Staff change at Charity: Karl Max Einhäupl, long-time CEO, is retiring, his successor comes from Göttingen. Heyo Kroemer is facing great challenges.
Mr. Kroemer, Charity is considered difficult to govern because of its size and complex structure. Are you impressed by your new job here in Berlin?
Heyo Kroemer Fear may not be the word. I respect a task in an environment that I need to know better. But I'm looking forward to the task. Charity is an exceptional institution.
You were head of the University Hospital Göttingen, before that of Greifswald. What else is different in Berlin?
All. It starts with the city that carries this university hospital. And the institution itself is different, with its size, its history, with the people who work there. And there is an absolutely unique environment in Berlin for biomedicine in Germany.
Do you see prospects that you can develop with this environment and reach the international summit?
It's less a question of growth. But thanks to the interaction and collaboration, a lot can develop. From the outside, though, it seemed like something was missing in the past. On the other hand, there is almost nothing in the metropolitan area of biomedicine that does not exist. Many groups are at a very high international level. Thanks to the competition of excellence, Charité and the universities have managed to give an innovative impulse to the Berlin research area with its aspect of great challenges and the question of what should the future society look like.
Charity has a very positive image. She often wins awards as the best hospital in Germany. Is the university hospital really up to your reputation?
The quality of an institution must always be evaluated externally. The performance in the rankings is very satisfactory in this respect, as is the success of the strategy of excellence. Always make sure that the reality is as congruent as possible with the call. This must be worked on continuously.
In what areas is Charity really scientifically excellent?
I can only really judge when I saw more and spoke to the people involved. For example, in neuroscience, diseases of the nervous system, there are excellent people. In oncology, very good vocations have been realized. There are outstanding groups in the field of immunology. Still in the field of cardiovascular medicine, exquisite services are provided with the German Cardiac Center. The cooperation with the Max Delbrück Center has resulted in a series of very good projects. in the institute of Nikolaus Rajewski, for example, in unicellular genomics, world leader. This technology is on the threshold of health care and has huge potential in cooperation with Charity.
Where do you see your greatest challenges?
I like to subdivide the challenges into two groups: some are external and therefore difficult to influence. The others are internal because we have an influence as an institution. On the external front, from my point of view, the main challenge is the demographic change that will occur over the next few years, with the shortage of skilled labor that is undoubtedly occurring. Currently, we are making rapid progress in almost all areas of medicine, which are generally very expensive. This creates a problem. More seniors need medical services, but at the same time there are fewer contributors and, most importantly, the number of people who can provide medical and care services. The combination of demographic change and advances in medicine will certainly be a challenge for our health system.
Why is medicine making such progress right now?
The discoveries of molecular biology arrive massively in clinics. There are a variety of new antibodies or cell-based therapies. New analytical methods are allowing more and more real agents to move from the genetic level to the proteins responsible for the disease. At the same time, digitization allows the recording and processing of very large amounts of data, which allows for a better understanding of therapeutic approaches.
Back to external challenges.
The second challenge, which limits academic medicine in Germany, is the current system of remuneration through lump sum payments. Germany is the only country in the world that treats its university clinics in the same way as any district hospital with respect to the reimbursement of clinical benefits. The lump sum system does not at all reflect the fact that, for example, a Charity must provide a completely different infrastructure. As a result, all university hospitals in Germany are under enormous economic pressure. If the funding system lasts for another ten years, it will no longer be the type of academic medicine we know today and the importance of it for the health system.
Will there still be 3000 beds in Charity ten years after the end of the Kroemer era?
You can not predict that. It depends on the future organizational structure of health care in general and their funding. These points are difficult to predict. Here is an example: when a new building was planned in Göttingen in 2008, it was predicted that due to the mobility of drugs, only half of the beds would be needed. Today, eleven years later, the 1,450 beds in Göttingen are still fully occupied and the current planning of the new building takes this into account. In this regard, I hold back with long-term forecasts.
But you should work with Vivantes. It has always been said that Vivantes should be simplified, the appendix and Charity being the most complicated cases.
I have a fundamental belief: there is no easy solution to complicated problems. And the medical care in a big city is extremely complicated. Crystal Clear is the unusual starting situation. Unlike Hamburg, Berlin did not sell its group of municipal hospitals. This is why 42% of all hospital beds are in public hands. If we use this initial structure intelligently, this can lead to attractive models. At the international level, there are many examples of how university and non-university hospitals work together. The goal must surely be that patients, who arrive largely from Berlin and its surroundings, receive excellent care in public hospitals.
His predecessor, Karl Max Einhäupl, has always said that Charity must have many beds to allow scientists to access many patients. Would access also be extended to Vivantes patients?
With an appropriate information technology that would be conceivable. If we had computer systems that allowed access to data for 42% of all hospital beds in Berlin, taking into account all aspects of data protection, this would offer great opportunities and would constitute a interesting option in the context of the aforementioned cooperation. It is important to use digitization in the interest of the common good. Digitization does not serve to dismantle jobs, but to the possibility that in the hospital of the future more people can take care of the well-being of the patient.
It was one of the great successes of Mr. Einhäupl to have Charity financially in black. Is it always an objective on your part?
This is a remarkable achievement, especially as the country has made enormous savings. No one can promise a black market forever, and health care conditions are too unpredictable. In this respect, a financial advantage can not be a requirement as a priority objective of the company. But if we do not produce a balanced result as a university clinic, we have a very difficult argument in politics. We will therefore do our utmost to avoid any deficit and hope much of the political support needed to improve the framework conditions.
The Mitte bed stands. What are the most urgent infrastructure issues that you need to solve with an investment?
The country intends to provide 1.4 billion euros over the next few years. There is a master plan. On this basis, the idea had to be further developed, how the four sites could be created first in terms of content and then structurally sustainable.
Some disciplines should be concentrated in Steglitz, others in Virchow?
The main purpose of homes is to take care of patients, so you can not take away some basic offers somewhere. But to develop individual locations more pronounced than before, I think it's very conceivable. It is useful in the political debate that Charity can present strategic ideas for each place.
They built or planned new hospital buildings in Greifswald and Göttingen. Do you go to Berlin without this new building? Historic sites may not be suitable for a modern and efficient hospital operation.
I find it an idea to abandon everything that exists and build on the unrealistic green meadow. I guess we will continue to develop the four sites in a targeted way, also combining the existing infrastructure and the new buildings.
Charity is regularly criticized by the data protection officer, it does not correctly manage patient data. Is it possible in these circumstances to realize the great vision of personalized medicine that is very intensive in data?
Data protection is a very high quality in the field of medicine and is absolutely necessary. This requires a digital infrastructure that was not always available in Charity. Here it will be essential to invest. If such a system were to be available in the near future, the question arises as to what we do with the data then available, for example in the field of research. Access to care data would provide a unique insight in progress. The data is there, we do not use it.
Does it also help you solve another problem of Charity? Many bills are not recognized by health insurance because the benefits are not documented properly. As a result, Charity misses several million euros each year.
I do not think it's a problem specific to Charity. It is clear that collection and therefore documentation of clinical services is much better if these services are fully digitized. There is room for improvement here. However, there is also a structural systemic problem: with the medical services of health insurance, we are now in unhealthy hospitals in unhealthy competition. In this area, a kind of control industry has become largely independent, so many of the services provided are neither recognized nor remunerated.
Charity is also working on the reorganization of the University Center of Cardiology. The Faculty Council opposes the original solution of organizing the heart center as a separate GmbH. How do you want to meet all expectations?
Firstly, it should be noted that this university center of cardiology is a unique opportunity for Berlin, which we should absolutely use. Here, it is possible to create a competitive structure internationally and for Berlin and its environment, the latest therapies available in the field of cardiovascular diseases. All participants in the discussion expressed themselves this way. We must therefore thoroughly analyze the interests of all parties involved, define their content precisely, and then determine the form of organization by consensus of the partners. In any case, the heart center is an extremely important future project.
A major problem for all hospitals is the shortage of skilled workers, especially in nursing. What can you do to have more nurses?
We can not consider such a monocausal problem. Of course, we need more conventional caregivers, which we also need to pay better. But at the same time, we need to redefine the relationship of the medical professions to each other. Tasks performed by doctors in this country are carried out by nurses trained academically in other countries. The joint structure planned by Charity and Vivantes for joint training in the health professions could give a significant boost here.
Do you still have a wish for the city, namely the Senate and the Berlin society?
No other large company, and including Charity, regardless of its academic responsibilities in research and teaching, is as dependent on the policy as a university hospital. I would therefore like to see positive long-term support for the development of charity through politics, as it currently happens through the mayor's governor and his secretary of state, for the Berlin company.
Heyo Kroemer (59) came to Göttingen to go to Berlin. He was Dean of the Faculty of Medicine and Director General of the University Medical Center. When he died in July, politicians in Lower Saxony declared that he was passionate about the place. Kroemer comes from East Friesland. From 1978 to 1983 he studied pharmacy at TU Braunschweig. He obtained his doctorate in Stuttgart and was qualified in 1992 in Tübingen. From autumn 1998, he was professor of pharmacology and toxicology at the University of Greifswald. He became dean of the faculty of medicine in 2000 and finally scientific director of the university medical center in 2011.
The boss of Charity Einhäupl stops – an inventory
This is what the new boss Heyo Kroemer has in mind with Charity