Health Care In Switzerland Research Articles

Impact of the Covid-19 pandemic on inpatient health care in Switzerland 2020-2021-A descriptive retrospective study using admission data of all Swiss hospitals.

As part of the Covid-19-restrictions in Switzerland, a federal ban on non-urgent examinations and treatments was applied to all hospitals during six weeks in spring 2020 ("spring lockdown"). The aim of this study was to comprehensively investigate the consequences of the Covid-19 pandemic on Swiss inpatient admissions based on data of all hospitals, focusing on selected procedures of different medical urgency. The study includes all acute care inpatient cases (including Covid-19 cases, excluding cases in psychiatry and rehabilitation) according to the Swiss Medical Statistics of Hospitals. Besides the total number of admissions, subdivided by regions, hospital types and age groups, we focused on selected procedures representing different medical urgency: elective surgeries, cancer surgeries, and emergencies. Procedures were selected based on expert interviews. We compared the number of admissions during spring lockdown and for the whole years 2020 and 2021 in absolute numbers and in percentage changes to the corresponding periods in 2019 (baseline year). During spring lockdown, the number of admissions decreased by 47,156 (32.2%) without catch-up effect by the end of 2020 (-72,817 admissions/-5.8%). With procedure-specific decreases of up to 86%, the decline in admissions was largest for elective surgery, a decline that was only fully reversed in the case of a few procedures, such as joint arthroplasty. Strikingly, admissions due to emergencies also substantially decreased during spring lockdown (stroke -14%; acute myocardial infarction STEMI: -9%, NSTEMI: -26%). Results for the selected procedures in cancer surgery showed no consistent pattern. In 2021, admission numbers for most procedures reached or even exceeded those in 2019. The substantial reduction in admissions, particularly in elective procedures, may reflect the impact of the triage in favor of anticipated Covid-19-cases during spring lockdown. By the end of 2020, admissions were still at lower levels relative to the previous, pre-pandemic year. The numbers in 2021 reached the same levels as those in 2019, which suggests that the Covid-19 pandemic only temporarily impacted inpatient health care in Switzerland. Long-term consequences of the observed reduction in admissions for emergencies and cancer surgery need to be investigated at the individual level.

SwissGenVar: A Platform for Clinical-Grade Interpretation of Genetic Variants to Foster Personalized Healthcare in Switzerland

Large-scale next-generation sequencing (NGS) germline testing is technically feasible today, but variant interpretation represents a major bottleneck in analysis workflows. This includes extensive variant prioritization, annotation, and time-consuming evidence curation. The scale of the interpretation problem is massive, and variants of uncertain significance (VUSs) are a challenge to personalized medicine. This challenge is further compounded by the complexity and heterogeneity of the standards used to describe genetic variants and the associated phenotypes when searching for relevant information to support clinical decision making. To address this, all five Swiss academic institutions for Medical Genetics joined forces with the Swiss Institute of Bioinformatics (SIB) to create SwissGenVar as a user-friendly nationwide repository and sharing platform for genetic variant data generated during routine diagnostic procedures and research sequencing projects. Its aim is to provide a protected environment for expert evidence sharing about individual variants to harmonize and upscale their significance interpretation at the clinical grade according to international standards. To corroborate the clinical assessment, the variant-related data will be combined with consented high-quality clinical information. Broader visibility will be achieved by interfacing with international databases, thus supporting global initiatives in personalized healthcare.

Towards an understanding of the digital transformation of facility management in healthcare: perspectives from practice

PurposeFacility management (FM) in healthcare is an organisational function that provides non-medical activities, ensuring operational functionality of critical health infrastructure. FM leaders are under pressure to implement the digital transformation, confronted with a highly complex and challenging operational environment. However, the current scope and understanding of the digital transformation in FM is rather limited, with a strong focus on technology. This perspective is inadequate to realise a digital transformation in healthcare organisations and requires a new framework. To ensure the practical applicability, a clearer depiction on how FM practitioners in the field, currently understand the digital transformation, is necessary.Design/methodology/approachA sequential exploratory mixed-methods design was chosen with a qualitative data collection and quantitative data analysis phase. A total of 23 semi-structured research interviews with professionals from FM in healthcare in Switzerland were carried out. Topic modeling was used to analyse, identify and cluster topics.FindingsIn total, nine distinct digital transformation topics were generated: ‘addressing future organisational and people needs’, ‘end-user-oriented processes’, ‘digitalisation management vs. digital tools’, ‘major organisational change’, ‘information exchange and work culture’, ‘digital systems’, ‘pressure’, ‘company-wide strategy’ and ‘management support and communication involving non-medical support services’. The findings indicate that FM practitioners perceive the digital transformation beyond the purely technological viewpoint, although they lack the know-how and instruments necessary to implement the digital transformation.Originality/valueThis study employs an innovative research design, resulting in foundational insights on how FM in healthcare perceives the digital transformation. As such, the study expands the notion on what the digital transformation means for the FM field.

Infection prevention practice in home healthcare: a mixed-method study in two Swiss home healthcare organisations.

Infection prevention and control (IPC) research has long neglected the home healthcare sector with its unique challenges. This study aimed to gain an understanding of the barriers to the implementation of infection prevention practices relevant to this setting, the related attitudes, perceived relevance and priorities from the home healthcare worker perspective in Switzerland. The mixed-method study involved semi-structured interviews (n = 18) and an anonymous web-based survey (n = 144) among nursing assistants and nurses from two home healthcare organizations in northwest Switzerland. Questions in both sub-studies focused on perceived challenges to infection prevention practices, perceived relevance, and related attitudes and mitigation strategies. Using an exploratory-sequential design, survey questions were designed to quantify and complement the findings from the interview study. Healthcare workers in these two organisations felt adequately protected, trained and supported by their organisations regarding IPC (survey agreement rates > 90%). General challenges to IPC in the home environment most agreed on were lack of cleanliness, lack of space, and the priorities of the patient to be respected (survey agreement rates 85.4%, 77.1%, and 70.8%, respectively). Practices and perceived challenges in the case of colonisation with multi-drug resistant organisms (MDRO) and potentially infectious diarrheal or respiratory illnesses varied highly regarding information transfer, use of protective equipment, and use and disinfection practices of multi-use equipment. Challenges to hand hygiene, sharps safety, waste management and decontamination of equipment did not feature as a prominent concern. This study is the first to characterise the implementation of infection prevention practices and the related challenges in home healthcare in Switzerland. Home healthcare workers describe various challenges related to infection prevention practices as largely manageable in their work routine, and generally show satisfaction with the support provided by their organisations regarding IPC precautions. Key findings regarding challenges amenable to interventions include uncertainty and inconsistency regarding the management of MDRO colonisation and acute illnesses, and gaps in information transfer. Those challenges may benefit from both organisational interventions and further research into the level of precautions that are appropriate to the home healthcare setting.

Evaluating the health and economic outcomes of a PCV15 vaccination program for adults aged 65 years-and-above in Switzerland

ObjectiveTo assess the health and economic outcomes of a PCV13 or PCV15 age-based (65 years-and-above) vaccination program in Switzerland.Interventions: The three vaccination strategies examined were:1)Vaccination with PCV13.2)Vaccination with PCV15.3)No vaccination (do-nothing alternative).Target population: All adults aged 65 years-and-above.Perspective(s): Switzerland health care payer.Time horizon: 35 years.Discount rate: 3.0%.Costing year: 2023 Swiss Francs (CHF).Study design: A static Markov state-transition model.Data sources: Published literature and publicly available databases or reports. Outcome measuresPneumococcal diseases (PD) i.e., invasive pneumococcal diseases (IPD) and non-bacteremic pneumococcal pneumonia (NBPP); total quality-adjusted life-years (QALYs), total costs and incremental cost-effectiveness ratios (CHF/QALY gained). ResultsUsing an assumed coverage of 60%, the PCV15 strategy prevented a substantially higher number of cases/deaths than the PCV13 strategy when compared to the No vaccination strategy (1,078 IPD; 21,155 NBPP; 493 deaths). The overall total QALYs were 10,364,620 (PCV15), 10,364,070 (PCV13), and 10,362,490 (no vaccination). The associated overall total costs were CHF 741,949,814 (PCV15), CHF 756,051,954 (PCV13) and CHF 698,329,579 (no vaccination). Thus, the PCV13 strategy was strongly dominated by the PCV15 strategy. The ICER of the PCV15 strategy (vs. no vaccination) was CHF 20,479/QALY gained. In two scenario analyses where the vaccine effectiveness for serotype 3 were reduced (75% to 39.3% for IPD; 45% to 23.6% for NBPP) and NBPP incidence was increased (from 1,346 to 1,636/100,000), the resulting ICERs were CHF 29,432 and CHF 13,700/QALY gained, respectively. The deterministic and probabilistic sensitivity analyses demonstrated the robustness of the qualitative results—the estimated ICERs for the PCV15 strategy (vs. No vaccination) were all below CHF 30,000/QALYs gained. ConclusionsThese results demonstrate that using PCV15 among adults aged 65 years-and-above can prevent a substantial number of PD cases and deaths while remaining cost-effective over a range of inputs and scenarios.

Exploring strategies for building a sustainable healthcare system in Africa: lessons from Japan and Switzerland.

Strengthening healthcare infrastructure is an important strategy for building a sustainable healthcare system in Africa. This involves investing in facilities, equipment, and supplies, as well as training and retaining skilled healthcare workers. Additionally, improving healthcare infrastructure and investing in healthcare education and training can lead to significant improvements in health outcomes, such as reducing maternal and child mortality. This is critical for building a sustainable healthcare system. Through a literature review, we assessed the approaches to building a sustainable healthcare system in Africa from the perspectives of Japan's and Switzerland's healthcare systems. It was discovered that Japan currently has the highest life expectancy, which can be attributed to insurance policies, healthcare policies, and the integration of emerging technologies and clinical research into their healthcare system. Lessons that Africa must emulate from the Japanese healthcare system include ensuring universal healthcare coverage, improving the workforce, improving primary healthcare, prioritizing the aging population, and investing in technology, infrastructure, and research. Japans healthcare system is also sustainable thanks to its stable workforce and primary healthcare. Switzerland also has an exceptional healthcare system globally, with technical and socioeconomic advancements leading to increased life expectancy and population aging through a worldwide health policy approach, programs tackling professional responsibilities and interprofessional cooperation, and initiatives to support family medicine. By learning from Japan's and Switzerland's approaches, Africa will gradually achieve the Sustainable Development Goals and build a sustainable healthcare system.

Digital health in perinatal care: Exploring usage, attitudes, and needs among Swiss women in urban and rural settings

Background Switzerland's healthcare system is known for its quality but faces challenges such as slow digitalization and fragmentation, especially in perinatal care. This study investigates Swiss women's use, needs, and attitudes in respect of digital health tools during pregnancy and postpartum, focusing on any differences between rural and urban populations. Methods A web-based cross-sectional survey targeted pregnant women and those who had given birth in the last 12 months. Participants were recruited through social media, and the data were analyzed using principal component analysis and multivariable regressions to explore factors affecting the use of digital tools and attitudes toward eHealth. Results A total of 1160 participants completed the survey. Healthcare professionals (92%) and private networks (77%) were the primary sources of information. Women expressed a strong preference for app features such as data access (73%), prescription management (73%), and scheduling appointments with healthcare professionals (71%). However, they also raised concerns about the impersonal nature of digital healthcare interactions (71%). Overall, rural women had more negative attitudes toward online health information seeking, which can be attributed to differences in education levels. Conclusion The findings indicate that while Swiss women in the perinatal period do utilize digital tools, they focus more on nonmedical topics such as tracking physiological development. The study underscores the importance of adapting digital health solutions to the specific needs of women in the perinatal period. Emphasis should be placed on developing applications that are not only informative but also empower women on their healthcare journey while ensuring data privacy and supporting personal interactions with healthcare providers.

What drives health care spending in Switzerland? Findings from a decomposition by disease, health service, sex, and age

BackgroundHigh and increasing spending dominates the public discussion on healthcare in Switzerland. However, the drivers of the spending increase are poorly understood. This study decomposes health care spending by diseases and other perspectives and estimates the contribution of single cost drivers to overall healthcare spending growth in Switzerland between 2012 and 2017.MethodsWe decompose total healthcare spending according to National Health Accounts by 48 major diseases, injuries, and other conditions, 20 health services, 21 age groups, and sex of patients. This decomposition is based on micro-data from a multitude of data sources such as the hospital inpatient registry, health and accident insurance claims data, and population surveys. We identify the contribution of four main drivers of spending: population growth, change in population structure (age/sex distribution), changes in disease prevalence, and changes in spending per prevalent patient.ResultsMental disorders were the most expensive major disease group in both 2012 and 2017, followed by musculoskeletal disorders and neurological disorders. Total health care spending increased by 19.7% between 2012 and 2017. An increase in spending per prevalent patient was the most important spending driver (43.5% of total increase), followed by changes in population size (29.8%), in population structure (14.5%), and in disease prevalence (12.2%).ConclusionsA large part of the recent health care spending growth in Switzerland was associated with increases in spending per patient. This may indicate an increase in the treatment intensity. Future research should show if the spending increases were cost-effective.

Enhancing Healthcare for Sarcoma Patients: Lessons from a Diagnostic Pathway Efficiency Analysis.

Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland's healthcare system, Europe's costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).

Use of electronic patient records and encrypted email patient communication among Swiss chiropractors: a population-based cross-sectional study

BackgroundThe implementation of electronic health information technologies is a key target for healthcare quality improvement. Among Swiss chiropractors, reliable data on the use of electronic heath information technologies and distribution of the health workforce was lacking.ObjectivesTo estimate the prevalence of electronic patient record (EPR) and encrypted email communication use among Swiss chiropractors and describe the geographic distribution of chiropractors in Switzerland.MethodsPopulation-based cross-sectional study of all active practising members of the Swiss Chiropractic Association (ChiroSuisse) between 3 December 2019 and 31 January 2020. We asked about clinician and practice characteristics, EPR use for clinical record keeping, use of encrypted email for patient communication, and information on EPR and encrypted email communication products used. Multivariable logistic regression analyses assessed the associations between clinician and practice characteristics and (1) EPR use, and (2) encrypted email use.ResultsAmong 286 eligible Swiss chiropractors (193 [68%] men; mean age, 51.4 [SD, 11.2] years), 217 (76%) completed the survey (140 [65%] men; mean age 50.7 [11.2] years). Among respondents, 47% (95% confidence interval [CI], 40–54%) reported using an EPR in their practice, while 60% (95% CI, 54–67%) endorsed using encrypted email technology. Chiropractors aged ≥ 60 (versus those ≤ 39) years were 74% less likely to use an EPR system (OR 0.26, 95% CI 0.08 to 0.77), while clinicians from practices with 4 or more chiropractors (versus those from solo practices) were over 5 times more likely to report EPR use (OR 5.6, 2.1 to 16.5). Findings for factors associated with encrypted email use were similar. The density of chiropractors in Switzerland was 3.3 per 100,000 inhabitants.ConclusionsAs of January 2020, 286 duly licensed chiropractors were available to provide musculoskeletal healthcare in Switzerland — just under 50% of responding Swiss chiropractors used an EPR system in clinical practice, while 60% used encrypted email technology. Better implementation of EPR and electronic health information technologies in Swiss chiropractic practice is possible and encouraged for the purpose of musculoskeletal healthcare quality improvement.

The Impact of COVID-19 on Mental Healthcare Utilization in Switzerland Was Strongest Among Young Females-Retrospective Study in 2018-2020.

Objectives: To provide a thorough assessment of the impact of the COVID-19 pandemic on the utilization of inpatient and outpatient mental healthcare in Switzerland. Methods: Retrospective cohort study using nationwide hospital data (n > 8 million) and claims data from a large Swiss health insurer (n > 1 million) in 2018-2020. Incidence proportions of different types of psychiatric inpatient admissions, psychiatric consultations, and psychotropic medication claims were analyzed using interrupted time series models for the general population and for the vulnerable subgroup of young people. Results: Inpatient psychiatric admissions in the general population decreased by 16.2% (95% confidence interval: -19.2% to -13.2%) during the first and by 3.9% (-6.7% to -0.2%) during the second pandemic shutdown, whereas outpatient mental healthcare utilization was not substantially affected. We observed distinct patterns for young people, most strikingly, an increase in mental healthcare utilization among females aged <20years. Conclusion: Mental healthcare provision for the majority of the population was largely maintained, but special attention should be paid to young people. Our findings highlight the importance of monitoring mental healthcare utilization among different populations.

Measuring workload of Swiss general practice: a five-yearly questionnaire-based survey on general practitioners' self-reported working activities (2005-2020).

General practitioners (GPs) play a key role in the delivery of health care in Switzerland. Assessing GPs' workload over time is essential to meet the population's health service demand and for future health care planning. The study involved four questionnaire-based cross-sectional studies among a representative sample of Swiss GPs on a five-yearly basis since 2005. Data on GPs' self-estimated workload and practice administration (face-to-face consultations, house calls, nursing home visits and clinical administrative work) were analysed in hours per week (h/week) or full-time equivalents (FTE; 100% = 55 h/week). The mean age of GPs (n = 2,037) in 2020 was 54.9 years, significantly higher than in 2005 (51.4 years, p <0.001, n = 1,780). The proportion of female GPs increased gradually from 16.5% in 2005 to 36.2% in 2020 (p <0.001). The GPs' workload significantly decreased over the last 15 years from 50.2 h/week to 43.4 h/week or from 90.9% FTE in 2005 to 78.9% FTE in 2020 (p <0.001). The decreased average workload across years was less pronounced in women (-4.4% FTE) than in men (-9.0% FTE, p = 0.015). Across all survey years, women worked on average 12.7 h/week or 23.2% FTE less than men (p <0.001). The time spent with patients gradually decreased, whereas the amount of time spent on clinical administrative work remained stable since 2005 (9 h/week). In 2020, GPs were working more frequently in group practices compared to 2005 (45.0% vs. 12.4%, p <0.001). This study demonstrates a decrease in GPs' overall workload from 2005 to 2020, indicating that the "new" generation of GPs prefers to work part-time. This decrease is at the expense of direct face-to-face encounters with patients. Over the last 15 years, a clear trend exists towards more women in the Swiss general practice, persisting over-ageing of GPs, replacement of single-handed practices by group practices, and increasing burden of administrative tasks, a risk factor for burnout and reduced job satisfaction. To maintain an efficient healthcare system in the future, substantial efforts are crucial to provide a positive and motivating insight into general practice to pre- and postgraduate students and improve the operational working conditions of GPs.

Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System.

Introduction:Switzerland’s fragmented healthcare system mirrors its federal structure and mix of cultures and languages. Although the Swiss have a higher life expectancy than most of their neighbours, their healthcare system faces similar challenges that call for more integrated care (IC).Aim/Method:This article aims to provide insight into the specificities of and latest developments in Switzerland’s healthcare system and how they may have influenced the development and implementation of IC there.Description/Discussion:The number of local IC initiatives has been growing steadily for 20 years. With a certain lag, various policies supporting IC have been established. Among them, a recent democratic debate on the federal mandatory health insurance law could either induce a radical move towards centralised support for IC or continue to support scattered local IC initiatives.Conclusion:In the future, Switzerland’s healthcare system will probably navigate between local IC initiatives and centralised, federal support for IC initiatives. This will be the reflection of a very Swiss way forward in a world without clear evidence on whether centralised or decentralised initiatives are more successful at developing IC.

Sustain and reinforce transition from child to adult mental health care in Switzerland: study protocol

Swiss Archives of Neurology, Psychiatry and Psychotherapy is an open access publication of EMH Swiss Medical Publishers Ltd. published in accordance with the terms of the Creative Commons licence attribution - NonCommercial - NoDerivatives 4.0 International.

Contributors to the development of intercultural competence in nursing students

Nurses deal more effectively with cultural diversity when they have an ethnorelative orientation toward cultural difference and commonality on the Intercultural Development Continuum, which was the theoretical framework of this study. Scholarly literature shows limited knowledge on what fosters nurses' intercultural development. Thus, this quantitative, retrospective study was the first investigation in health care in Switzerland conducted on nursing students' orientation on the Intercultural Development Inventory (IDI). The sample consisted of the IDI results from nursing students enrolled between 2010 and 2016 at the largest Nursing College in Switzerland (N = 1.112 students in 40 cohorts) where the systematic integration of the development of intercultural competence into the curriculum began in 2010. The aim was to examine to what extent the orientation toward cultural difference and commonality on the Intercultural Development Continuum of nursing students in Switzerland differs from the start- to the end-point of their nursing education. The paired samples t-test demonstrated a higher end of program developmental orientation (p = .01) compared to beginning developmental orientation scores, suggesting the program provided challenges that met the students' level of readiness for cultural development. Educators can use the knowledge provided in this study and implement intercultural competence as a central element within the curriculum following the example of the Nursing College included in this study.

Sustain and Reinforce the Transition From Child to Adult Mental Health Care in Switzerland : A Monocentric Nested Cohort Randomized Controlled Trial: The SORT Study.

Sustain and Reinforce the Transition From Child to Adult Mental Health Care in Switzerland : A Monocentric Nested Cohort Randomized Controlled Trial: The SORT Study.

Perinatal Mental Health Care in Switzerland

Perinatal Mental Health Care in Switzerland

The migration-related language barrier and professional interpreter use in primary health care in Switzerland

BackgroundWith increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential unmet needs for professional interpreters, using Switzerland as a case study.MethodsPrimary healthcare providers were invited nation-wide to participate in an online questionnaire on language barriers faced and interpreter use.ResultsMore than 90% of the 599 participants in this nation-wide cross-sectional study face relevant language barriers at least once a year, 30.0% even once a week. Using family members and friends for translations is reported as the most frequent resort for overcoming the language barrier (60.1% report it for more than 50% of encounters), followed by “using gestures” (32.0%) or just accepting the insufficient communication (22.9%). Minors interpret frequently (frequent use: 23.3%). Two thirds of physicians facing language barriers never have access to a professional interpreter, the majority (87.8%) though would appreciate their presence and approximately one quarter of these even see a cost-saving potential. Multiple consequences affecting quality of care in the absence of professional interpreters are identified.ConclusionLanguage barriers are relevant in primary care. Improved access to professional interpreters is warranted.

Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland.

We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013–2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD = 21.13) years for the Swiss patients and 39.70 (SD = 15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution, with a predominance of males. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%). SE patients of working age (16–65 years) were six times more often admitted by ambulance than older (≥65 years) SE patients, whereas this ratio was similar in the Swiss population. In both groups, the fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). We identified some indications for access to primary care in emergency departments for immigrants and highlighted the need for attention to the role of organizational characteristics of primary health care in Switzerland. We highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, we will need more primary care services and general practitioners with a migrant background.

Process Model for the Food Service in Swiss Hospitals

ABSTRACT Background Since the introduction of Swiss Diagnosis Related Groups in 2012, a Swiss hospital's core business requires Facility Management that provides more transparent, effective and efficient services. In that respect, the new remuneration system has caused a growing interest in processes. Food provision is of high importance since it is one of the costliest support services and is a critical image factor of a hospital. Purpose The purpose of this research was to analyse the food service processes in Facility Management in hospitals through the lenses of social, economic and ecological sustainability as well as hygiene and safety, and to identify which issues arise from each viewpoint for the respective sub-processes. Methodology A two-fold qualitative case study design was applied, based on the reference model theory Process Model for Non-Medical Support Services in Hospitals. First, based on focus groups, the process model was developed. Second, the model was validated by input from interviews with Facility Management professionals. Results Each sub-process requires the consideration of individual factors from the perspectives of sustainability, hygiene and safety. Similarly, various overarching factors were identified, such as the production method that impact not only a single sub-process, but also play a role in the whole catering process. Additionally, it became evident that food provision in hospitals is particularly affected by the conflicting priorities of cost-effectiveness and sustainability. Conclusion The outcome of this work is a model that allows a holistic process analysis of catering activities in hospitals since it takes into account social, economic and ecological sustainability, as well as both hygiene and safety aspects for the individual sub-processes. This research gives guidance to facility managers who strive for process optimisation to guarantee efficient and effective food provision in hospitals. Unique Value to the Body of Facility Management Knowledge This work applies established catering sub-processes in hospitals to the context of sustainability, hygiene and safety. The proposed model caters to the increasing interest in processes in healthcare in Switzerland and can presumably be applied to hospitals of other countries.