Download PDF
Gesundheitswesen 2020; 82(03): 236-241
DOI: 10.1055/a-0894-4775
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Wandel im Gesundheitswesen: Analyse der Auswirkungen auf Ärzte und Patienten am Beispiel der Ukraine

Effects of Changes in Healthcare on Doctors and Patients using the Example of Ukraine
Yevgen Bogodistov
1   ProcessLab, Frankfurt School of Finance & Management, Frankfurt a.M.
,
Fynn Malte Reck
1   ProcessLab, Frankfurt School of Finance & Management, Frankfurt a.M.
,
Jürgen Moormann
1   ProcessLab, Frankfurt School of Finance & Management, Frankfurt a.M.
,
Oleksandr P. Krupskyi
2   Faculty of Economics, Oles Honchar Dnipro National University, Dnipro, Ukraine
› Author Affiliations
Further Information

Publication History

Publication Date:
11 June 2019 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund Das Gesundheitswesen befindet sich weltweit im Umbruch. Dieser hat nicht nur Auswirkungen auf die Organisation von Krankenhäusern, Arztpraxen, Pflegeeinrichtungen usw., sondern auch auf die beteiligten Personen und Personengruppen. Welche Auswirkungen der Wandel für Ärzte und Patienten hat, wird am Beispiel einer umfassenden Gesundheitsreform in der Ukraine untersucht.

Methoden Die Analyse basiert auf einer empirischen Erhebung, die bei Ärzten in 2 Städten der Ukraine durchgeführt wurde. Auf Basis des Job Demands-Resources Model wurden Hypothesen entwickelt, die anhand eines Strukturgleichungsmodells überprüft worden sind. An der Befragung haben 178 Familienärzte (81% der Grundgesamtheit) teilgenommen.

Ergebnisse Die Untersuchung zeigt einen klaren Zusammenhang zwischen den organisationalen Herausforderungen (zusätzliche Aufgaben, struktureller Wandel, neue Prozesse) und ihren psychologischen Folgen (z. B. Burnout). Letztere wirken sich u. a. negativ auf die Zusammenarbeit der Ärzte in Kliniken aus, was wiederum die Zufriedenheit der Patienten beeinträchtigt.

Diskussion und Schlussfolgerung Der Wandel im Gesundheitswesen ist unausweichlich. Das Beispiel der Ukraine zeigt, dass Offenheit der Kliniken für Wandel die Wahrscheinlichkeit für Burnout von Ärzten reduziert und letztlich die Patientenzufriedenheit erhöht. Daher sind Ansätze des Prozessmanagements, die dazu beitragen, Offenheit in Organisationen zu erzeugen, in Zeiten starken Wandels dringend zu empfehlen.

Abstract

Background The health care sector is experiencing a drastic transition all over the world. This has an impact not only on the way hospitals, clinics, special-care homes etc. are organized, but also on patients, personnel and other stakeholders involved. The consequences of changes for both physicians and patients are investigated using a comprehensive health care reform in Ukraine as an example.

Methods The analysis is based on empirical data collected from general physicians in 2 Ukrainian cities. Based on the Job Demands-Resources Model, we developed a set of hypotheses and tested them using the structural equation modelling technique. A total of 178 general physicians (81% of the approached population) participated in the study.

Results Our investigation reveals a clear relationship between the organizational job demands (additional tasks, structural changes, new processes) and their psychological effects (e. g., burnout). The latter have a negative impact on cooperation of physicians in hospitals leading to lower patient satisfaction.

Discussion and Conclusions Change in health care is inevitable. The example of Ukraine shows that openness of hospitals towards change reduces the probability of physicians’ burnout and, eventually, increases patient satisfaction. We strongly suggest applying the process management approach in order to increase openness to change, especially in turbulent times.

Schlüsselwörter

Burnout - Gesundheitsreform - Patientenzufriedenheit - Prozessinnovation - Strukturreform

Key words

burnout - health care reform - patient satisfaction - process innovation - structural reform

Anhang

 

  • Literatur

  • 1 Boerner S, Dütschke E. The impact of charismatic leadership on followers’ initiative-oriented behavior. Health Care Manage Rev 2008; 33: 332-340
    CrossrefPubMedGoogle Scholar
  • 2 Gilbert S, Laschinger HKS, Leiter M. The mediating effect of burnout on the relationship between structural empowerment and organizational citizenship behaviours. J Nurs Manag 2010; 18: 339-348
    CrossrefPubMedGoogle Scholar
  • 3 Schneider J, Kaplan SH, Greenfield S. et al. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med 2004; 19: 1096-1103
    CrossrefPubMedGoogle Scholar
  • 4 Ashford SJ. Individual Strategies for Coping with Stress during Organizational Transitions. J Appl Behav Sci 1988; 24: 19-36
    CrossrefPubMedGoogle Scholar
  • 5 Schweiger DM, Denisi AS. Communication with Employees Following a Merger: A Longitudinal Field Experiment. Acad Manage J 1991; 34: 110-135
    PubMedGoogle Scholar
  • 6 Wanberg CR, Banas JT. Predictors and outcomes of openness to changes in a reorganizing workplace. J Appl Psychol 2000; 85: 132-142
    CrossrefPubMedGoogle Scholar
  • 7 Haines VA, Hurlbert JS, Zimmer C. Occupational Stress, Social Support, and the Buffer Hypothesis. Work Occup 1991; 18: 212-235
    CrossrefPubMedGoogle Scholar
  • 8 Rhoades L, Eisenberger R. Perceived organizational support: A review of the literature. J Appl Psychol 2002; 87: 698-714
    CrossrefPubMedGoogle Scholar
  • 9 Demerouti E, Bakker AB, Nachreiner F. et al. The job demands-resources model of burnout. J Appl Psychol 2001; 86: 499-512
    CrossrefPubMedGoogle Scholar
  • 10 Maslach C, Jackson SE, Leiter MP. et al. Maslach Burnout Inventory: Manual. Consulting Psychologists Press; Palo Alto: 1986
    Google Scholar
  • 11 Bakker AB, Demerouti E. The Job Demands-Resources model: state of the art. Journal of Managerial Psychology 2007; 22: 309-328
    CrossrefPubMedGoogle Scholar
  • 12 Demerouti E, Bakker AB, Nachreiner F. et al. A model of burnout and life satisfaction amongst nurses. J Adv Nurs 2000; 32: 454-464
    CrossrefPubMedGoogle Scholar
  • 13 Bakker AB, Demerouti E, de Boer E. et al. Job demands and job resources as predictors of absence duration and frequency. J Vocat Behav 2003; 62: 341-356
    CrossrefPubMedGoogle Scholar
  • 14 Hobfoll SE. Conservation of resources. A new attempt at conceptualizing stress. Am Psychol 1989; 44: 513-524
    CrossrefPubMedGoogle Scholar
  • 15 Jungbauer J, Ehlen S. Stressbelastungen und Burnout-Risiko bei Erzieherinnen in Kindertagesstätten: Ergebnisse einer Fragebogenstudie. Gesundheitswesen 2014; 76: 1-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Hobfoll SE, Freedy JR. The Availability and Effective Use of Social Support. J Soc Clin Psychol 1990; 9: 91-103
    CrossrefPubMedGoogle Scholar
  • 17 Baltes PB. On the incomplete architecture of human ontogeny: Selection, optimization, and compensation as foundation of developmental theory. Am Psychol 1997; 52: 366-380
    CrossrefPubMedGoogle Scholar
  • 18 Semlitsch T, Abuzahra M, Stigler F et al. Qualitätsindikatoren für Primary-Health-Care-Einrichtungen in Österreich. Gesundheitswesen 2017 Online-Publikation
    PubMed
  • 19 Hobfoll SE, Shirom A. Conservation of resources theory: Applications to stress and management in the workplace. In: Handbook of organizational behavior. Golembiewski RT. Ed. Marcel Dekker; New York, NY, US: 2001: 57-80
    Google Scholar
  • 20 Bakker AB, Demerouti E, Verbeke W. Using the job demands-resources model to predict burnout and performance. Hum Resour Manage 2004; 43: 83-104
    CrossrefPubMedGoogle Scholar
  • 21 Shanafelt TD, Bradley KA, Wipf JE. et al. Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program. Ann Intern Med 2002; 136: 358
    PubMedGoogle Scholar
  • 22 Allen J, Jimmieson NL, Bordia P. et al. Uncertainty during Organizational Change: Managing Perceptions through Communication. Journal of Change Management 2007; 7: 187-210
    CrossrefPubMedGoogle Scholar
  • 23 Möltner H, Leve J, Esch T. Burnout-Prävention und mobile Achtsamkeit: Evaluation eines appbasierten Gesundheitstrainings bei Berufstätigen. Gesundheitswesen 2018; 80: 295-300
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Hobfoll SE. The Influence of Culture, Community, and the Nested-Self in the Stress Process: Advancing Conservation of Resources Theory. Appl Psychol 2001; 50: 337-421
    CrossrefPubMedGoogle Scholar
  • 25 Kristensen TS, Borritz M, Villadsen E. et al. The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress 2005; 19: 192-207
    CrossrefPubMedGoogle Scholar
  • 26 Vorhies DW, Morgan NA. Benchmarking Marketing Capabilities for Sustainable Competitive Advantage. J Mark 2005; 69: 80-94
    PubMedGoogle Scholar
  • 27 Hair JF, Black WC, Babin BJ. et al. Multivariate Data Analysis. Pearson Education Limited; Harlow, Essex, UK: 2014
    Google Scholar
  • 28 Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling 1999; 6: 1-55
    CrossrefPubMedGoogle Scholar
  • 29 Richardson HA, Simmering MJ, Sturman MC. A Tale of Three Perspectives. Organizational Research Methods 2009; 12: 762-800
    CrossrefPubMedGoogle Scholar
  • 30 Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis. Second Edition A Regression-Based Approach. Guilford Press. Im Internet; https://www.guilford.com/books/Introduction-to-Mediation-Moderation-and-Conditional-Process-Analysis/Andrew-Hayes/9781462534654
    Google Scholar
  • 31 Schmelzer HJ, Sesselmann W. Geschäftsprozessmanagement in der Praxis. Kunden zufrieden stellen-Produktivität steigern-Wert erhöhen, Hanser 2008
    PubMed
  • 32 Womack JP, Jones DT. Lean Thinking: Banish Waste And Create Wealth In Your Corporation. Simon and Schuster; 2013
    Google Scholar
  • 33 Pande P, Neuman R, Cavanagh R. The Six Sigma Way. McGraw Hill; 2000
    Google Scholar
  • 34 De Koning H, Verver JPS, van den Heuvel J. et al. Lean six sigma in healthcare. J Healthc Qual 2006; 28: 4-11
    PubMedGoogle Scholar