Hospital Federation Research Articles

Belgian Integrated Health Record (BIHR): from 2025, all well-being and health data will be available for all members of the care team, including the patient himself. 

•Why are you conducting a workshop? Please explain the problem, the context, or the case study,
 It would be an absolute added value for the BIHR-project to also hear the voice and opinion from other countries and experts: what went very smoothly? But also, what obstacles were they confronted with and how did they tackle these challenges.
 •Who is it for? Please explain who you would like to engage with.
 BIHR is a ‘Moonshot’: the expert group defined four major groups that are essential to bring BIHR to a successful project: the citizens, the healthcare providers, the various governments, and partners from the industry.
 In the panel debate we would like to have representatives from those different stakeholders around the table.
 It would also be an absolute added value to hear success stories from other countries and see if things could be realized in Belgium in the short and/or medium term.
 •Ilke Montag, MD, MSc: lead of the Belgian expert panel about BIHR 
 •Jan De Maeseneer, MD, PhD: Head of WHO Collaborating Centre on Family Medicine and Primary Health Care - Ghent University Belgium
 •Bart Van den Bosch, MD, PHD: CIO at University Hospital Leuven Belgium
 •A representative of the European Patients Forum (European Patients' Forum - Home (eu-patient.eu))
 •A representative of the International Hospital Federation (Home - IHF - International Hospital Federation (ihf-fih.org))
 •Someone who can explain the concept and the functioning of EHRs in the Canadian Primary Health Care Services
 •Someone who can explain the concept and the functioning of Slovenian Community health centers with multidisciplinary teams 
 •What are you going to do? Please explain the structure of the session. Please remember that workshops’ objective is to be interactive and engage with the audience - At least ½ of the time should be based on the interaction with the audience. 
 •How are you going to engage with the audience?
 •How are you going to summarize the take home messages?
 We will start with a short 15 min. presentation/introduction of the concept of BIHR. Afterwards, the moderator asks for a short reflection on this concept by the various panel members. The panel members are then asked to name both a success story and the lessons learnt from less successful projects. To involve the public in the debate, statements for debate will be used, each time from a unique perspective (citizens, care providers, governments, industry). The panel members will be confronted with the voting results on the statements. 
 The take home message will be a compilation of the success keys cited by each of the panel. There will also be a warm appeal to work together not only across the various levels in health care, but also across national borders.

Gaß: ‚Deep intervention in the hospital landscape‘

Back in February of this year, the German Hospital Federation (DKG) submitted a comprehensive structural and financing proposal to the current debate on a major hospital reform in Germany. As Federal Health Minister Karl Lauterbach and the government commission he had appointed had presented a comprehensive reform concept for hospitals in Germany, but neither the government commission nor the Federal Health Minister had presented a concrete impact analysis, the DKG commissioned the research institute Institute for Health Care Business (hcb) in cooperation with Vebeto to carry out such an analysis.

Does cost minimization of hypofractionated radiation therapy content all health stakeholders?

Does cost minimization of hypofractionated radiation therapy content all health stakeholders?

Analysis of risk factors for dropping out of residency in orthopedics and trauma surgery

Currently, there are no data available on dropouts from residency programs and changes of clinic in orthopedics and trauma surgery (O&T). The aim of the study is to identify personal and structural risk factors leading to dropout or switching of postgraduate training in O&T in order to present solution strategies. Anationwide anonymous online survey was conducted among residents in O&T in summer 2020. Official mail addresses were identified via the Traumanetzwerk© of the DGU and the German Hospital Federation (n = 2090). Aquestionnaire (51questions) was administered using SurveyMonkey (San Mateo, CA, USA). All residents who worked in O&T for at least 1month in the 6years prior to the start of the survey (from 07/2014) were eligible to participate. Abinary logistic regression was calculated to identify the risk factors. The significance level was p = 0.05. Of the 221 respondents, 37% switched hospital and 5% dropped out altogether. The regression revealed 3significant risk factors for switching hospitals. Living in apartnership (p = 0.029, RR: 2.823) and less than 2days of shadowing before the start of residency (p = 0.002, RR:2.4) increased the risk of switching. Operating room (OR) allocation of residents according to the training plan/status (p = 0.028, RR: 0.48) reduces the risk of switching. Significant risk factors for leaving postgraduate training could not be determined (insufficient number of cases, n = 11). Switching the hospital and residency dropouts in O&T are arelevant problem (42%). Gender has no significant influence. Tools such as longer job shadowing, as well as OR allocation according to the training plan/status can minimize the risk of switching.

Integrative Model Of Organizational Behavior In The Perspective Of Organizational Citizenship Behavior Through Organizational Commitment And Employee Engagement Of Patient Safety’s Implementation Toward Health Workers In Hospitals For Handling Covid-19 Ba

The International Hospital Federation and the International Society for Quality in Health Care have presented data on "Health Services Patient Safety: A Priority with Multiple Dimensions including a first look at the impact of COVID-19", that the major gap in the implementation of patient safety during the pandemic has an impact changes from aspects of safety culture 28%, crisis management 26%, external measurement & evaluation 23%, staff physical and mental safety 11%, quality & safety all along the continuum of care 6%, and also facilities' infrastructure 6%. The orientation performance of hospitals is undoubtedly influenced by the variable determiner of the hospital's performance, so this study aims to: "analyze and measure the integrative model of organizational behavior in the perspective of organizational citizenship behavior through organizational commitment and employee engagement on the application of patient safety health workers in hospitals for handling Covid-19." The study population was all over the health worker, which measures in the construction, a totally of 267 respondents, with a purposive sampling technique as the sample population. The data were analyzed using Structural Equation Model (SEM). The software used for the structural analysis is LISREL version 8.7 for Student, and for a descriptive study using SPSS version 23. The research proves that: Servant Leadership, Patient Safety Culture, Work Team Characteristic, Emotional Ability on OCB and Organizational Commitment has a significant effect; Servant Leadership, Patient Safety Culture, Work Team Characteristic, Emotional Ability on OCB through the Organizational Commitment has significant Effect; Servant Leadership, Patient Safety Culture, Work Team Characteristic, Emotional Ability on OCB through the Employee Engagement has significant Effect. Pursuant to the result of this study is suggested that management of hospital in order to have a concern of patient safety in COVID-19 related events, so that application of patient safety`s vision which is " Every patient receives safe health care, every time, everywhere" can be reached.

Healthcare and Leadership Competencies, Training Methods, and Venues

Healthcare systems and health organizations are amongst the most complex and ever-changing human and social enterprises. All countries in the world are involved in various phases of health reforms to expand access, improve quality, and/or control costs. The choice of which structures to use for public and private healthcare initiatives, including Public-Private Partnerships (PPPs), is influenced by economic factors. A high level of professionalization is needed throughout the different levels of these multidisciplinary establishments to ensure effective management. In some healthcare delivery models, increased attention has been given to the significance of quality assurance in higher education and professional leadership development of clinician and healthcare managers’ teams. The International Hospital Federation (IHF) has been involved in efforts to characterize healthcare management competencies and create tools to ensure that healthcare managers and organizations can be more aware of their strengths and aspects needing improvement. We provide an overview of the IHF competencies as well as what training methods and venues are available to help promote professional development of healthcare managers.

Pediatric hospital care organization: Cross-sectional enquiry in four regions in France

ObjectiveThe aim of this study was to characterize conventional pediatric care capacities in French public hospitals and identify the main difficulties in guiding upcoming health policies. The secondary objective was to assess the quality of care by the implementation of the European Charter of the Rights of Children in Hospital. MethodMulticenter cross-sectional study using a questionnaire survey sent by e-mail to the heads of conventional pediatric departments in four French regions identified on the French Hospital Federation's website. The survey was conducted between 25 September and 25 October 2018. ResultsFifty-six of 113 heads of departments participated in the survey. The mean annual number of admissions per unit in 2017 was 2066 (SD, 1433), with a median length of stay of 2.7 days (range, 1–10). Children were admitted up to age 18 years in 76% of the departments, and 83% of the departments had an individualized pediatric emergency department. The nurse care load was very high, specifically during the night shift (9.5 patients/nurse). Inpatient education and academic teaching were unavailable in 38% of the departments. Overall, 89% of department heads declared knowing the European Charter of the Rights of Children in Hospital, and a copy of it was posted in all units in 57% (95% confidence interval, 44–70) of the services/departments. At all times and in all departments, parents were allowed to be with their children, and for 34% (95% CI, 21–47) of the departments, an accommodation for parents was available close to the hospital. ConclusionPublic hospital pediatric departments lack sufficient medical and nonmedical caregivers. Department heads were well aware of the European Charter, and it was well disseminated but should be updated to address today's challenges in pediatrics. An area of improvement would be to include parents in their child's care more effectively.

Zurück zur Struktur? Zur gegenwärtigen und zukünftigen Gewährleistung stationärer Gesundheitsversorgung

The article analyzes regulatory structures in German public health law in the light of the pandemic. It focuses on the responsibility of the welfare state to provide access to hospital treatment. While the public law corporations that finance statutory health insurance, keenly argue in favor of centralization and specialization, others, including the German Hospital Federation, prefer regional planning and highlight the importance of sufficient hospital bed capacity. The German hospital sector is characterized by a mixture of public, private for profit and charity-based hospital owners who provide hospital treatment. The state and independent public law corporations guarantee equal access to healthcare via statutory health insurance. For historic reasons, there is a highly complicated system of “self-administration”, in which representatives of doctors and hospitals are given the power to “regulate themselves” in cooperation with public law health insurance fonds. Non-medical staff, especially nursing staff, is not represented in this system, which explains why their interests tend to be ignored. Additionally, the German Bundesländer (states) have the power to determine hospital capacities, usually understood as bed capacities, via hospital plans. Over the last two decades, the German hospital financing system was fundamentally changed by the introduction of diagnosis related groups (DRGs), potentially causing hospital owners to prioritize profit over patient care. The article examines the legal framework of hospital planning as well as the latest developments in hospital financing and quality assurance and argues against the idea that the health care sector should be shaped by market competition rather than planning.

Knowledge of Medication Safety among Dentists in Saudi Arabia

International Journal of Pharmacology and Clinical Sciences,2021,10,1,28-33.DOI:10.5530/ijpcs.2021.10.5Published:March 2021Type:Research ArticleAuthors:Yousef Ahmed Alomi, Fouzia Abdul Karim Bukhary, Tawfik A. M. Khoja, and Rahmah Abdulilah Alsinan Author(s) affiliations:Yousef Ahmed Alomi*, BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE, Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor and Data Analyst, Riyadh, Saudi Arabia. Fouzia Abdul Karim Bukhary, BDS. King Abdul Aziz University, SBARD (MOH ) Consultant of Advanced Restorative Dentistry, MOH, Makkah, SAUDI ARABIA. Tawfik A. M. Khoja, Prof of Public Health – Imperial College – London, Family & Community Medicine Consultant, General Secretary of the Arab Hospital Federation, Deputy Chairperson of Arab Public Health Association, SAUDI ARABIA. Rahmah Abdulilah Alsinan, B.D.S, Ramclinics, East Province, SAUDI ARABIA Abstract:Objectives: The present study aimed to affirm the dentist’s knowledge of medication safety in the Kingdom of Saudi Arabia. Methods: It is an analysis of a cross-sectional survey that conferred dentists’ knowledge of medication safety in Saudi Arabia. Selfreported an electronic survey of dentists, comprising dentists from internship to the consultant, dental specialisms in Saudi Arabia. The survey contained respondents’ demographic information about dentists and knowledge information of designated medication safety elements, and the resources of knowledge of medication safety elements in dental care. The 5-point Likert response scale system was employed with closed-ended questions. The data analysis of the dentist’s knowledge of medication safety is completed through the survey monkey system. The statistical package of social sciences (SPSS), Jeffery’s Amazing Statistics Program (JASP), and Microsoft excel sheet (version 16) were used in the study. Results: The total number of responding dentists was 242, with the mainstream of them coming from the central region 95 (39.26%) with statistically substantial among the areas (p<0.05). Of those, 144 (59.75%) were male, while 97 (40.25%) were female, with statistically significant between them (p<0.05). The total average scores of dentist knowledge of medication safety in dental care were 2.78 with high scores element, knowledge of the high alert medication in dental care was 3.48, consider the Medication Errors (MEs) as a sentinel event (3.25), and familiar with medications reconciliation in dental care (3.23). The most resources employed for medication safety for dental care were health practitioners [129 (54.20%)] and scientific literature [118 (49.58%)]. The reliability test was evaluated in McDonald’s ω (0.955) and Cronbach alpha (0.955). Conclusion: The dentist’s knowledge of medication safety was insufficient in the kingdom of Saudi Arabia. Targeting training and education of dental medication safety during undergraduate and postgraduates school of dentistry is highly suggested to improve patient’s safety in dental care in Saudi Arabia. Keywords:Dentists, Experiences, Knowledge, Medication safety, Saudi ArabiaView:PDF (215.63 KB) PDFClick here to download the PDF file. Images Knowledge of Medication Safety among Dentists in Saudi Arabia

Impact of a Swiss pressure ulcer prevention breakthrough collaborative.

Pressure ulcers may have severe impacts on the quality of life of patients, including pain, low mood and restrictions in performing daily life and social life activities. In Switzerland, 4% of patients develop hospital-acquired pressure ulcers. Six hospitals teamed up with the Vaud Hospital Federation (Switzerland) in a Breakthrough Collaborative, with the goal of reducing hospital-acquired pressure ulcers by 50%. The aim of this study was to assess the actual reduction. A multimodal set of interventions was deployed in all wards except obstetrics and gynaecology, over 18 months starting in October 2016, including systematic risk assessment, use of a prevention bundle, education through e-learning, measurement and feedback, patient engagement and promotion of a safety culture. All six hospitals monitored compliance with the use of the risk assessment, bundle application and patient involvement aspects. A safety calendar was implemented in all wards, for recording and visually displaying the numbers of new patients with pressure ulcers, as well as the presence of such ulcers upon admission and their category. Compliance with performing Braden risk assessments rose from 39% at baseline to 61% by the end of the collaborative (P < .001), prevention bundle compliance from 2% to 30% (P < .001%) and documented patient engagement from 2% to 21% (P < .001%). The percentage of days where one or more patient was reported as having developed one or more pressure ulcers in the ward decreased from 8.21% to 4.18%, a 49% reduction (P < .001) which amounts to preventing 1124 new patients from developing one or more pressure ulcers during the collaborative. The Breakthrough Collaborative using a multimodal improvement approach combined with measurement and feedback was associated with a statistically and clinically significant improvement in compliance to best practice and with a reduction of hospital-acquired pressure ulcers by half.

Why, what and how do European healthcare managers use performance data? Results of a survey and workshop among members of the European Hospital and Healthcare Federation.

Objective of this study was to better understand the use of performance data for evidence-based decision-making by managers in hospitals and other healthcare organisations in Europe in 2019. In order to explore why, what and how performance data is collected, reported and used, we conducted a cross-sectional study based on a self-reported online questionnaire and a follow-up interactive workshop. Our study population were participants of a pan-European professional Exchange Programme and their hosts (n = 125), mostly mid-level hospital managers. We found that a substantial amount of performance data is collected and reported, but could be utilised better for decision-making purposes. Motivation to collect and report performance data is equally internal and external, for improvement as well as for accountability purposes. Benchmarking between organisations is recognised as being important but is still underused. A plethora of different data sources are used, but more should be done on conceptualising, collecting, reporting and using patient-reported data. Managers working for privately owned organisations reported greater use of performance data than those working for public ones. Strategic levels of management use performance data more for justifying their decisions, while managers on operational and clinical levels use it more for day-to-day decision-making. Our study showed that, despite the substantial and increasing use of performance data for evidence-based management, there is room and need to further explore and expand its role in strategic decision-making and supporting a shift in healthcare from organisational accountability towards the model of learning organisations.

Perspectives on Developing Healthcare Managers in Africa: The Strathmore Business School's Healthcare Management Programme.

A substantial shortage of qualified healthcare professionals in Africa continues, but it is now apparent that professionally trained healthcare managers are an equally important need. Health facilities in Africa typically promote physicians into the role of general manager, but physicians and their lay counterparts routinely admit to being ill-prepared for roles as leaders of health systems, healthcare facilities and other services. Few, if any, degree programmes for healthcare management—be they master's in hospital administration or specialized MBA programmes— are available in these regions. And while many master's in public health programmes exist, inclusion of healthcare management content is often an afterthought. This article presents a prototype programme that was designed to address this gap. This comprehensive healthcare management MBA programme that was established at the Business School of Strathmore University in Nairobi, Kenya in 2013 was built around the “Leadership Competencies for Health Care Managers” as promulgated by the International Hospital Federation. The article further presents the development, structure and innovations of the programme, thus providing a blueprint for the development of similar programmes throughout the continent, aimed at addressing the substantial shortage of professionally trained healthcare managers.

Development and Use of the Leadership Competencies for Healthcare Services Managers Assessment.

Healthcare management as a profession continues to evolve as the field of healthcare delivery becomes more complex. In some countries, formal degree programs in healthcare management and related professional associations have helped to establish the field as a distinct profession with a defined body of knowledge. In other countries, the professionalization of healthcare management has not developed, or is in the early stages of development. Many of these Low and Middle Income Countries (LMIC) have no formal training programs or professional associations to help set and define minimum standards and competencies for the profession. In many countries, national associations have been created by healthcare managers for sharing knowledge, information, and expertise. While major differences exist in the contexts where healthcare managers operate around the world, all have a common responsibility to enhance the leadership and managerial capacity and capability of their membership as well as promote the profession they represent. In spite of these efforts by national professional organizations and various ministries of health, healthcare management has not been universally recognized around the world as a profession. The Leadership Competencies for Healthcare Services Managers (Global Competency Directory) framework developed by the International Hospital Federation's global consortium for healthcare management serves as a catalyst and resource for defining the skills, knowledge, and abilities needed for the healthcare management profession. This article documents the purpose, development, validation, and use of the framework.

Beyond the Bifurcated Myth: The Medical Migration of Female Korean Nurses to West Germany in the 1970s.

This study investigates beyond the bifurcated myth of the medical migration of Korean women to Germany in the 1970s, which is known as the "German dispatchment" myth from the Korean perspective and the "development aid" discourse from that of the Germans, by focusing on the newly-released documents from the German Hospital Federation (Deutsche Krankenhausgesellschaft, DKG). The migration was essentially a transfer of labor from a weak to a strong state, and the disparity of state strength characterized the nature of the recruitment mechanism. Both Korea and Germany have romanticized the labor transfer and appropriated the collective experiences of migrants for their own political purposes. In this transnational business, the Korean Overseas Development Corporation (KODCO) and the DKG maintained exclusivity in the labor migration channel and were faithful to their own interests. The DKG, as a representative of the German healthcare industry, was concerned about being criticized for destroying the healthcare system of developing countries by stealing their skilled workforce. They, therefore, tried to influence publicity in Korea and Germany to persuade the people that the recruitment benefited both countries. However, the DKG was aware of the deceitfulness of its "development aid" discourse. The Korean government, which advanced the labor export for the sake of obtaining foreign currency, romanticized it as patriotism and used the term "German dispatchment." However, the incapacity and corruption of KODCO as an agency from the Korean perspective resulted in criticism regarding its recruitment program. The DKG complained that the selection of incapable personnel coupled with corruption was causing unforeseen financial damage to its member hospitals. Nevertheless, it officially defended its partner for the sake of its own interests, such as avoiding bad publicity and securing the sustainability of the recruitment program. The conflicts regarding nursing tasks and working conditions between Korean nurses and their German colleagues and employers captured in the documents of the DKG trace the origin of the issues in relation to cultural misunderstanding and pervasive racism. The disparity of state strength between the two countries resulted in the subaltern position of Korean female healthcare workers in the global labor market, and they tried to bring forth the best possible outcome while working in a foreign country in unfamiliar circumstances. However, the difficulties with female guest workers from Asia were generally credited to their inability to adhere to the German working style. This study contributes to the existing scholarship on this topic by filling the gaps. Historical research on the medical migration of Korean nurses and nurse-aides to West Germany has relied on limited historical sources. In 2013, the National Archives of Korea transferred official documents regarding these workers that were produced and archived by the DKG, which represented the interests of German healthcare institutions. Its documents on Korean nursing personnel provide supplementary information and display findings in different perspectives. They do not bring forth completely new findings that have never been researched before but are still valuable for delivering concrete evidence on the circumstances of that time, which were previously merely inferred.

Descriptive Analysis of Patient Misidentification From Incident Report System Data in a Large Academic Hospital Federation.

Patient misidentification continues to be an issue in everyday clinical practice and may be particularly harmful. Incident reporting systems (IRS) are thought to be cornerstones to enhance patient safety by promoting learning from failures and finding common root causes that can be corrected. The aim of this study was to describe common patient misidentification incidents and contributory factors related to perioperative care. We retrospectively analyzed IRS data reported by healthcare workers from a large academic hospital federation from 2011 to 2014. All patient misidentification incidents that occurred during perioperative care were reviewed and classified using the international classification for patient safety taxonomy. Incident type, contributory factor, error type, and consequences for the patient and for the organization were extracted for each incident report. Among the 293 reported incidents, the most frequent errors were missing wristbands (34%), wrong charts or notes in files (20%), administrative issues (19%), and wrong labeling (14%). The main contributory factors included the absence of patient identity control (30%), patient transfer (30%), and emergency context (8%). Data on patient and institutional consequences were scarce. Events of missing and wrong identities on wristbands were rarely detected when patients were transferred from the admission ward to the operating room or the radiology department. These results illustrate that misidentification errors are still common in France. This work contributes to enhancing interest in IRS data analysis to define or refine patient safety improvement strategies related to misidentification errors in healthcare institutions.

Cross-Border Care and Cooperation

IntroductionThe movement of health professionals and patients and has highlighted appeals for better coordination of health systems and policies across the EU. Yet the absolute numbers of patient mobility within the EU remain relatively small, in some cases the most appropriate and accessible care happens to be in another Member State (Bertinato et al., 2005). Where phenomenon does take place it raises complex questions about its impact for health systems, patients, and health professionals. In 2011 the European Union decided to tackle issue on the legal platform.1.The Directive on Patients' Rights in Cross-border HealthcareThe health systems of the EU State Members are a key component of the Union's high levels of social protection, and contribute to social justice. Although each and every EU country is responsible for ensuring its citizens the access to health care, based on the national rules, patient mobility within EU State Members is a growing phenomenon.It is truth that most citizens prefer to be treated near their own homes, in their native language, and with familiar procedures, but some groups of patients may decide to be treated abroad if it offers some advantage (WHO, 2014). Among these groups are:- temporary visitors abroad who travel for work and for leisure,- people who retire to another country,- citizens in border regions,- people going abroad on their own initiative,- patients sent abroad by their home systems.Although the absolute level of patient mobility within EU is still relatively low, the most accessible or appropriate care for certain groups, such as people living in border regions, may be in another EU Member State. It makes cross-border patient mobility within European Union high on the agenda.In March 2011, the Council and the European Parliament adopted the Directive on Patients' Rights in Cross-border Healthcare. It was to provide a clear legal framework and to clarify the mechanisms involved in providing cross-border care (European Council, 2011). One can read that this Directive aims to establish rules for facilitating access to safe and high-quality cross-border healthcare in the Union and to ensure patient mobility in accordance with the principles established by the Court of Justice and to promote cooperation on healthcare between Member States, whilst fully respecting the responsibilities of the Member States for the definition of social security benefits relating to health and for the organisation and delivery of healthcare and medical care and social security benefits, in particular for sickness (European Council, 2011).In 2013 the Directive 2011/24/EU was transposed into national law. These legislative changes that clarified patient entitlements to cross-border care, are very likely to have important impacts on national and EU-wide policies.2.Main objective and results of PGHS 2015 projectAlthough patients mobility across EU, especially across Poland and Germany, is not intense, there are challenges for communication and continuity of care between health professionals for those patients who do receive care abroad. The financial aspects of the patient flow constitutes also fundamental issues in cross-border cooperation. These problems there among those that have been addressed by the project entitled German Health Summit 2015 (PGHS, 2015). It was a joint initiative, undertaken by the academic and business organizations, namely University of Szczecin, University of Greifswald, German Hospital Federation and Polish Hospital Federation.The project brings together experienced researchers from Poland and Germany, as well as business people who are active in the field of health care. It engaged altogether 86 scientists and managers, who attended 8 hours of scientific content delivered by 25 speakers. Among hot topics, transposition of the EU Cross -Border Care Directive was particularly interesting. …

What can we learn in future from the data of the German Arthroplasty Registry (EPRD) in comparison to other registries?

The German Arthroplasty Registry (EPRD) was founded in 2010 and has been in full operation since 2014. Previous attempts at a systematic data collection of elective and non-elective knee and hip replacement in Germany failed mainly because of the long-term lack of funding. The EPRD is an interdisciplinary collaborative partnership between the German Association of Orthopedics and Orthopedic Surgery (DGOOC), all implant manufacturers of the German Medical Technology Association (BVMed), health insurers (AOK and the Association of Additional Healthcare Insurance) and hospitals (German Hospital Federation). As part of this cooperation a worldwide unique implant database has been set up, which includes all relevant components and a detailed description of implant specifications. This implant library enables a detailed evaluation of implant survival, revision rates and possible inferior implant performance of knee and hip replacements in Germany. At the end of 2015 the EPRD encompassed over 200,000 registered operations. Due to the high number of hip and knee arthroplasties in Germany with many different implants from different manufacturers there will be a rapid growth of data that are available for a national and also international comparison of the results.

Integrated health care delivery in Oncology using ‘Comprehensive Cancer Networks’

Introduction: In late 2013, 9 stakeholders, including the Dutch Federation of University Hospitals (NFU), the Dutch Hospital Federation (NVZ), and Top Clinical Hospitals (STZ), announced their plan to optimize delivery of oncology care in the Netherlands. In order to do so, cooperation among hospitals and between hospitals and primary care practices, in so-called ‘Comprehensive Cancer Networks’ (CCN), is to be intensified. The goal is to offer patient centered, high quality, efficient care, under increasingly cost-sensitive (e.g. competitive) circumstances. These networks should be fully functional by the end of 2015 and the NFU is said to invest an annual 2 million euro’s in their realization. In a practical sense, the CCN’s are advised to organize their care delivery based on existing regional situations. Health care providers are to agree on division of labor, standardization, diagnostics, follow-up, and referrals. However, these existing regional situations, especially in terms of division of labor among organizations and referral patterns, are unclear. Therefore, we seek to contribute to the question how oncology care is currently, informally, organized, by exploring organizational relations through patient referral networks in the Netherlands. Methods: We use over 1.3 million medical claims to build patient referral networks among secondary care providers of roughly 385 thousand oncology patients between 2008 and 2011 in the Netherlands. Using Social Network Analysis techniques, we built networks of referrals within 3, 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117092– http://www.ijic.org/ 6, and 9 months after initial diagnosis. We focus on four different tumor types, namely breast tumors, prostate tumors, colon tumors, and gynecological tumors. We characterize these patient referral networks based on network level characteristics such as the existence or absence of price competition and the types of organizations active in the network, and ode level (i.e. organizational level) measures such as centrality, density, reciprocity, and the number of cliques. Next, we statistically compare these characteristics across and within each tumor type to explore differences, and the development of referral networks over time. Results and Conclusions: We find that structures of the referral networks for oncology care differ between tumor types. Although academic medical centers play a central role across all tumor types, the role of top-clinical hospitals, general hospitals, and independent treatment centers differs depending on the tumor type. For most tumor types referrals predominantly flow towards university hospitals, for others, most notably prostate tumors, referrals are more equally distributed between different organization types. It is noteworthy that referrals can occur up to 9 months after the initial diagnosis and that most referrals are unreciprocated. That is, when a patient is referred to another medical center, they are seldom referred back to the original hospital (for example for post-surgical care). Especially the lack of such reciprocated ties shows potential for improvement through constructing CCN’s. We conclude that the existing care situation does not always match the CCN goals and we therefore advise that these networks should be critically assessed during the formalization of network structures.

Impact of a Swiss adverse drug event prevention collaborative.

The Hospital Federation of Vaud (Switzerland) used a Breakthrough Collaborative with the aim of reducing adverse drug events (ADEs) by 20% in 10 participating hospitals. A set of interventions (covering patient identification, high-alert medication and medication preparation in the ward) was deployed over 18 months starting in October 2010. All hospitals monitored discrepancies between drugs prescribed and those prepared for administration, as well as the occurrence of ADEs using the ADE Trigger Tool for 18 months (cohort 1). A subset of five hospitals continued this monitoring for 12 additional months (cohort 2). In cohort 1, pill box discrepancies were present in 5.9% of doses (n = 9772) in 2011 and in 5.8% (n = 2251) in the first 3 months of 2012 (no statistical significance). There were no significant differences in the rate of ADEs/1000 doses across time (1.2 in 2010, 1.0 in 2011 and 1.0 in 2012). In cohort 2, pill box discrepancies were reduced from 6.5% (n = 4846 doses) in 2011 to 4.4% (n = 7355) in 2012 (P < 0.001) to 3.0% for the first 3 months of 2013 (n = 2251; P = 0.004). The rate of ADEs/1000 doses decreased (1.8 in 2010, 1.1 in 2011 and 0.6 in 2012/13 (P = 0.008 for 2010-2011, and P < 0.001 for 2011-2012/2013). Reductions in drug discrepancies and ADEs occurred in the cohort with the longer monitoring duration. Factors contributing to success may include the strategic status of the project, executive support, perseverance in post-intervention measurement, and institution-wide rather than partial deployment.

Interview with Thomas C. Dolan, PhD, FACHE, CAE, President and CEO, American College of Healthcare Executives

Thomas C. Dolan, PhD, FACHE, CAE, is president and CEO of the American College of Healthcare Executives (ACHE). He previously served as ACHE's executive vice president. Prior to joining ACHE, he held various teaching, research, and administrative positions at Saint Louis University, University of Missouri, University of Washington, and University of Iowa. Dr. Dolan has chaired the American Society of Association Executives (ASAE), Association of University Programs in Health Administration, Association Forum of Chicagoland, Board of Overseers of the Malcolm Baldrige National Quality Award, and Institute for Diversity in Health Management. He has also served as president of the Mental Health Association in Missouri and on the board of trustees of Alexian Brothers Hospital in St. Louis. Dr. Dolan is president of the International Hospital Federation (IHF) and serves on the Association Committee of 100 of the U.S. Chamber of Commerce. Dr. Dolan has been listed on Modern Healthcare magazine's 100 Most Influential People in Healthcare list each year since its inception in 2002. He is a recipient of the Key Award from ASAE and the Samuel D. Shapiro Award from Association Forum. Dr. Dolan is a Fellow of both ACHE and ASAE. He earned his doctoral degree from the University of Iowa and his bachelor's degree from Loyola University Chicago. He was awarded ACHE's 2013 Gold Medal Award in the Nondelivery Healthcare Organizations category. The Cold Medal is ACHE's highest honor bestowed on outstanding leaders. The purpose of this award is to identify Fellows of ACHE who best exemplify leadership at the organizational, local, state/provincial, and national levels. The Gold Medal Award recognizes individuals who go beyond the confines of their own organization to continually contribute to the improvement of healthcare services and community health. Dr. O'Connor: Congratulations on being a recipient of the 2013 Gold Medal Award and on your upcoming retirement! The award is certainly well deserved and truly reflects your many achievements. In your mind, what stand out as the more significant accomplishments that you and ACHE have achieved for the field of healthcare management? Personally, what are you most proud of having accomplished? Dr. Dolan: Over its 80-year history, ACHE has made many significant contributions to our health system. Having the privilege of working here for 27 years has given me the opportunity to have an impact in the areas of diversity and inclusion, ethics, lifelong learning and the FACHE[R] credential, and the ACHE chapters initiative. To date, my greatest contribution has been in the area of diversity and inclusion. When I became CEO in 1991 we weren't asking our members about their ethnicity, but I felt it was important to find that out. Following our initial collection of those data, we conducted a study comparing the career patterns of our members. We found what we expected: that discrimination in career opportunities existed. Since that time we have tried to address this issue within the field. This, I believe, is the greatest contribution I have been involved in. More so than ever, I am a big proponent of the FACHE credential. In the 1970s, 88 percent of our new members had a graduate degree in health administration. Today, less than 50 percent do. A lot of bright people are entering the field out of general business, medicine, nursing, and other disciplines, but they do not have that foundation in health administration. The FACHE credential, while not comparable to a master of health administration degree, at least assists them to be effective healthcare leaders. Furthermore, the number one reason people join ACHE is for the knowledge we impart through our educational programs and publications. This is an organization that is dedicated to lifelong learning. I am also very proud of our chapter initiative. We started chapters nine years ago; today we have 81 chapters, which held nearly 1,000 events in 2012 that were attended by more than 54,000 people. …