip prosthesis is three days, while in Germany it is seven to ten.
Look at Scandinavia
Denmark has another health system.
The Scandinavian countries are superior to us. By 2021, there will be more than 17 hospitals in Denmark and health centers with community nurses, doctors and therapists will be spread around him. However, the system can not be transferred to us one by one.
Denmark has 5.5 million inhabitants, the transfer of the system would indeed be difficult. Does Bertelsmann Stiftung suggest closing every second hospital in our country?
Yes and no The question is how many hospitals have come into existence. After the Second World War, it was thought that one or two hospitals would be needed in each county. Today, people are much more mobile. So we have dedicated Vaihingen again and reconsider Marbach. Markgröningen will remain the highly specialized clinic with patients nationwide. We did our homework. In the future, we will have approximately 1,500 acute care beds for 540,000 inhabitants in the district, Ludwigsburg and Bietigheim-Bissingen. Small houses become health centers or other medical facilities, the supply does not get worse. The city of Stuttgart, however, has about 635,000 inhabitants and 5,000 to 6,000 beds.
They contradict the Bertelsmann Foundation, which gives no future to small houses. Do not you want to chastise district councilors and mayors for whom every home is a factor in location?
Bietigheim has about 500 beds in the future, it is not a small unit, but an average unit of average size. We coordinated and distributed the drug and it works well. Otherwise, we would need a large hospital with 1,500 beds to supply. We do not want to concentrate everything in a big hospital. But I do not have to offer everything at every place.
The fundamental problem remains. There is no nurse. How do you control it?
We tried to relieve our caregivers with assistants, secretaries and logistical assistance. We must also do it in the future. The federal Minister of Health, Jens Spahn, can therefore come with his lower limits as he pleases: we do not have enough nurses. 13,000 host families are already open in Germany.
This is not only known since yesterday. Have you been silent for too long?
I've always publicly emphasized that social professions are designed to be less appealing. We need a social consensus on the fact that these professions have more value for us than before. This consensus must be obtained by politics. We are collectively bound and we can not pay more, which I do not want because we belong to a tariff unit. The tariff system and collective autonomy have brought us 75 years of social peace.
What must happen to make the professions more attractive?
We are talking about the accreditation of nursing to be grouped in another merit group with a master or a bachelor's degree. We cooperate with the Paracelsus University of Salzburg because there is a chair of nursing. You can do your bachelor and master, do your PhD and habilitate. We train our graduate and graduate nurses to stay in bed and not go to any organization. We will build a skills lab in Vaihingen. ,,,
,,, the replica of a station. ,,,
,,, with actors or simulators as patients. It's about building a team of doctors, nurses, therapists and helpers to work more hand in hand. We have not reinvented that either, Canada and Ireland have had it for a long time. In Germany, in the intensive care unit, the doctor and the nurse form a team, which we must also lead to normal service.