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

Abstract

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 10 years to 5.4 years 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.

Keywords: anesthesiology; human resources; skill mix; staff capacity; staff fluctuation.

Figure 1

(A) Incision to closure time, number of operations, and incision to closure time per operating room as benchmark for performance development compared to 2010. (B) Cumulative use of the operating rooms measured in hours in relation to working hours of a day to benchmark when the performance increase took place.

Figure 2

Number of anesthesia cases, minutes under anesthesia, and average duration of anesthesia as benchmark for the performance development compared to 2010.

Figure 3

(A) Development of the number of anesthetists measured as full-time equivalent (FTE) working only in the operating rooms of the University Hospital Muenster (UKM), Germany. (B) Distribution of all Anesthetists working at the Department of Anesthesiology, Intensive Care Medicine an Pain Management, UKM, Germany.

Figure 4

Development of the amount of full-time equivalent (FTE) compared to 2010 distinguished between attending specialist (AS), specialist (S), and resident (R) as well as the change in total.

Figure 5

Licensing age at starting and at leaving the clinic as indicator for work experience compared from 2009 to 2014. It compares how long a doctor stays after he graduates as a specialist (usually after 5 years) and with how much work experience the leavers are compensated by new appointments.