Fragmentation Of Case Management In German Hospital Departments

Background Strategic goals of hospitals are positive results in quality, safety, efficiency, and effectiveness of care. This is intimately linked to case management performance on the hospital wards (CM).Methods For analysis of the micro and macro processes of the inpatient case management, a structured interview inventory was invented. This was followed by a field investigation with the interview inventory as a community-based participatory research (CBPR) on homogeneous focus groups of 24 German public hospital departments with maximum care, which act as profit centers from an economic perspective.Results With the CBPR field study of 24 tertiary referral hospital departments of maximum care, 1,682 micro processes of case management on hospital wards could be detected and assessed. The study shows that all departments conduct a comprehensive clinical case management on the hospital wards. However, the micro processes of the CM are neither carried out optimally to minimize costs nor to maximize liquidity, income, or quality of care. The study also shows that the professional cross-grouping in carrying out the processes of CM by doctors and nurses in the studied departments is associated with a substantial fragmentation of the CM.Conclusions The intense fragmentation of activities and sub-processes of the CM on hospital wards suggests the development of strategies to homogenize the processes especially regarding the control of treatment processes of the inpatient case management.