Outpatient before inpatient: process adjustments without strategic anchoring

The shift to outpatient care is a hot topic in many hospitals. In acute somatic care in particular, two-thirds of the doctors surveyed say that the change is being discussed intensively. Nevertheless, many hospitals lack a clear strategic foundation: only around one-fifth of those surveyed see an explicit strategy, while 40 per cent do not know whether such a strategy even exists. In practice, this means that changes often remain at the process level – for example, through new procedures or outpatient centres – without being embedded in an overarching structure.

Doctors continue to spend a lot of time on administrative tasks. In psychiatry in particular, the amount of documentation required has increased once again. Requirements imposed by authorities and insurance companies take up a considerable amount of working time. In rehabilitation, the daily workload averages 67 minutes, compared to 35 minutes in acute somatic care. Most of the burden is caused by clarifying invoices and reports for insurance companies.

The majority of doctors continue to rate the quality of care as good. At the same time, however, there is growing criticism of discharge times: respondents increasingly feel that patients are being discharged either too early or too late. This assessment is consistent across all specialist areas. In psychiatry in particular, many report increasing cost-cutting targets and a growing focus on profit optimisation.

Job satisfaction has improved slightly, especially in acute somatic care. However, it remains lowest in psychiatry, at 74 per cent. The shortage of skilled workers remains critical: although more respondents say that there are enough colleagues available, the proportion is still low, at just over half. The recruitment of skilled personnel remains particularly problematic.

Within teams, cooperation is once again viewed somewhat more positively – particularly with regard to error culture and leadership. However, the opposite trend can be seen across departmental and institutional boundaries. Cooperation with health insurance companies and rehabilitation and psychiatric institutions is particularly difficult.