Voraussetzungen für Spitäler zur Verbesserung der Performance

Hospitals are under great stress. The environment within which they function is complex and demanding. Some hospitals show substantially higher rates of performance improvement than their competitors. The source of this difference lies not so much in the way individual improvement projects are managed as in the competencies on which the projects can draw. An organization's performance improvement capability reflects five key components: skills, systems, structure, strategy and culture. These five components form a hierarchy. Larger performance improvements require changes at the higher levels such as strategy and culture, but that changes at the higher levels take longer to accomplish. Hospitals that want to strengthen the structural components of their improvement capability need to have more standardized processes, more oversight and accountability mechanisms. These have to be developed by an extensive dialogue across the layers of authority and status. Improvement capability needs a robust strategic leadership. Independence of professional groups has to be replaced by interdependence, but not by frustrating dependence (Review article).