Integrated care

Dr Darius Jakubowski, a perinatal specialist and former senior physician at Holweide Hospital, works for three days a week at Holweide Hospital as a resident gynaecologist.

Professor Friedrich Wolff MD, Head of Gynaecology and Medical Director at...
Professor Friedrich Wolff MD, Head of Gynaecology and Medical Director at Holweide Hospital, in Cologne, Germany, describes a novel approach to obtaining perinatal diagnoses, despite staff shortages and tight budgets

During that period he carries out all the obstetrics department’s perinatal diagnostics (deformities and other advanced diagnostics). However, for the rest of the week he works in his private ultrasound scanning practice in the town – an arrangement, he says, that succeeds without causing any deficits.

We asked Professor Wolff what inspired this unusual work pattern. 
F. Wolff: ‘The special feature of this structure is that we were the first to think of outsourcing this area of perinatal diagnostics into a perinatal centre. This means it was outsourced from clinical routine, but is still on site. The basic problem in large perinatal centres is that the number of births is very high, which also means many high-risk births. Most clinics find it difficult to supply a senior physician who does perinatal diagnostics and at the same time is responsible for the delivery room. This split gave us the idea to bring in a former consultant, who had left and opened his own specialist gynaecological practice outside the hospital, back into the hospital and to assign him to perinatal diagnostics.

Wouldn’t employment of a second consultant be easier?
FW: It just wasn’t possible. Perinatal diagnostics is not a very lucrative area for hospitals; the cost of services is barely covered. However, for a gynaecologist in private practice who, in addition, can also offer the IGeL services (individual health services) this is very different. This type of work is indeed lucrative for him and also allows him to acquire new ultrasound scanners. For the hospital, on the other hand, this would have meant a large deficit. So we escaped the economic trap of having to employ additional staff without having more pregnant patients to look after in return for services. However, these now come to us through integrated care. The delivery room consultant is responsible for the delivery room and is authorised to cover for the consultant in private practice. Otherwise, he is on site, in the delivery room, where he is also responsible for obstetric processes and the pregnant patients.

Is this ‘outsourcing’ of services on the agenda for other diagnostic areas?
FW: Yes, our next, very recent project was developed due to our acquisition of a Xario and to achieve equipment utilisation. We have used the same concept in our mamma-ultrasound surgery, which is in high demand and which we outsourced. This project has only just started. Dr Henatsch, a gynaecologist in private practice, comes to the clinic each Friday to carry out mamma ultrasound scans on patients whom we have not managed to see during normal surgery hours. He investigates suspected cysts or tumours, which are then biopsied, and he holds a large surgery with the Xario, ensuring the equipment is fully utilised.

Does Dr Henatsch gain more patients through your clinic?
FW: Yes, definitely – the patients we simply cannot see during the week.

What other tasks remain for the clinic?
FW: We are trying to focus on our key business, which mainly means treating a large number of patients. We tend many patients during births and surgery, for which a hospital receives a set remuneration. Mostly, prior diagnoses associated with these services have been financially covered already and often just result in additional costs. With personnel resources in short supply – i.e. with only a small number of assistant doctors – one has to consider very carefully who to employ where and where jobs might be reduced through integrated care, but with the same level of service.

So the managers are very happy?
FW: I think so. From that point of view we are considered examples for others.


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