I nternational S ociety of O rthopaedic C enters ENDO-Klinik, Hamburg/Germany
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Transcript of I nternational S ociety of O rthopaedic C enters ENDO-Klinik, Hamburg/Germany
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IInternational SSociety of OOrthopaedic CCenters
ENDO-Klinik, Hamburg/Germany
Bologna/Italy, April 29 – May 1, 2010
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Agenda
• Background of Sibylle Stauch-Eckmann
• German Health Care System
• Structure and data of ENDO-Klinik
• Teaching and research efforts
• Strategic plan
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Background
SIBYLLE STAUCH-ECKMANN,
Dipl. Wirtsch.-Ing.
• 39 years old, married, 2 sons (6 and 1.5 y.)• Studies of economics and mechanical
engineering at TU Darmstadt,1989-1995• Internat. Traineeprogramme Dräger Medical
(Germany, Belgium), 1995/96• Executive on sales and marketing within Dräger
Medical Germany, 1996-2001• Executive assistant of Damp Group, 2001/02• Administrative Director of ENDO-Klinik, 2002-
2005• Managing Director of ENDO-Klinik, since 2005• Honorary member of the Hamburg Chamber of
Commerce & Industry and delegate of DIHK, special focus on life sciences
• Member of Rotary Club Hamburg Steintor
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Agenda
• Background of Sibylle Stauch-Eckmann
• German Health Care System
• Structure and data of ENDO-Klinik
• Teaching and research efforts
• Strategic plan
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• Expenses on health services in Germany, 2009: € 280 billions– 10.5 % gross domestic product
– € 65 billions in the hospital sector
• > 5 mill. employees– of those 3 mio. female
– 1.1 mill. in the hospital sector
• Economic growth of 2 % p.a. up to 2030• International top position of special branches, e.g. medical technology
(patent pending and part of world trade)
• Health insurance system (app. 370 insurance companies)
– solidarity based system - compulsory insurance
– high competition between private and state health insurance companies
• 2,087 hospitals – 32% public, 38% non-profit and 30% private hospitals
– 17.2 mill. patients treated with 8.3 days of average stay in hospitals
• Since 1989 eight reforms of health care legislation• Since 2003 the hospital finance system is based on DRGs
(adoption and development of the Australian DRG-system)
• External state quality control for defined operations (e.g. hip and knee joint replacement)
German Health Care System
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Agenda
• Background of Sibylle Stauch-Eckmann
• German Health Care System
• Structure and data of ENDO-Klinik
• Teaching and research efforts
• Strategic plan
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Ostseeklinik Damp GmbHOstseeklinik Kiel GmbH Reha-Klinik Ahrenshoop GmbHReha-Klinik Damp GmbHReha-Klinik Lehmrade GmbHReha-Klinik Schloß Schönhagen GmbHTherapie Centrum Damp GmbHSCHLEI-Klinikum Schleswig FKSL GmbH
SCHLEI-Klinikum Schleswig MLK GmbHReha-Zentrum Harburg GmbHReha-Zentrum Norderstedt GmbHReha-Zentrum Lübeck GmbHENDO Reha-Zentrum GmbHSport-Reha Kiel GmbHTagesklinik am Kurpark Lüneburg GmbHZentrale Service-Gesellschaft Damp mbH
Ahrenshoop Service GmbHAkademie Damp GmbHDamp Holding AGDamp Sundhedscenter TondernDamp Touristik GmbHENDO-Klinik Hamburg GmbHHANSE-Klinikum Stralsund GmbHHANSE-Klinikum Wismar GmbH
SCHÖNHAGEN
DAMP
AHRENSHOOP
LÜBECK
TONDERN
SCHLESWIGKIEL
NORDERSTEDT
HAMBURG
HARBURG
LÜNEBURG
STRALSUND
WISMAR
LEHMRADE
Since 1998 ENDO-Klinik part of Damp-Group, which is the leading private hospital group in Northern Germany
Location
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Structure and data of ENDO-Klinik
2009 Turnover appr. € 450 mill.Employees: 7,800
2009 Turnover appr. € 450 mill.Employees: 7,800
GENERAL VIEW
Surgery and
HospitalTreatment
Beds: 2,100
RehabilitationBeds: 1,488
TourismBeds: 2,500
Damp Holding AGDamp Holding AG
Board: Dr. Claus-Michael Dill (Chairman)
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FactsPioneer of total joint replacement in Germany
Implantation of 115,000 prostheses since foundation
Long lasting scientific cooperation in development of hip- and knee-prostheses (Link Inc., Zimmer Inc.)
Strategic partnership with the Technical University of Hamburg in biomechanics
Education and Training of app. 400 medical specialists since foundation, 300 visitors p.a.
since 1976 focused in the field of total joint
replacement of knee, hip, shoulder and foot
Infected arthroplasty (400 cases p.a.)
Spine center (900 cases p.a.)
Blood bank and bone bank in-house
Turnover 2009: € 48 mill.
EBITDAR 2009: 12.8%
Employees: 413 (incl. all physicians)
Beds: 250 on 4 wards
Orthopaedic surgeons: 22
Other physicians: 52
Investments on buildings since 2007:€ 90 mill. thereof € 38.1 mill. contribution of the Hanseatic City of Hamburg
Figures
Specialities
Structure and data of ENDO-Klinik:Speciality center for bone, joint and spinal surgery
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New Building (since May 2009) restructuring of ambulance and reception center
8 innovative operating theatres (7,500 m2)
• 4 and 2 in open-plan and 2 singles• Recovery area [PACU] (20 beds)• Intermediate and Intensive Care Unit (19 beds)
sterilization center
radiology center (incl. CT, MRT, Teleradiology)
4 wards (64 or 48 beds) with standard double or single rooms
ecological technologies (concrete core cooling, photovoltaics, re-using of water) Old Building (refurbishment 2010-2012)
40 additional beds with special comfort
40 stationary rehabilitation beds in-house Rehab-Center on 2 floors out-patient Operating-Center
Teaching and Science Center (ENDO foundation)
Restaurant and bistro areas
Structure and data of ENDO-Klinik:Building structure
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Structure and data of ENDO-Klinik: Surgeries (2009)
TOTAL 5,973
Primary implants 3,165
Hip 1,770
Knee 1,277
Shoulder 62
Other joints 56
Implant exchanges 1,255
Hip 806
Knee 413
Shoulder and other joints 36
Other joint surgeries 493
Septic cases 399
Periprosthetic Infection - Algorithm of the ENDO-Klinik Hamburg
pathogendetected
signs of infection < 6 weeks after primary implantation / revision
Pathogen probable (e. g. Erysipelas, previous records)
Pathogen unknownno hints from patients history
High level resistance of pathogenLokal application of ABX impossible
Succion erigation:- revision, radical débridement - succion erigation- ABX systemically administered
One stage revision:- revision, radical débridement - removal of all foreign bodies- implantation of AJR using anti-
biotic loaded PMMA-bone cement- ABX systemically administerd
Multiple stage revision:- revision, radical débridement - removal of a foreign bodies- Entfernung allen Fremdmaterials- ABX systemically administered- re-implantation after infection is
controlled
persisting infection
SUCCESS
Special conditions - Arthrodesis of the knee: If function is impossible because of deficient ligaments or muscular disorder- Girdlestone’s arthroplasty: If function of the hip cannot be reconstructed or as temporary condition in multiple
stage revision - Amputation / exartikulation: If infection cannot be controlled otherwise
positive
nega
tive
- no
pat
hoge
n de
tect
ed SUCCESS
persisting infection
SUCCESS
persisting infection
signs of infection > 6 weeks after primary implantation / revision
• Average patients stay: 10.1 d
• Primary joints: 8.2 d
• Occupancy: 95 %
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Agenda
• Background of Sibylle Stauch-Eckmann
• German Health Care System
• Structure and data of ENDO-Klinik
• Teaching and research efforts
• Strategic plan
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Teaching
23 residents
4 fellows
5 interns (Hamburg University Hospital)
clinical focus (no in-house laboratories)
mainly on joint replacement
comparative outcome studies on TKA and THA implants
clinical database since 1968
large retrieval collection (> 7,000)
outcome of one staged septic revisions
2 attendings
1 fellow
4 residents
1 research assistant
4 students (actively involved)
Staff
Research
Teaching and research efforts
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Agenda
• Background of Sibylle Stauch-Eckmann
• German Health Care System
• Structure and data of ENDO-Klinik
• Teaching and research efforts
• Strategic plan
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Strategic Plan and major issues
STRATEGY• Local diversification and growth by refurbishing the old clinic building
– medical competence center (combining treatment of out- and in-patients AND clinical sector with rehab sector)
– growth in wards for private patients (1 bedroom)– offering high level services
• ENDO branding as an opportunity for external growth – first step in German locations– ENDO-inside-strategy versus franchise– standardization and training issues implicated
• More intensive cooperation with ENDO-charity and ENDO-foundation– fund raising mainly for financing research efforts and training issues
FUTURE CHALLENGES• Personnel development because of skills shortage (e.g. qualified nurses, physicians) !• Price competition: CAVE selective contract system for elective cases !• Quality competition: which are the right indicators or independant data collectors ?
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THANK YOU !