“To Guarantee Quality, We First Have to Measure it”

How to Improve Treatment Processes and Optimize Treatment Results


The German hospital group Schön Klinik is a pioneer in results-oriented patient care. Managing Director Dr. Markus Hamm explains how the company verifies treatment quality, and what results it achieves through this.

Management Summary

Challenge: Quality-oriented treatment is playing an increasingly important, global role in competition between hospitals and in the payment of services. Appropriate indicators and evaluation tools are needed to measure and verify treatment results.
Solution: Over the last few decades, German hospital group Schön Klinik has developed an extensive system of indicators that document results over the entire course of a treatment.
Results: Thanks to systematic quality measurements and quality feedback, Schön Klinik has continuously improved its treatment processes and optimized its treatment results. The group is one of the most profitable hospital operators in Germany.

Dr. Hamm, how do you measure treatment quality?
Hamm: We measure it in three dimensions: medical treatment results, patient safety, and patient satisfaction. In other words, we are concerned with both the objective and subjective aspects of treatment – the result as well as the experience.

How did you develop your approach?
Hamm: Schön Klinik has concerned itself with questions of quality since the 1980s. The idea initially came from psychosomatic treatment. The question asked back then was which treatment truly improved quality of life from the patient’s point of view. We feel that the crucial point is not how well this or that process works in our hospitals, but rather how patients actually benefit from the treatment and whether their real needs are taken into account.

Can you give an example?
Hamm: In psychosomatic medicine, for instance, we measure how many patients who come to us with depression regain their drive and vitality through our therapy. With patients who have a herniated disc or an artificial knee joint, on the other hand, we ask whether surgery has made them mobile again, pain-free in the long term, and able to go back to work.


"We verify therapeutic success over the entire course of treatment.” Dr. Markus Hamm

To measure such results, it’s necessary to have a reliable set of indicators to hand.
Hamm: Exactly. Over the years, we have developed an extensive system of standardized indicators that are applied in all of our hospitals. With a hip operation, for example, we start by determining whether the procedure is in fact necessary, what the patient’s quality of life is, and his or her level of physical function. Then, during the treatment process, we document whether complications or infections occur and how quickly the patient can stand up after the operation. At discharge and during rehabilitation, the changes in the patient’s physical mobility and pain level are measured. In other words, we verify therapeutic success over the entire course of treatment. To do this, we also use internationally established instruments, such as the Short Form Health Survey (SF-36) for measuring health-related quality of life. All of the measured data are recorded in a standardized electronic patient record.

With a hip replacement, though, it sometimes takes many months to determine whether the treatment was actually successful.
Hamm: This is the case with many clinical pictures. That is why, a few years ago, we started sending our patients an additional survey after three or even twelve months to measure the long-term success of their treatment. Fortunately, the response rate for these surveys is fairly high. We can use the long-term results to draw conclusions on possible improvements for the treatment.


Schön Klinik: Profile

Schön Klinik, which was founded in 1985, is a family-owned group of private hospitals with 17 facilities across Germany. The group specializes in psychosomatic medicine, orthopedics, and neurology. It generates 80 percent of its earnings in these three areas. In 2015, its sales were nearly €750 million. Annual growth over the last ten years has stood at between 8 and 10 percent. Schön Klinik pursues a strategy of results-oriented treatment and conducts systematic quality measurements in its hospitals and clinics.1   


“Establishing effective quality measurements in an entire hospital group is more like a marathon than a 100-meter sprint.” Dr. Markus Hamm

Do your hospitals actually improve as a result of this quality feedback?
Hamm: In at least some cases, we can prove that it does. For example, our treatment results for anorexia nervosa have improved considerably. This can be measured by the patients’ average weight gain during treatment, which has increased continually over the last 20 years and is now significantly higher than the national reference standard in Germany. One key to success is that we also compare the results of our hospitals among each other in order to determine the best practice for a specific disease, and then apply it in our other hospitals. This is obviously a long-term, iterative process that requires many discussions among experts and a strong culture of trust. Establishing effective quality measurements in an entire hospital group is more like a marathon than a 100-meter sprint. Many claim to offer quality, but in order to guarantee it, we first have to reliably measure it.

Does treatment quality also lead to economic success?
Hamm: First and foremost, our philosophy is to focus on a treatment’s actual benefits for the patients. The owners of our hospital group fully support this approach. We cannot accurately estimate the costs and profits resulting from our quality system. Also, there is currently little leeway to negotiate success-based payment agreements with health insurance companies. Still, we are convinced that high and measurable treatment quality contributes significantly to economic success. Our patient satisfaction surveys show a very high recommendation rate, and we have been one of the most profitable hospital operators in Germany for many years. For patients, quality plays an increasingly important role, and a growing number of insurers are also starting to value measurable results in an international context.


“Our aim is to always establish an optimum balance between quality and costs – in other words, to achieve the best possible value of a treatment.” Dr. Markus Hamm

Is there resistance among your employees to time-consuming quality measurements?
Hamm: Of course the question of which indicators are truly useful is frequently discussed. Are certain indicators perhaps an end in themselves? But when we see that quality measurements result in actual improvements in treatment, we have the doctors and nurses on our side. After all, they are in this profession because they want to help patients and want to see the success of their work. It is also important for internal discussions that we do not simply regard high treatment quality as the antithesis of low treatment costs. It is indeed possible that a better result can be achieved with lower costs. Our aim is to always establish an optimum balance between quality and costs – in other words, to achieve the best possible value of a treatment. This approach facilitates an exchange between hospital management and doctors that goes beyond well-worn argumentation patterns.

With this kind of results-oriented healthcare, what do you expect from the medical technology industry?
Hamm: The world of healthcare is increasingly moving toward networks and partnerships. The industry should, therefore, not only be interested in selling products. Instead, it should be asking: How can I, as a supplier, contribute to added value within the treatment process? How can I make my own services transparent and how can my services be measured? In future, it will be crucial to think even more in terms of treatment processes and, for example, to deliver medical devices with a concept on how to increase the value of treatment.
“Our aim is to always establish an optimum balance between quality and costs – in other words, to achieve the best possible value of a treatment.”

About the Author

Martin Lindner is an award-winning science writer based in Berlin, Germany. After completing his medical studies and a doctoral thesis on the history of medicine, he went into journalism. His articles have appeared in many major German and Swiss newspapers and magazines.

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