Friday, October 31, 2014

Guest blog: Mini-summit health care system

The “Mini-summits” entered the second round on September 11 on the topic of the “health care system”. Among the major challenges for health care professionals are the tension between an increasing cost pressure and the lack of public will to reduce health care services.

Organized by Prof. Sybille Sachs and Matthias Mölleney, these issues were discussed by: Dr. Leo Boos, partner at H Focus AG, Jeanette Bürki, former head of various hospitals, Andrea Dörig, head of the department of care of the hospitals Schaffhausen, Monika Eichelberger, director of long-term care of Schlössli Biel, Hans Groth, president WDA Forum St. Gall, Franz Schneller, consultant for health projects, Markus Stauffer, Co-Head of the Center for Health Care Management at HWZ and CEO of Wittlin Stauffer AG, Beat Stierlin, CEO of the hospital of Barmelweid AG, Dr. Tania Weng, head of the project “QualiCCare”, Dr. Peter Wittlin, Co-head of the Center for Health Care Management at HWZ and CEO of Wittlin Stauffer AG.

What new strategic challenges are arising for the health care system?

One new dimension for the health care system is economization. In the past, the efficacy of health care services has not been evaluated. People believed the treatment and care given by medical practitioners to be right and important. Today, the services of both doctors and the nursing staff are measured. Their actions have to be transparent and they have to take responsibility for the resulting costs. On the one hand, the health care system thereby gains public attention, which increases the responsibility of the authorities and politicians, e.g. in hiring leaders for public hospitals. On the other hand, the administrative workload of service providers has increased significantly. Filling out questionnaires and documenting individual care takes up 20 or 30 % of the time. It is unclear whether this has lead to an actual improvement of care services or to a reduction of costs. This system measures in tax points or in francs. Today, finances are an increasingly dominant part of health care systems. Besides medical practitioners and nurses they now form the third column in hospitals, thereby increasing the pressure on efficiency improvements for hospitals. As a consequence, in addition to technical efficiency improvements, hospitals face a continuing professionalization and more and more specialized work areas – thereby contrasting the traditional, sometimes still valid image of the profession as a calling.

A second topic is the demographic development of the society. People are getting increasingly old. In internal medicine, a majority of patients is now over 70. Chronically ill people are increasingly a challenge for the health sector. Rationalizing and limiting health care services is a social issue, which leads to the question of whom decides on these services and what value society is willing to attribute to health. The Swiss citizens have rejected any restrictions in the health sector so far. They are willing to pay a higher price for a specialized health care system. Patients themselves are unable to assess care services in detail: Polls show that 75% of respondents prefer specialists to decide on their procedures.

What does this imply for leadership?
With increasing job specialization, new links start to appear. The continuity of the 24-hour work shifts common in nursing is now also introduced in other areas, e.g. the physicians. Leadership issues play a larger role here. These particular, new connections have to be managed, and the individual actors in this multi-professional environment have to cooperate and be managed accordingly, which requires high social skills from a leader. He or she has to define the values and “non”-values, position him or herself as well as set boundaries. Crucial skills in this process are appreciation and attention, since the annual staff turnover in the health sector is over 20%. This turnover rate is especially problematic when it comes to leadership. Commitment implies continuity, and commitment is crucial for building trust and cultivating relationships. Leaders lead through their personality and reliability. They have to set a framework for people in order to give them an orientation. The aim of this, in the end, is to build a learning organization.

Thus it is important to put more energy into the question of how to keep good staff, rather than just acquire new people. Employees should identify with an institution, and therefore the work on relationships should be at center stage. Employees should also have the opportunity to contribute. Here, not everyone has to do the same thing; new models can be created as well. It is especially important in the health sector, with its high proportion of women that talented female leaders don’t have to leave an organization when they have children and want to work part-time. Promising models to solve this problem include job-sharing.

What do we gain from this for our leadership project?
The leaders of tomorrow have to learn how to keep the goal in mind and how to respond flexibly. They should lead with their whole personality and create an environment of learning. Complexities should be reduced, while the human being is at center stage and is fully appreciated. It is crucial in this process to cultivate relationships among the various specialized actors. Here, the aim should be to achieve even better things together with the various stakeholder groups.

Everyone agrees: Cultivating relationships can be learned, but the first step is to actually want it!

Gabriella Signer


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