Joachim Hasebrook

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal

Background University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine. Objective In order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life. Methods Structured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production (“industry 4.0”) because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts’ scenarios, consensus groups will be established in each university hospital trying to reach consensus about the implementation of relevant factors in order to improve employee retention. Results We expect these consensus groups to develop and introduce measures for more structured training procedures, individual and team incentives, organizational guidelines for better recruiting and retention in hospitals, models of flexible and attractive working conditions including shift work and vacation planning, and use of new learning tools (eg, tablet PCs and mobile phones). Conclusions All measures are implemented in the Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine at the University Hospital Muenster (UKM) with approximately 150 physicians and in the further 44 departments of the UKM and 22 teaching hospitals, which all together employ more than 5000 physicians. The measures will also be implemented at the university hospitals in Aachen, Rostock, and Greifswald. All decisions and measures will be discussed with representatives from hospital management and professional associations. Results will be presented at conferences and published in journals.

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design

Background All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe. Objectives The MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts. Methods We capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women’s academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on “personal construct theory” through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management. Results A discussion group on gender equality in academic medicine will be established on an internationally renowned open-research platform. Project results will be published in peer-reviewed journals with high-impact factors. In addition, workshops on gender dimension in research using the principles of Gendered Innovation will be held. Support and consulting services for hospitals will be introduced in order to develop a European consulting service. Conclusions The main impact of the project will be the implementation of innovative GEP tailored to the needs of university hospitals, which will lead to measurable institutional change in gender equality. This will impact the research at university hospitals in general, and will improve career prospects of female researchers in particular. Simultaneously, the gender dimension in medical research as an innovation factor and mandatory topic will be strengthened and integrated in each individual university hospital research activity. Research funding organizations can use the built knowledge to include mandatory topics for funding applications to enforce the use and implementation of GEP in university hospitals.

Growing Pains at Hospitals: Opportunities and Issues of Service Expansion in Maximum Care

Purpose Due to the demographic change morbidity raises the demand for medical hospital services as well as a need for medical specialization, while economic and human resources are diminishing. Unlike other industries hospitals do not have sufficient data and adequate models to relate growing demands and increasing performance to growth in staff capacity and to increase in staff competences. Method Based on huge medical data sample covering the years from 2010 to 2014 with more than 150,000 operations of the Department for Anesthesiology at the University Hospital Muenster, Germany, comparisons are drawn between the development of medical services and the development of personnel capacity and expertise. Results The numbers of surgical operations increased by 21% and “skin incision to closure” time by 17%. Simultaneously, personnel capacity grew by 16% largely resting upon recruiting first-time employees. Expertise measured as “years of professional experience” dwindled from 10u2009years to 5.4u2009years on average and staff turnover accelerated. Conclusion Static benchmark data collected at fixed reference dates do not sufficiently reflect the nexus between capacity and competence and do not reflect the dynamic changes in a hospital’s requirements for expertise and specialization, at all. Staff turnover leads to a loss of experience, which jeopardizes patient safety and hampers medical specialization. In consequence of the dramatic shortage of medical specialists, drop-off rates must be reduced and retention rates must be increased. To that end, working conditions need to be fundamentally converted for a multigeneration, multicultural, and increasingly female workforce.

Was erwarten Mitarbeiter der Notfallmedizin vom Telenotarzt

ZusammenfassungHintergrundIn immer mehr Regionen Deutschlands wird ein prähospitales Telemedizinsystem als Ergänzung der Regelversorgung eingeführt. Ein Telenotarzt kann von einer Zentrale aus mit Rettungsdienstmitarbeitern am Einsatzort in Echtzeit kommunizieren, diagnostisch unterstützen und therapeutische Maßnahmen delegieren. Die technische Machbarkeit und der medizinische Nutzen wurden bereits belegt. Für den dauerhaften Erfolg eines Telemedizinprojekts ist die Erwartungshaltung der Anwender essenziell. Diese wurde im Projekt Land/Rettung vor der Einführung einer Telenotarztanwendung erhoben.FragestellungWas erwarten die zukünftigen Anwender (Leitstellendisponenten, ärztliches und nichtärztliches Personal im Rettungsdienst und in der Notaufnahme) von der Einführung eines prähospitalen Telemedizinsystems?Material und MethodenIm Mai bis August 2017 wurde die Erwartungshaltung der Personen, die mit dem Telenotarzt zusammenarbeiten werden, mittels papierbasiertem Fragebogen erhoben.ErgebnisseEs wurden 411 Personen kontaktiert, die Rücklaufquote betrug 51,6u202f%. Die Mehrheit der Befragten stimmte den Aussagen zu, dass das Telenotarztkonzept zu einer schnelleren Diagnosefindung und einem schnelleren Therapiebeginn führe und die Qualität der Patientenversorgung verbessere. Eine Verbesserung der persönlichen beruflichen Leistung sowie Reduktion der Arbeitsbelastung und des Dokumentationsaufwands werden (eher) nicht erwartet. Der Großteil der Befragten hält das Telenotarztkonzept für (eher) sinnvoll.DiskussionDie Mitarbeiter in der Notfallmedizin erwarten eine verbesserte Patientenversorgung durch die Einführung eines Telenotarztes. Persönliche Vorteile wie Arbeitserleichterungen werden nicht erwartet. Zusammenfassend wird das Telenotarztkonzept als sinnvoll erachtet.AbstractBackgroundThere is axa0trend in Germany to add telemedicine, e.u202fg. in the terms of axa0tele-emergency doctor, to the existing medical emergency system. Axa0tele-emergency doctor can support paramedics at the emergency site via axa0secured real-time connection while assessing vital signs. Technological feasibility and medical benefit of the system were already proven. But to ensure the long-term success of axa0telemedical project it is important to evaluate expectations of future users. In the Land/Rettung Project expectations of future users were accessed preceding the implementation of axa0tele-emergency doctor.ObjectivesWhat do future users (emergency dispatchers, paramedics, prehospital emergency doctors and doctors and nurses working in an emergency department) expect from axa0tele-emergency doctor?Materials and methodsThe expectations were accessed in May to August 2017 with axa0paper-based survey conducted among future users.ResultsA total of 411 persons were approached (response rate 51.6%). The majority of respondents agreed that the tele-emergency doctor leads to axa0faster determination of diagnosis, faster start of therapy and increased quality of patient care. Most future users did not anticipate an improved job performance, decreased workload or decreased documentation effort. The majority agreed, at least partly, that the tele-emergency concept is beneficial.ConclusionsMembers of the medical emergency system expect the tele-emergency doctor to improve patient care. Personal advantages, e.u202fg. decreased workload, are not anticipated. Overall, the tele-emergency system was perceived as useful.

Sektorübergreifender, lebensphasenorientierter Kompetenztransfer: Was Krankenhäuser von anderen Branchen lernen können

Trotz vieler wirtschaftlicher Anstrengungen ist die Investitionslucke in deutschen Krankenhausern auf den Rekordwert von fast 27 Milliarden Euro gewachsen. Wahrend Fallzahl und -schwere mit dem Durchschnittsalter der Patienten/-innen ansteigen, wird die Personallucke immer groser: Bis zu 400.000 Pflegekrafte fehlen bis 2030. Als Auswege werden wirtschaftlicheres Management, mehr Industrialisierung und Digitalisierung im Krankenhaus sowie die Ubernahme erfolgreicher Modelle aus dem Ausland gefordert. Wie gehen andere Branchen erfolgreich mit Entwicklung und Sicherung von Kompetenzen uber alle Lebensphasen hinweg vor? Lassen sich ihre Erfolgsmodelle auf deutsche Krankenhauser ubertragen? Bedrohen am Ende mehr Wirtschaftlichkeit die Patientensicherheit und die Qualitat der Versorgung? Das vom BMBF geforderte Projekt „FacharztPlus: Arztliche Kompetenzkontinuitat im Krankenhaus“ geht diesen Fragen nach und hat dazu in anderen Branchen und Landern nach Antworten gesucht.

Berufs- und Tätigkeitsmigration in der Dienstleistung: Beschäftigungswandel und lebensphasenorientierte Kompetenzanpassung durch Digitalisierung

In diesem Beitrag werden wissenschaftlich fundierte Prognosen zur Berufs- und Tatigkeitsmigration durch Digitalisierung fur die Branche der Dienstleistung naher untersucht und kritisch gewurdigt. Der Finanzwirtschaft als eine Teilbranche, die aktuell einem besonders starken Strukturwandel unterworfen zu sein scheint, wird dabei spezielle Aufmerksamkeit gewidmet. Anhand branchenspezifischer Studien wird herausgearbeitet, welchen Anpassungsbedarf die Digitalisierung in dieser Branche auslost, in welcher Form mit einem Beschaftigungswandel in der Finanzdienstleistung zu rechnen ist, und was dies fur lebensphasenorientierte Personalarbeit bedeutet. Es werden Handlungsempfehlungen abgeleitet, wie dieser Wandel und insbesondere erforderliche Kompetenzanpassungen aktiv gestaltet werden konnen.

Lebenslang kompetent: Lebensphasenorientiertes Kompetenzmanagement zwischen Anforderung und Überforderung

In diesem Band geht es um die Verbindung von Lebensphasen des Menschen und die Entwicklung seiner Kompetenzen vor allem im betrieblichen Umfeld. Als Kompetenz wird die Fahigkeit verstanden, in unklaren oder problemhaften Situationen erfolgreich handeln zu konnen. Nur mit einer berufsbegleitenden, in den Arbeitsprozess integrierten und professionell unterstutzten Kompetenzentwicklung konnen Leistungs-, Beschaftigungs- und Handlungsfahigkeit im gesamten Erwerbsleben gesichert werden. Dazu werden neue Modelle der Arbeitsorganisation, Konzepte fur eine lebensereignisorientierte Personalpolitik und Strategien fur ein unternehmensspezifisches Kompetenzmanagement benotigt. In diesem Kapitel werden das Konzept der Lebensphasen diskutiert und die einzelnen Buchbeitrage kurz vorgestellt.

Lebensphasen und internationale Karriere: Bildungswege und Arbeitsmigration Hochqualifizierter

Bereits 72 % der deutschen Unternehmen haben die Auslandsentsendung ihrer Mitarbeitenden ausgebaut, die Tendenz ist weiter steigend. Viele dieser Unternehmen setzen auf „Hauskarrieren“ und verringern damit die Chancen fur den internationalen Quereinstieg. Hochschulabsolvierende sind zunehmend an internationalen Karrieren interessiert und wahlen daher Grosunternehmen als Arbeitgeber, da ein Aufstieg dort wesentlich einfacher erscheint. Auslandsentsendungen nehmen zwar auch bei kleinen und mittleren Unternehmen (KMU) zu, werden aber aus Kostengrunden immer fokussierter und kurzer. Zudem haben KMU Nachteile gegenuber Grosunternehmen durch weniger Produktsparten, Standorte und Karrieremoglichkeiten sowie einen geringeren Gestaltungsspielraum bei weiteren wichtigen Rahmenbedingungen. Der Beitrag zeigt besondere Karrierepotenziale, die KMU gegenuber Grosunternehmen durch individuelle und flexible Karriereangebote und den gezielten Aufbau einer internationalen Arbeitgebermarke nutzen konnen.

Improving female physician's careers in academic medicine: Chances and challenges.

University hospitals are involved in the care of critically ill patients, pregraduate and postgraduate education, and medical research with an increasing demand on physicians due to a higher burden of disease. The number of female physicians is increasing; however, young female physicians are less willing to work at university hospitals under the given conditions. They often do not find appropriate working conditions in mostly hierarchically structured university hospitals. Institutional structures involuntarily erect barriers against the recruitment, retention, and career progression of women. Gendered working conditions remain firmly fixed, and this is even more challenging - overt discrimination has been replaced by less visible mostly implicit stereotypes and prejudices against women. Having children is an additional career stopper for female physicians: those with children are less likely to be promoted and have a lower income. Regulatory measures should act in several directions: cultural gender equality policies, family support policies, and active work policies.

How Anesthetists Manage Growing Demands with Dwindling Resources in German University Hospitals: Overview and Outlook

As a central service provider in medical care, anesthetists manage the growing demand on medical services, thereby increasing specialization and patient morbidity. Various indicators and measurements have been used to match staff capacity, competence, and workload. It remains unclear whether the problems are due to real shortages or just to a wrong distribution. Medical services, service development, infrastructure, capacity, and competences of medical staff of 15 departments of anesthesiology at German university hospitals were compared. They reported an increase in medical service and staff capacity. Competences did not grow, fluctuation rates were high, and part-time employment increased. The broad variety of hospitals infrastructures requires different staff capacity and competence structures. Anesthetists need to take on a key role in redesigning hospital performance and staff management to ensure performance increases, patient safety, and bearable workloads. Optimal distribution of expertise and early counteraction for shortages in staff capacities and competences is needed.