[Expectations and patient satisfaction in hospitals: construction and application of an expectation-based experience typology and its use in the management of quality and expectations]. / Erwartungen & Patientenzufriedenheit im Krankenhaus: Konstruktion und Anwendung einer erwartungsbasierten Erfahrungstypologie und deren Nutzung im Rahmen des Qualitäts- und Erwartungsmanagements.

Patient satisfaction (PS) surveys are frequently used evaluation methods to show performance from the customer's view. This approach has some fundamental deficits, especially with respect to theory, methodology and usage. Because of the significant theoretical value of the expectation confirmation/disconfirmation concept in the development of PS, an expectation-based experience typology has been developed and tested to check whether this approach could be a theoretical and practical alternative to the survey of PS. Due to the mainly cognitive-rational process of comparison between expectations and expectation fulfilment, it is easier to make changes in this stage of the process than in the subsequent stage of the development of PS that is mainly based on emotional-affective processes. The paper contains a literature review of the common concept of PS and its causal and influencing factors. Based on the theoretical part of this study, an expectation-based experience typology was developed. In the next step, the typology was subjected to exploratory testing, based on two patient surveys. In some parts of the tested typology explorative differences could be found between hospitals. Despite this rather more complex and unusual approach to expectation-based experience typology, this concept offers the chance to change conditions not only retrospectively (based on data), but also in a prospective way in terms of a "management of expectations".

[The role of management in health care]. / Die Rolle des Managements im Gesundheitswesen.

The situation in the health care sector is affected by a shortage of public funds on the one hand and, on the other hand, by rapid developments in medicine and nursing with an enormous expansion of both diagnostic and therapeutic possibilities. This and the aging population are generating a steadily increasing demand for health care services. The result is an increased cost consciousness in society calling for more professional management in health care organizations. However, the traditional administration of health care organizations, which is closely aligned with health professionals and production processes, was not able to cope with these dynamics or did so only unsatisfactorily. An improved management would surely lead to an optimization of health care delivery processes and a more effective use of resources. The question, however, is whether the effectiveness of the total system can be improved and whether patients' and society's needs can actually be met by classical management approaches.

[Achieving an evaluated health care system]. / Zur Realisierung einer evaluierten Gesundheitsversorgung.

One approach to avoiding unfair rationalisations in a health care system is evaluation. Five main obstacles (tantamount to five points of criticism) that hamper the widespread evaluation of health technologies can be specified: 1. The limited number of clinical studies and overviews, 2. the unsystematic selection and alignment of studies, 3. the additional administrative and other demands made that do not relate to the treatment of patients, 4. methodological deficiencies (e.g. searches for evidence not carried through, undocumented criteria for the inclusion or exclusion of data), and 5. the unknown economic consequences of implementing evaluation results-based recommendations. The five points of criticism are met by specifying conclusions in these five areas of activity: the creation of an inventory of demands, the selection and prioritisation of studies, the standardisation of methodology, the dissemination and the implementation of educational measures.