[Centralisation of breast cancer management by giving minimum work-load. Empirical effects in the region of North-Rhine, Germany]. / Zentralisierung der Behandlung des Mammakarzinoms bei der Vorgabe von Mindestmengen. Empirische Auswirkungen in der Region Nordrhein.

INTRODUCTION: The concentration of treatment on a few hospitals is discussed to improve the outcome of care. For the treatment of the breast cancer the distributional effects are evaluated. METHOD: A systematic literature search in Medline identified six studies dealing with the evidence on the relation between outcome and workload. Using administrative data of a sickness fund in the region of Rhineland, Germany, the number of hospitals and patients affected by minimum work-loads was determined. RESULTS: Study results show that in general a minimum workload of 100 to 150 new diagnosed cases per year and hospital is recommended. These recommendations would lead to 46% of the presently treating hospitals being excluded (minimum work-load of 150 cases; year 2001). If the workload is set to 100 cases, 31% of the hospitals will be excluded from breast cancer management. No significant differences could be detected in the data of the years 2000 and 2001. DISCUSSION: The association between minimum workload and outcome of care seems to be evident. Further studies involving larger regions are needed to evaluate the distributional effects and gains of outcome.

[The influence of quality management on job satisfaction and work load--exemplary study in a German hospital]. / Wie wirkt sich die Einführung des Qualitätsmanagements auf die Arbeitszufriedenheit und Arbeitsbelastung aus? Exemplarische Untersuchung in einer Klinik.

Surveys among employees are getting more and more relevant in hospital settings since an increase in both (1) efficiency and (2) quality in connection with (3) enhanced patient orientation will only be achieved, if at the same time the employees' health status and satisfaction are taken into account. Thus, the objective of this study was to compare the satisfaction of employees in a single hospital enquired in 2002 with that of 2005. Particular consideration was given to their view of quality management. Is there a correlation between employees' satisfaction, their degree of information on quality management, and their assessment of quality management? In the survey of 2005 employees were more satisfied with their work and their working conditions than in the previous inquiry conducted in 2002. They felt less mental stress, despite the declining length of hospitalisation combined with a higher turnover of in-hospital cases and with lower numbers of full-time staff. The employees' satisfaction, however, differed widely among the three departments with regard to the items "involvement with decisions" and "support by the superiors". The overall assessment of quality management is positive. Specific items such as the assessment of the management's commitment to quality management were strongly influenced by the employees' degree of information on quality management, which varies between departments. In the department with the lowest work satisfaction quality management was attributed a high potential for change and improvement. After quality management will have been implemented throughout the hospital, a new survey should be undertaken to evaluate whether quality management affects the employees' satisfaction with their work.