Germany

• A rapidly growing private hospital corporation; it buys public hospitals (complete with operating licenses) and under contract to the State (Region/Lander) delivers a full range of public hospital services as defined in the operating licence
• The group now owns and operates 46 hospitals across Germany, it tends to focus on small to medium hospitals but recently has bought its first teaching hospital
• Its philosophy -  “cutting-edge medicine for everyone”
• Its strategy – “continuity in change” by which it means: 
  • growth in its mainstay area of acute inpatient healthcare
  • applying advances in technology and process optimisation as well as the expansion of medical services networks across all its sites
  • extending the foundation of its business model by bringing about closer integration between outpatient and inpatient care
  • establishing high-quality, affordable and at all times reliable healthcare delivery
• The company is adept at achieving a high degree of synergy between its workforce, the care processes and the capital assets (buildings and technology)
• Considerable emphasis is placed on clinical governance:
  • Auditing clinical and care outcomes
  • The group wide application of patient care pathways for the organisation of work and financial control, and
  • Work process systemisation – introducing high degrees of standardisation balanced against clinical autonomy
• The company has a high rate of capitalisation (replacement, renewal and refurbishment of technologies and buildings) at over three times the average for public hospitals; this is seen as a major contribution to continuous quality improvement and cost efficiency
• It operates on a multi-disciplinary team basis (breaking down barriers between departments) and operates a workforce shareholding and bonus system.
• It is developing new ways of making its services more locally available through the development of (diagnostic) portal clinics and local medical centres (MDVs); in effect moving towards vertical integration of healthcare delivery

• Strong corporate vision and culture; and emphasis on quality in all it does
• High levels of investment in state of the art buildings and technology to support its workforce and create a better environment and improved accessibility for patients
• Well developed clinical audit and work process systemisation networked across all hospitals
• Strong work process / building design synergy

• High reliance on growth by acquisition to sustain high rates of capitalisation
• May face financial pressures as governments tighten tariff payment systems
• Some concerns over the drive towards ‘standardisation’ of care processes: Rhoen Klinikum claim this does not inhibit clinical freedoms

• This is a hospital centric model with important lessons for those developing new acute hospital projects
• The lessons focus predominately on workforce (and work process) / hospital design synergy and the culture change necessary to introduce services built around care pathway based models of care
• Rhoen Klinikum demonstrates the benefit of high levels of investment in ICT to improve quality and delivery cost efficiencies

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