Abstract
BackgroundDuring the last two decades the German hospital sector has been engaged in a constant process of transformation. One obvious sign of this is the growing amount of hospital privatization. To date, most research studies have focused on the effects of privatization regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Yet little attention has been devoted to the effects of privatization on physicians' working routines. The aim of this observational real-time study is to deliver exact data about physicians' work at hospitals of different ownership. By analysing working hours, further impacts of hospital privatization can be assessed and areas of improvement identified.MethodsObservations were made by shadowing 100 physicians working in private, for-profit or non-profit as well as public hospital departments individually during whole weekday shifts in urban German settings. A total of 300 days of observations were conducted. All working activities were recorded, accurate to the second, by using a mobile personal computer.ResultsResults have shown significant differences in physicians' working activities, depending on hospital ownership, concerning working hours and time spent on direct and indirect patient care.ConclusionThis is the first real-time analysis on differences in work activities depending on hospital ownership. The study provides an objective insight into physicians' daily work routines at hospitals of different ownership, with additional information on effects of hospital privatization.
Highlights
During the last two decades the German hospital sector has been engaged in a constant process of transformation
Hospitals were grouped into three main ownership types: (1) public hospitals run by the local authorities, the towns and the "Länder"; (2) private, voluntary, non-profit-making hospitals run by churches or non-profit-making organisations; (3) private, for-profit hospitals run as free commercial enterprises
An average of 36 minutes was spent on rest periods in private, for-profit hospitals (CI 95% = 0:32:22 h to 0:39:42 h), 22 minutes in public hospitals (CI 95% = 0:19:47 h to 0:25:21 h) and 27 minutes in private, nonprofit hospitals (CI 95% = 0:24:21 h to 0:30:44 h)
Summary
During the last two decades the German hospital sector has been engaged in a constant process of transformation. Little attention has been devoted to the effects of privatization on physicians' working routines The aim of this observational real-time study is to deliver exact data about physicians' work at hospitals of different ownership. Hospitals must compensate for declining public financial resources [5] For these reasons, reforms have been adopted in recent years, causing restrictions on the funding situation and an initial increase in competition among health services providers [6,7]. Reforms have been adopted in recent years, causing restrictions on the funding situation and an initial increase in competition among health services providers [6,7] Objectives such as effectiveness, appropriateness, quality and cost-effectiveness as well as patient involvement gained an increasing importance and shaped the behaviour of health care providers and payers [5]
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