Consideration of AMBIENT ASSISTED LIVING as a strategic approach of the hospital management in view of the challenged hospital sector

Bachelorarbeit von Christina Engler

Introduction:

Hospitals in Germany:

On 25th September 2008 a crowd of more than 130.000 people, ‘armed’ with oriflammes and severe faces, filled the streets in Berlin. Clinical staff members from all over Germany congregated to demonstrate for a reform of the compensation system. This is just one of the banner headlines that underline the current state of things: The German health care system is marked by a lasting and fierce political discussion, discontent and insecurity of the participators, cost pressure and challenges within the provision of care and health services. Successful stories are rather rare than standard.

Hospitals, as service providers of the stationary sector, play a main role within the political discussion of expenses improvement and reorganisation in the health care system. The next chapters will give an overview challenges the hospitals are exposed to and their enjoined legal and socio-economic requirements.

An important sector in transition:

The German hospital territory is in motion. Already in the 80s started a surge of redeployment and reformation in the health care sector. An undisputable flash point is foremost the demographic and society change. Due to the improvement of medical treatment, common wealth and a healthier attitude towards lifestyle the life span is prolonged. For example in the period of 1950 until 2007, the average expectancy of men’s life increases by 10,7 years and for woman by almost 15 years. Furthermore in the same year, while the birth rate declines, the Federal Statistical Office assumes that the number of 60year-old citizen will be twice than the newborns. In combination with a boost of chronic diseases, growing demands and pretensions for medical treatment and costs of the technical improvement, these drivers generate an immense cost pressure and a lack of financing within the health care system. Not for no reason the German hospital environment is marked by a disproportionate increase in cost and financing bottleneck.

Because of a high portion of cost (34 percent) in relation to the total expenditure within the health care sector, hospitals take centre stage of legal deregulation efforts.

Referring to this fact a new accounting system for hospitals was adopted. In 2002 the DRG (Diagnosis Related Groups) system displaced the old one with a performance-oriented allowance instead of settling the length of stay, case-based lump sum, extra recompense and budgets. The transparent performance presentation and ‘capped” budgeting lead to an efficient commitment of resources. Therefore hospitals are forced to position themselves more as a company in a competing environment. To act in an economically way implies process orientation while protecting the quality and meeting the patients´ needs and demands. Hereby the efficiency rule affects the performance disposition of the stationary sector.

Additionally the Health Modernisation Act, which came into effect on 1st January in 2004, affords organisation, cooperation and economy incentives. The act allows a flexible form of contract between performer and health insurance companies. New forms of provision, like the integrated supply, amplify the possibilities of performance and may disintegrate the ‘Great Wall of China’ between the stationary and the ambulatory sector.

All in all the hospitals are spoilt for choice to accept the ongoing transition including new legal conditions and requirements and use them as base of their performance disposition in the field of competition. These ones those are able to react adequately and apace, according to the circumstances, have the chance to avoid or minimize financial shortages and sustain their competitive position in the long run.

Prevailing exigencies of the hospital management:

The competition increases, hospitals consolidate or become privatised and if the worst comes to the worst they do not survive the merciless reconditioning of the hospital sector. Taking the right measures is indispensable.

Strategic thinking concerns with the question how to generate competitive advantage. Simplified, it bases on an analytical examination of strengths and weaknesses as well as opportunities and threats and devises hereby the dynamic of the competitive environment (by e. g. SWOT analysis).

Retrospectively the term ‘strategy” played an underpart in hospitals, because the planned economy aspects prevailed. But to deal with the mentioned circumstances it´s important to develop strategies and evaluate strategic instruments.

There does not exist a consistent definition of the term ‘strategy’, but Hansmann outlines it comprehensible:

‘A strategy is the embodiment of topics relevant for competition and corporate-policy conditions in order to build up durable competitive advantages’.

Therewith a strategy is a long-term creation and maintenance of potential for success. It contains an accurate plan of procedures allowing for influencing factors in future and even more it´s based on a vision respectively overall concept that helps to react appropriate towards the competitive course of action.

Concerning hospitals this means a formulation of the approach towards legal and competitive conditions by the hospital management. Questions like the following may help to point out the requirements referable to a strategy: What is the focused area and target audience the hospital wants to address with the service offer? Which profile is allocated to the hospital and what should be invested?

The strategic management devises, on the base of the attained consolidated findings, recommendations for exhausting the opportunities and upgrading the existing strengths. On the other hand it is necessary to concept the cutback of weaknesses likewise certain defence measure concerning evaluated risks.

The management has to ensure the conversion of fixed targets, communication and definition of operative courses of action. Consequently it is enjoined to improve functional competences like strategic planning, business development, strategic controlling as well as developing human resources and marketing activities. But if the strategy isn’t internalised in all core processes and become a firm component of the corporate mindset and activities, the success will be marginal or is a long time coming.

All in all the achievements of a hospitals management rather of a hospital itself is bound to celerity, sustainability, sufficient qualified personnel, transparent approach, acceptance within the company and political support.

CONTENT:

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CHAPTER 4.1.2, SYSTEM PROPERTIES:

Due to the technical concept all system properties are affected as well. In some cases time notably appoints the quality of the treatment via telemonitoring. This fact contains, for example, the transfer rate of the measured and analysed parameter, the processing time itself till release of alert or simply the time per measurement and expenditure of time a day, which in turn partly influences patients` acceptance of the application.

Another system property is the security concept. Nowadays the pervasion of all areas of life with information and communication technologies is checkless. For example, the digitalisation, transfer and utilisation of patient data are standard, but acknowledges especially in this case the data privacy protection a most fundamental importance. However the electronic communication is promoted to increase quality and efficiency within the health care sector as well as causing cost savings. Further it is intended to improve the communication between institutions and to optimise their performance.

Concerning patient data the data privacy protection accompanies as a fundamental requirement, which is regulated by common data protection regulations like the Federal Data Protection Act. In case of telemedicine, aroused by modified technical conditions, partly new data protection concepts are required. Because within the telemonitoring process a lot of private data in strict confidence are transferred partly via mobile communications and therefore may generate insecure interfaces with the danger of third party access as well as abuse of data. Finally, concerning this fact, legal requisitions are in force for every telemonitoring solution, which lead to criminal liability in case of nonobservance. Thence a security concept (e.g. codification of data, firewall etc.) including the compliance of these legal guidelines is indispensable.

According to the mentioned security aspects the used network takes centre stage. As well as quality and security of data transfer the time management within the telemonitoring process is influenced by the chosen network, but usually the choice of networks is limited to the IT infrastructure of the application area.

Furthermore the interaction of all components, the applications mode of action and electric power supply carry weight on the performance of the solution. The energy consumption is an important aspect concerning costs and patients handling, farther mobility and acceptance. In this regard the averaged hours of application usage need to be examined.

Summing up following indicators could be considered exemplary in context of the system properties:

averaged transfer rate of data, averaged time per measurement, level of variability of network usage, level of data codification, averaged access of third party, averaged hours of application usage.