Who is actually the customer in the hospital?

For Jeremy Dähn, Head of Digitalization and Innovation at Johanniter GmbH, this question is not easy to answer from a hospital’s perspective. Nevertheless, he tries and emphasizes the importance of the focus that the legislator places on the patient with the KHZG.

Mr. Dähn, to me you symbolize a new generation of leadership in healthcare. What’s it like being a “young wild one” in the hospital world?

I may be a “young savage” in the hospital context, but for me it’s really the startups that are justifiably shouting for change, thinking from the patient’s point of view, knowing the rhythm of consumers and being able to transfer it to patients. That’s why they ask the sometimes uncomfortable questions like “in other markets we can do this too, why not in healthcare?” While I am also among those who want change, I also have an understanding that we cannot change everything. Much has legitimately grown and for good reasons the way it is. For example, data protection or patient safety. As a rule, you only become a patient when you are not well. And in such a situation, a patient must not be harmed further. So I stand somewhere between the “old establishment” and the real “young guns” and say we need change, but we also need to keep regulation and patient protection high at the same time. It’s possible to do both.

Is that a plea to look at healthcare in isolation from the digitization processes in other industries?

No, I think that we in the healthcare sector can and should think outside the box and learn from other sectors and industries. From the hospital’s point of view, of course, we have to constantly re-evaluate how we can improve processes that may not necessarily be visible to patients in the first step, but that nevertheless reach them because services are more effective and relieve the burden on the workforce.

If we exclude data that needs to be protected, there is a lot of catch-up potential in a system that largely excludes patients, at least in terms of comprehensive communication, so that they are to some extent at the mercy of this system.

As far as catch-up potential is concerned: Absolutely! However, this automatically raises the question of who actually is the customer of a hospital. And that is much more difficult to answer. In the U.S., several attempts have already been made to answer this question, with the realization that, at best, you can only serve one customer. Hospitals are very much based on reputation. The higher it rises, the more attractive the house becomes for a very good medical staff and dedicated nursing staff. And the better a hospital is positioned in both areas, the better the care it generally provides. This in turn raises the question of whether the medical and nursing staff are not perhaps the “customers” on whom a hospital should focus because they make a significant contribution to the quality of care. And this does not even take us to those who actually pay for the services in a hospital, i.e., the health insurers. We would certainly have to conduct this discussion much more intensively. But since it would change many processes and create uncertainties on all sides, only a few are concerned with it. All three groups are relevant: Patients, staff and the insurers. However, the focus depends on whether only one of the three groups is really a customer, while the others are stakeholders, or whether all three are customers to be served.

However, the KHZG clearly focuses on the patient and his or her care. Doesn’t this at least answer the question of the legislator?

The legislator creates a framework and has clearly done so with the wording of the KHZG. I therefore consider the KHZG to be a very, very good guideline. But the rest is up to the self-governing authorities, i.e., the health care providers, or the state authorities that set up the application procedure. So the first question is how strong is the voice of patients in self-governance to advance their interests. Because actually in the KHZG, for the first time, the patient is clearly focused, the services for the patients are defined and it is clearly communicated what the legislator expects in the care and what services a hospital could still fulfill in the acute care. The second is in operational bureaucracy, for example, when it comes to funding applications. Hospitals have very good ideas here about what is most sensible to implement in terms of the hospital and the patient, and also how. One example, which also falls within my area of responsibility, is the patient portal. Here it is clearly stated which services the legislator expects from the KHZG. And these are indeed services that a “customer” in other areas would consider quite normal. Whether the state authorities will be able to assess the success of these applications, process the applications quickly and ensure a smooth process has yet to be answered. Unfortunately, the specifications and procedures vary from state to state. Also, individual states seem to be hostile to the so-called cross-state applications.

So the KHZG creates an initial basis for patients to feel more comfortable, more involved and better informed?

I’m convinced of that – especially through the funded patient portals, which provide a long-term relationship with patients and let patients know that their questions will be answered comprehensively. However, KHZG is very focused on acute care hospitals. Referrers and post-acute care providers are mentioned, but a patient journey begins at home, moves through the office-based physician as well as possibly an acute care hospital, and can extend into outpatient or inpatient rehab, curative care, and even retirement homes. For a holistic view and digitization of healthcare, these stations would naturally all have to be included. This is so clear for us as Johanniter because we are active in all areas and not just in acute hospitals. So we can currently see very clearly that the KZHG only promotes one sub-sector of healthcare. However, the better we network all health care services, the better the offers we can make to patients via full health care. This also makes it clear that the KHZG can only be a start.