Annual Report 2015/16

ANNUAL REPORT 2015/16

EXPERTISE YOU CAN TRUST.

HIRSLANDEN A MEDICLINIC INTERNATIONAL COMPANY 2 FINANCIAL YEAR AT A GLANCE

THE HIRSLANDEN PRIVATE HOSPITAL GROUP IN FIGURES* 16 2,030 8,750 6,570 hospitals in 11 cantons affiliated and staff (without employed full-time jobs employed doctors doctors)

98,600 469,200 6,230 inpatients care days** newborns

* Financial year 2015/16 ** based on midnight census, without newborns

CONTENTS

FINANCIAL YEAR PERFORMANCE

Editorial 3 Financial year 2015/16 in figures 38 Interview with the Executive Committee 4 Range of services 39 End-of-year review 6 SwissDRG 40 Key data 8 Diagnoses and operations 42 Organisational structure 9 ICD and CHOP 43 Investments 10 Diagnosis related groups (DRG) in figures 44 HR Report 12 Specialties at each hospital 46 Health policy 13 Specialty: heart medicine 47

QUALITY REFERENCES

Improving the quality of treatment 14 Infrastructure of the hospitals 48 Patient satisfaction 16 Glossary 50 Unplanned readmissions, unplanned Swiss sites 52 reoperations and falls 20 Strategic partnerships and company details 54 Infection monitoring and patient safety 24 Mortality in the intensive care unit 28 Quality medicine initiative 30 Peer review procedure 3 1 Comprehensive quality management system 34 CIRS 36 FINANCIAL YEAR 3 EDITORIAL

DEAR HIRSLANDEN FRIENDS LADIES AND GENTLEMEN

Throughout its history, the Hirslanden Private Hospital This results in a higher quality of care and added efficiency. Group has always adapted itself successfully to changes in We are also following this goal in our core business at the the healthcare system. In order for this to continue in the hospitals, where we are further refining the provision of our future, we have decided to make some changes to our stra services. We see ourselves as a service provider that not tegic vision. Hirslanden is currently in the midst of trans only offers the necessary infrastructure for affiliated doctors, formation from a pure hospital operator to an integrated but also provides all common medical functions. These healthcare group. This means two things: On the one hand, include internal medicine, radiology, anaesthesia, intensive we want to increasingly offer a range of services that care and emergency care, and are carried out by both builds on our established core business. On the other hand, affiliated and employed doctors. The interdisciplinary cen we are establishing uniform, group-wide structures and tres of expertise can access these services at any time and processes that we can use to further increase patient bene thus concentrate fully on their main specialist tasks. This fits. This includes both an absolute focus on the quality division of tasks not only has a positive effect on treatment of medical care and patient satisfaction, plus improvements results, but also on the satisfaction of patients, employees in productivity. and referrers alike.

Growth around our core business primarily focuses on We are convinced that we can once again significantly in expanding our range of outpatient and diagnostic services. crease the benefits for our patients as an integrated health Hirslanden already operates four practice centres, eleven care group. And that’s not all – as the largest medical radiology centres and four radiotherapy centres. Other simi network in Switzerland, we also make an important contri lar facilities are currently being planned, as are outpatient bution to a high-quality, efficient healthcare system in operation centres close to the hospitals. Moreover, we are our country. also examining the opportunities for growth in related spe cialties, such as psychiatry. The goal is to offer a range of services that covers all levels of outpatient, day patient and inpatient treatment, from family medicine through to diag nostics and highly specialised medicine.

With our range of outpatient services, we are not only react ing to an increased market demand and the shift in medical services from the inpatient to the outpatient sector. We are also strengthening patient care across sectors and from a DR OLE WIESINGER single source, and all without delays or loss of information. Chief Executive Officer 4 FINANCIAL YEAR INTERVIEW WITH THE EXECUTIVE COMMITTEE

Dr Christian Westerhoff, CCO, Dr Daniel Liedtke, COO, Magnus Oetiker, CSO, Dr Ole Wiesinger, CEO, and Andreas Kappeler, CFO (from left to right)

THE PRESSURE ON TARIFFS IN THE HEALTHCARE SYSTEM DR CHRISTIAN WESTERHOFF: We not only wish to increase IS INCREASING, WHICH IS ONE OF THE MAIN REASONS productivity with this best practice approach, but patient BEHIND THE DESIRE TO FURTHER INCREASE THE benefits as a whole. In addition to improving efficiency, this PRODUCTIVITY OF THE CORE BUSINESS. HOW ARE also includes enhancing the quality of medical treatment YOU ACCOMPLISHING THIS? and patient satisfaction.

DR DANIEL LIEDTKE: Anyone wishing to improve them “ANYONE WISHING TO IMPROVE selves has to first be aware of where they stand. The best way of finding this out is by comparing yourself to others – THEMSELVES HAS TO FIRST BE while always taking comparability into account, of course. AWARE OF WHERE THEY STAND.” This is why we only make comparisons between those Hirslanden hospitals that have a similar profile. For example, APART FROM LEARNING FROM THE BEST, WHICH CON- we take the orthopaedics department at Klinik Am Rosen CLUSIONS CAN YOU DRAW FROM THE COMPARISONS berg and compare this to the same department at Klinik BETWEEN THE HOSPITALS? Birshof. Such comparisons allow us to derive internal bench marks that the hospitals are then required to follow. These DR DANIEL LIEDTKE: We also take the results into account benchmarks range from the materials used per operation among other things when it comes to putting together to the costs per minute during operations and the bed occu the range of services offered by the individual hospitals. This pancy per hospital. They create healthy competition between takes place within the framework defined by the cantonal the hospitals and promote the concept of learning from hospital lists and the associated service obligations. It is thus the best, which in turn consistently increases the perfor obvious that we have to strengthen those specialties in which mance level within the hospitals. the hospitals can generate a high level of patient benefits. FINANCIAL YEAR 5

The days of our hospitals only providing the infrastructure “ACCUSATIONS OF CHERRY for affiliated doctors from many different specialisations are now long gone. Nowadays, the specialties must be com PICKING HAVE ALWAYS BEEN patible and complement each other. In this way, we aim UNFOUNDED – MORE SO to raise the profile of the hospitals and further improve our position on the market. TODAY THAN EVER BEFORE.”

DR CHRISTIAN WESTERHOFF: In addition, the individual IN THE PAST FINANCIAL YEAR, HIRSLANDEN INTRO- specialties will also be integrated into a holistic system in DUCED A NEW MANAGEMENT STRUCTURE. WHY DO the future. This system is based on a clear division of tasks YOU NEED AN OPERATIONS COMMITTEE IN ADDITION between common medical functions such as anaesthesia, TO THE EXECUTIVE COMMITTEE, AS IT IS NOW KNOWN? radiology and intensive care, and the increasingly important sub-specialised or super-specialised teams of doctors. DR OLE WIESINGER: This structure enables tasks to be We call this type of organisation the “system provider ap assigned in a way that has proven practical in top manage proach”. ment of companies of our size. The Executive Committee (EXCO) is responsible for the long-term strategic planning SO THE PROFILING OF THE HOSPITALS IS NOT AIMED of the company, something which is incredibly important AT STRENGTHENING THE PARTICULARLY PROFITABLE due to the growing complexity involved. In contrast, the RANGE OF SERVICES FOR PRIVATE PATIENTS? Operations Committee (OPSCO) deals with implementing corporate strategies and optimising performance in the DR OLE WIESINGER: Accusations of cherry picking have here and now. always been unfounded – more so today than ever before. 15 of our 16 hospitals are on the hospital list of their re WHO IS ON THE OPERATIONS COMMITTEE? spective cantons. This means that we are obligated to admit patients with basic insurance without restrictions, which DR DANIEL LIEDTKE: The OPSCO includes both hospital is also exactly what we wish to do. The proportion of pa managers and managers from the Corporate Office, who tients with basic insurance has risen once again in the then jointly assume operational responsibility for the Group. last financial year and now stands at 43.5 percent, with This means we can achieve close co-operation between some sites even reaching figures above 60 percent. headquarters and the organisational units, make decisions that enjoy wide support and ensure a consistent imple THE TASKS ASSIGNED TO HEADQUARTERS, THE CORPO- mentation of the group strategy. RATE OFFICE, AND THE OPERATIONAL UNITS ARE BEING PUT ON A NEW FOOTING AT HIRSLANDEN. WHAT DOES THIS MEAN IN PRACTICE?

MAGNUS OETIKER: In the coming years, we will be standard ising and further centralising many non-medical services. By doing this, the workload for the hospital management on site will be reduced, thereby enabling it to concentrate fully on its main task – namely to enhance patient benefits as previously mentioned. By combining such services, we can also achieve significant economies of scale. We want to fully utilise the potential here for reducing costs. Only if we exploit group benefits to the full can we also continue to grow profitably while tariffs are falling.

ANDREAS KAPPELER: This not only applies to the growth of our existing range of services. Unifying and centralising support functions is also necessary for growth through the acquisition or development of new operational units. These can then be integrated much easier into the Group and benefit from group-wide standards right from the outset.

DR OLE WIESINGER: We would also like public hospitals to take advantage of these group benefits, for example by our taking on management tasks on a contractual basis. Thanks to our size and the associated economies of scale, we would be able to improve the cost structure in pur chasing and other non-medical areas and thus reduce the burden on taxpayers and health insurance companies. 6 FINANCIAL YEAR END-OF-YEAR REVIEW 2015/16

KLINIK BIRSHOF APRIL MAY JULY Daniela de la Cruz (43) becomes new Hospital Man CLINIQUE LA COLLINE KLINIK BIRSHOF KLINIK IM PARK ager at Klinik Birshof in Clinique la Colline becomes Klinik Birshof celebrates the Klinik Im Park opens the Münchenstein. From 2006, one of the first hospitals grand opening of its new VorsorgeZentrum Zürich, she worked for the Ministry in Switzerland to introduce radiology facilities, which which offers patients of Finance and Healthcare the second generation of have been expanded to individual preventive pro- of the Canton of Glarus – 2 the O-arm®. This machine 600 m and include new MRI, grammes for maintaining and most recently headed enables high-precision 3D CT and X-ray equipment. good health and the the Department of Health imaging during orthopaedic The hospital can now offer screening of diseases. Ex care. and neurosurgical opera a full range of services aminations made at the tions – and all with minimal across the entire treatment VorsorgeZentrum Zürich exposure to radiation. chain, from diagnosis and are based on the interna SEPTEMBER treatment right through to tionally recognised guide physiotherapy and ergo lines from the US Preventive KLINIK ST. ANNA Service Task Force. therapy. A state-of-the-art “Da Vinci” surgical robot was put into ANDREASKLINIK operation in the urology de The Swiss Federal Admin partment at Klinik St. Anna istrative Court upholds back in January 2015. Other the complaint made by departments are now also AndreasKlinik on the restric reaping the benefits, with tion in the number of beds. the specialists in the visceral The hospital lodged the HIRSLANDEN BERN surgery team successfully complaint in 2011 after the The Hirslanden hospitals in carrying out robot-assisted Governing Council of the Bern take part in the in operations since September. dependent benchmark study HIRSLANDEN KLINIK Canton of Zug restricted the “Great Place to Work®” for number of beds for patients AARAU KLINIK HIRSLANDEN from the canton to 37. the first time, and take sec The Hirslanden Klinik Aarau Around 170 pupils from ond place in the “Healthcare wins the Hirslanden Award Balgrist primary school and Social Affairs” category. for the successful introduc spend a day learning from AUGUST tion of a treatment concept specialists in the field of KLINIK ST. ANNA for quick recovery following resuscitation to mark inter CLINIQUE BOIS-CERF Klinik St. Anna recruits replacement of the knee or national World Heart Day. Hirslanden Lausanne opens Dr Gerson Strubel – one of hip joint. This treatment con The goal of the event is to another facility – the Institut the few specialists in the cept leads to added patient raise the children’s long- de radiologie de l’ouest field of lymphology in safety, promotes a swift term awareness of the issue lausannois (IROL). The centre Switzerland. The Hirslanden return to normal everyday and reinforce their civil offers patients the latest hospital in Lucerne will now life and increases patient courage. be the place to go for pa satisfaction. radiological devices across tients with lymphoedemas 600 m2 of floor space. and lipoedemas from across Switzerland. JUNE April also sees the commis sioning of the multi-func CLINIQUE LA COLLINE tional urology room, includ Stéphan Studer (40) is ap ing a lithotripter for the pointed as Hospital Manager treatment of kidney stones. of Clinique la Colline. In taking this step, the Geneva native is giving up his sec CLINIQUE CECIL ond career as a football ref Jean-Claude Chatelain (68) eree, something he has been becomes new Hospital doing for 24 years – includ Manager at Clinique Cecil. ing as a FIFA-listed interna He has long-standing ex tional referee since 2009. perience in the Swiss health care system and hospital HIRSLANDEN BERN management in particular As part of the inaugural and served for several years “World Pancreas Forum” in as Chairman of the Hospital Bern, Klinik Beau-Site Directors’ Conference of broadcasts two pancreas Western Switzerland and operations from the operat Ticino. ing theatre to an interna tionally renowned audience. FINANCIAL YEAR 7

CLINIQUE CECIL HIRSLANDEN FRIBOURG OCTOBER Clinique Cecil has two rea DECEMBER The Hirslanden practice sons to celebrate. Firstly, centre in Düdingen opens KLINIK STEPHANSHORN there is the opening of the KLINIK HIRSLANDEN its doors following a nine- Klinik Stephanshorn re expanded operation wing, The second research day month renovation. It offers ceives four stars from the featuring the first cardio at the Hirslanden Private a range of outpatient ser European Foundation for vascular hybrid operating Hospital Group sees doctors vices for the local region, Quality Management (EFQM) theatre in French-speaking discussing the latest re including family doctors, for outstanding quality Switzerland. Secondly, the search topics, coordinating specialists and radiology management – the first and new outpatient surgical studies within the Group facilities. so far only hospital in the centre also opens its doors. and evaluating the needs canton of St Gallen to re- of researchers. ceive this award. As a result, the hospital achieves the KLINIK ST. ANNA EFQM level “Recognised Klinik St. Anna expands its for Excellence”. site at Lucerne railway station further. New prac tices broaden the clinical NOVEMBER spectrum, with an additional 3 Tesla MRI scanner also KLINIK AM ROSENBERG integrated. KLINIK BELAIR Klinik Am Rosenberg suc HIRSLANDEN KLINIK The Praxiszentrum am Bahn cessfully passes the ISO AARAU hof Schaffhausen looks back maintenance audit according Radio Argovia reports live JANUARY on a successful and exciting to ISO 9001:2008 without from Hirslanden Klinik Aarau first year. The centre is used conditions being imposed. as part of an all-day show KLINIK HIRSLANDEN for both short-term walk-in It also receives the EFQM In January, Klinik Hirslanden dedicated to cardiac health. consultations and long-term certification “Committed to opens ENDOMIN – a centre In the morning, the show family doctor services. Excellence”, which confirms for endoscopic and minimally features a cardiac operation Dr Peter Werder (42) also that the hospital successfully invasive neuro-surgery. by Prof. Thierry Carrel and joins Klinik Belair as its new puts elements of an out As the name suggests, the PD Dr Lars Englberger, Hospital Manager. From standing management sys centre offers optimal surgical while listeners can follow 2011 to 2015, he was Head tem into practice. results with the lowest pos operations in the cardiac of Corporate Communica sible burden on the patient. catheterisation laboratory tions at the Hirslanden KLINIK BIRSHOF in the afternoon. Private Hospital Group. Klinik Birshof achieves the CLINIQUE BOIS-CERF EFQM level “Recognised for An extension to the ophthal Excellence” with three stars. mology department features MARCH new examination rooms, ANDREASKLINIK a second operating theatre KLINIK BIRSHOF Following a two-month and a treatment room for In March, Klinik Birshof renovation, AndreasKlinik refractive surgery. opens its new reception celebrates with an open day area and the new to mark the reopening of HIRSLANDEN KLINIK restaurant “le bistouri”. its obstetrics department. AARAU As a result of the growing KLINIK ST. ANNA HIRSLANDEN KLINIK demand for specialist medi Klinik St. Anna expands its MEGGEN cine, Hirslanden Klinik Aarau AltersunfallZentrum for Andrea Bazzani is appoint invests in the expansion elderly patients and receives ed as the new Hospital and renovation of the emer the appropriate certifica Manager of Hirslanden Klinik gency centre, renovations tion – the first Hirslanden Meggen. She takes over to the intensive care unit and hospital to do so. from Jost Barmettler, who the latest largescale equip is retiring. ment for the cardiac cathe terisation laboratory and KLINIK IM PARK radiotherapy. Klinik Im Park renovates and expands its A&E unit. The new unit is expected to open around the clock from summer 2016, and will fea ture six individual emergency berths and an outpatient clinic. 8 FINANCIAL YEAR CONSOLIDATED FIGURES

THE MOST IMPORTANT CONSOLIDATED FIGURES FOR 2015/16 WITH THE COR- RESPONDING COMPARATIVE FIGURES FOR THE PREVIOUS YEARS

Change compared to 2012/13 2013/14 2014/15 2015/16 2014/15 in %

Patients

Patients, maternity patients1 82,653 87,248 94,037 98,609 5%

Patient days2 396,488 418, 7 1 1 453,741 469,167 3%

Length of stay 4.8 4.8 4.8 4.8 –1%

Turnover

Turnover total (in CHF, millions) 1,314 1,437 1,563 1,647 5%

Turnover inpatient services (in CHF, millions) 1,010 1,114 1,222 1,288 5%

Turnover outpatient services (in CHF, millions) 241 252 262 275 5%

Other operating income (in CHF, millions) 63 71 79 85 8%

Number of employees

Average FTEs3 5,065 5,530 6,213 6,573 6%

1 Inpatient admissions, without newborns 2 Based on midnight census, without newborns 3 Apprentices, students and interns uniformly weighted, incl. employed doctors FINANCIAL YEAR 9 ORGANISATIONAL STRUCTURE

MEDICLINIC INTERNATIONAL / BOARD

Corporate Executive Office / Communication Company Secretariat F. Nehlig M. Seikel (from June 2016) Chief Executive Officer Dr O. Wiesinger

Public Affairs Legal & Compliance U. Martin C. Dusold

Chief Operating Officer * Chief Clinical Officer * Chief Strategy Officer Chief Financial Officer Dr D. Liedtke Dr C. Westerhoff M. Oetiker A. Kappeler

Klinik Beau-Site Klinik Stephanshorn Clinical processes & ICT & Processes * Group Finance * Dr C. Egger A. Rütsche concepts C. Meyer S. Warthmann Hospital Manager Hospital Manager D. Ostovan Human Resources * Corporate Controlling Salem-Spital Klinik Am Rosenberg M. Zürcher P. Aregger N. Schnitzler A. Rohner Coding centre Zurich Hospital Manager Hospital Manager Real Estate Revenue Management * Bern Site Coding centre Bern D. Hauswirth L. Eichenberger Klinik Permanence AndreasKlinik D. Freiburghaus Cham Zug Quality Management / Corporate Procurement & Supply Hospital Manager Dr U. Karli Hygiene / Development Chain Management * Hospital Manager Patient safety R. Baumgartner A. Heinzmann Clinique Cecil J.-C. Chatelain Hirslanden Klinik Aarau * Nursing science Finance / Administra Hospital Manager P. Keller Organisational tion Bern Site Hospital Manager Medical data analysis development C. Streit Clinique Bois-Cerf C. Bossart Klinik Birshof Radiation safety & Hospital Manager Lausanne Site D. de la Cruz rad. processes Risk, Assurance & Hospital Manager Advisory Klinik Hirslanden * Swiss Tumor Institute Dr C. Müller Klinik Belair Hospital Manager Dr P. Werder Hospital Manager Klinik Im Park

S. Eckhart Zurich Site Clinique La Colline Hospital Manager S. Studer Hospital Manager Klinik St. Anna * Dr D. Utiger Hospital Manager Radiotherapie Hirslanden Hirslanden Klinik Dr C. von Briel Meggen Manager

A. Bazzani Site Lucerne Hospital Manager Business Development * Dr S. Pahls

Marketing J. Buro

Hirslanden Executive Committee International Hospitals / Business Units Corporate Office Corporate Office: direct reporting departments / admin. functions disciplinary management * Member Operations Committee As of 31.3.2016 (OPSCO) 10 FINANCIAL YEAR OVERVIEW OF INVESTMENTS 2015/16

The Hirslanden Private Hospital Group continued to invest consultations and treatment in Hirslanden hospitals thanks in real estate and movables in the 2015/16 financial year, with to outpatient practice centres, such as the one opened in the total investment volume amounting to CHF 144 million. Düdingen in January 2016. With ongoing investments in new hospital sites and the technical infrastructure, the Hirslanden Private Hospital The table below gives an overview of the most important Group is fully implementing its growth strategy and con investments in real estate and movables in the last tinuously creating added value for both patients and financial year. affiliated doctors.

The growth strategy at Hirslanden focuses on the realisation of an integrated healthcare network that strengthens re gional partnerships at the hospitals. In this network, patients receive rapid access to general and specialist medical

Hospital Project Total project volumes

Klinik Stephanshorn Ward block and A&E department 7,000

Klinik Birshof Radiology facilities and doctors’ practices 17,000

Clinique Bois-Cerf Renovation of ophthalmology operating theatre 2,800

Clinique Bois-Cerf Institut de radiologie de l’ouest lausannois (IROL) 4,600

Klinik Hirslanden Second CT device 3,260

Clinique Cecil Hybrid operating theatre and outpatient clinic 19,950

Hirslanden Fribourg Praxiszentrum Düdingen 6,700

Hirslanden Klinik Aarau Intensive care unit, recovery room and A&E 8,700

Hirslanden Klinik Aarau Linear Accelerator 3,250

Klinik Hirslanden Replacement of refrigeration plant 3,400

Klinik Im Park Renovation of A&E 3,700

Klinik Hirslanden Linear Accelerator 2,960

Klinik St. Anna Expansion of operating capacity 2,950

Klinik Stephanshorn Expansion of operating capacity 2,900

Projects starting from CHF 1 million; amounts in 1,000 FINANCIAL YEAR 11

KLINIK BIRSHOF CLINIQUE BOIS-CERF

Following 18 months of planning and construction, Since August 2015, the “Institut de radiologie de l’ouest Klinik Birshof opened new doctors’ practices and a lausannois” (IROL) has treated patients from the region radiology unit in May 2015. five days a week.

m2 of floor space in the new radiology m2 of floor space at the IROL 600 department 600 16 new treatment rooms 2 experienced radiologists head up the IROL state-of-the-art radiology devices are new doctors’ practices 14 6 used in the IROL

CLINIQUE CECIL HIRSLANDEN FRIBOURG

Since the start of November 2015, Clinique Cecil in With the Praxiszentrum Düdingen, patients from the Lausanne boasts an outpatient surgical centre and the Sense region can take advantage of an expanded range first cardiovascular hybrid operating theatre in of medical services, from family doctor services to Western Switzerland. diagnostic radiology.

900 m2 of floor space in the new centre 20 new jobs 9 day beds in the outpatient surgical centre 9 doctors 80 m2 of space in the hybrid operating theatre 12 medical specialists 12 FINANCIAL YEAR HR REPORT: SATISFIED EMPLOYEES ARE THE BEST ADVERTISEMENT

THE STAFF ARE THE MOST IMPORTANT RESOURCE OF A HEALTH- CARE GROUP. HOWEVER, WELL-QUALIFIED PERSONNEL ARE FEW AND FAR BETWEEN ON THE EMPLOYMENT MARKET, ESPECIALLY THOSE WORKING IN PROFESSIONS IN GENERAL OR SPECIALISED NURSING CARE. THIS IS WHY HIRSLANDEN IS MAKING GREAT EFFORTS, BOTH IN PROMOTING ITS EXISTING EMPLOYEES AND RETAINING THEM OVER THE LONG TERM AND ALSO IN ACQUIRING THE BEST TALENT AVAILABLE FOR THE COMPANY.

STAFF LOYALTY COMES FROM THE HEART RECRUITING AND RETAINING The main incentive for retaining staff over the long term lies THE BEST TALENT in their emotional connection to their workplace and team. The many awards in the reporting year confirm that Hirslanden With this in mind, Hirslanden’s parent company Mediclinic is an attractive employer and is perceived as such by others. has launched the “Employee Engagement” programme as For example, Hirslanden Bern was immediately named part of an international HR strategy. Hirslanden also carried “Best Employer in Switzerland” in the “Great Place to Work®” out the “Your Voice” staff survey for the first time in 2015. benchmark study. A study by the world’s largest employer Scheduled every four years, the goal of the survey is to record, branding company Universum also illustrated just how strong analyse and ultimately improve the emotional connection students consider the “Hirslanden” brand name to be. Of and job satisfaction of employees. When compared to our 50 companies in the medical/healthcare sector, Hirslanden sister companies in Dubai and South Africa, Hirslanden had was third in popularity among students. Awards such as the highest participation rate in the survey (78 percent). these help to position Hirslanden optimally on all media The results of the survey were even more pleasing, with the channels and at trade fairs and conferences, and also to Hirslanden Private Hospital Group achieving good results recruit the most talented young professionals. These efforts in terms of both employee satisfaction (3.94 points out of have not gone unnoticed, with the latest “Best Recruiter” 5) and emotional connection (3.85 points out of 5). The selecting Hirslanden as the sixth best recruiter among the results will be analysed in detail in the coming months and top 89 employers in Switzerland – and the best in the measures taken towards increasing emotional connection healthcare sector. and satisfaction.

8,750 employees (without employed doctors) 6,730 female employees 2,020 male employees 78 percent participation rate in the staff survey 3.94 points out of 5 for employee satisfaction at Hirslanden points out of 5 for emotional connection 3.85 of employees at Hirslanden FINANCIAL YEAR 13 HEALTH POLICY: A FREE CHOICE OF HOSPITALS? NOT IF SOME CANTONS CAN HELP IT!

FOUR YEARS HAVE PASSED SINCE THE NEW HOSPITAL FUNDING SCHEME CAME INTO EFFECT. THE INITIAL PROBLEMS HAVE SINCE BEEN SMOOTHED OUT AND THE NEW SYSTEM IS NOW STARTING TO TAKE EFFECT. HOWEVER, NOT EVERYONE IS A FAN OF COMPETITION. THIS IS WHY SOME CANTONS ARE TRYING TO NULLIFY THE FREE CHOICE OF HOSPITALS IN THEIR MULTIPLE ROLE AS HOSPITAL OWNERS, WHICH IS A PROBLEMATIC DEVELOPMENT.

In Bern, a hospital has been converted into a refugee centre, RESTRICTIONS IN WESTERN SWITZERLAND while public hospitals in many other cantons are report‑ Another example can be seen in the allocation of quotas to ing financial losses – with some even cutting jobs. At the private hospitals in Western Switzerland. Certain cantons same time, private hospitals are succeeding in gaining only allocate an extremely limited quota to private hospitals significant market shares each year. Four years after the within the canton. This is in contrast to public service pro introduction of the new hospital funding scheme, and the viders, which are given much greater freedom. Moreover, effects of the reform are gradually becoming more visible. the cantons do not allow the treatment of patients in private The competition strived for by the federal legislator is hospitals outside the canton. Several legal proceedings becoming reality, much to the chagrin of many cantons – are ongoing here. not least in their position as hospital owners. This is why these cantons are leaving no stone unturned in trying to prevent the free choice of hospitals. CANTONS IN THE COURTROOM The third example affects German-speaking Switzerland. One canton complained that the hospital planning in two QUESTIONABLE REFERENCE TARIFFS other cantons was improper, and its claims were upheld by In theory, the base prices in the cantons ought increasingly the Swiss Federal Administrative Court. While the motives to conform to the new hospital funding scheme, with the behind taking legal action are understandable, the conse reimbursement of hospitals then dependent on the severity quences of the two verdicts are highly uncertain. Many of the case in question. Different compensation payments cantons are postponing revisions to their hospital lists for could then be explained through lower tariffs for the treat fear of also ending up in court, which means the status quo ment of less complex cases within the canton and higher remains firmly in place for the time being. However, in the tariffs for more complex procedures at specialist hospitals medium term there is the risk that the cantons will come to and university hospitals outside the canton. a mutual arrangement on hospital planning in their role as hospital owners and bypass the private hospitals entirely. However, in practice the exact opposite is the case. For This would be contrary to the will of the federal legislator, example, some cantons in Western Switzerland pay a base which has stated that public and private service providers price for a simple hand operation within the canton that is must be treated equally. almost CHF 1,000 more than for an open-heart quadruple bypass operation outside the canton. Due to the fear of The Hirslanden Private Hospital Group is committed to free losing patients from their own hospitals to private hospitals, and fair competition and will do everything in its power to the reference tariffs for hospital treatments outside the ensure this. For this reason, it is important to prevent restric canton are arbitrarily set so low that healthcare providers tions to competition and to draw attention to cases of un from outside the canton are no longer interested in treat‑ equal treatment. The revised Swiss Federal Law on Health ing these patients. By introducing the new hospital funding Insurance must be implemented according to the will of the scheme, the goal of the federal legislator was exactly the federal legislator so that patients are free to choose their opposite – to promote competition across cantonal borders desired hospital according to quality and efficiency criteria – instead of creating tariff-related obstacles. irrespective of the canton. 14 QUALITY IMPROVING THE QUALITY OF TREATMENT AND INCREASING PATIENT BENEFITS

FOR OVER TEN YEARS, THE HIRSLANDEN PRIVATE HOSPITAL GROUP HAS ACQUIRED LARGE AMOUNTS OF QUALITY DATA AND HAS PUBLISHED THIS IN AN ANNUAL/QUALITY REPORT SINCE 2010. THE ACQUISITION AND PUBLICATION OF THIS DATA HELPS TO IMPROVE THE QUALITY OF TREATMENT IN SWISS HOSPITALS AND THE COMPETITION BETWEEN THEM.

The primary goal of the Hirslanden Private Hospital Group bodies in the field of quality management. These bodies is to generate patient benefits. In order to achieve this are also responsible for deriving the relevant measures goal and consistently increase patient benefits, treatment from the results and thus ensuring a continuous process quality and patient safety have to be guaranteed. Each of improvement. year, Hirslanden analyses whether this takes place and to what extent as part of several comprehensive quality Hirslanden has several bodies involved in assessing and measurements, with the resulting performance indicators maintaining quality. These include the cross-departmental published in the quality report. In this financial year, the quality commission, a hygiene committee and a committee full quality report for 2015/16 will be published online for on critical incidents (Critical Incident Reporting System, the first time. The print version of the quality report gives CIRS) at every hospital, plus the position of Head of Clinical a brief overview of the most important information and Services, which has been in place at every Hirslanden hos performance indicators from the corresponding surveys. pital since 2014. The Head of Clinical Services supports the hospital managers in matters relating to the quality of medi cal care and patient safety, and is tasked with supervising MEASURING QUALITY the provision of medical services. He is also responsible for Measuring the quality of medical care is an extensive and ensuring the regulatory requirements and cantonal perfor complex task that requires a great deal of commitment from mance mandates are implemented correctly. all hospitals. When measuring quality, Hirslanden bases its results on clinical performance indicators that have been developed and improved over many years, together with COMPARING RESULTS national and international healthcare guidelines. By using As previously mentioned, one advantage of making continu the same surveys at each hospital, those with a similar ous group-wide quality measurements is that comparisons range of services can be compared with one another and can be made between hospitals and benchmarks derived specific benchmarks can be derived from the results. accordingly. These are always based on the principles of best practice. However, not only the results are compared. The These benchmarks help when assessing performance and quality management teams at the hospitals are also in con defining measures for further improvements – both in terms stant contact with each other in order to draw up concrete of treatment quality and patient safety. Furthermore, the measures and proactively prevent losses in quality. The fact acquisition of national and international performance indi that Clinical Services has been represented on the Execu cators also allows comparisons to be made with hospitals tive Committee since the start of the financial year shows at home and abroad. just how important measuring, analysing and improving quality is at Hirslanden.

UNDERSTANDING THE QUALITY MEASUREMENTS In order to understand the methods and basic principles involved in the different quality surveys, an in-depth look at the material involved is required. However, it is not only the acquisition itself that has to be looked at from a range of different viewpoints – the complexity of the results themselves also demands comprehensive analysis and inter pretation. The results of the quality measurements are analysed and assessed at Hirslanden by different specialist QUALITY 15

QUALITY OF MEDICAL CARE IN Hirslanden sees the ANQ measurement plan as a helpful SWITZERLAND instrument for comparing the quality of Swiss hospitals, There are many initiatives for improving the quality of medical and complements it by acquiring additional indicators. On care in Switzerland, which shows how committed the the following pages, you will find detailed information on country is to ensuring a high-quality, constantly improving patient satisfaction, unplanned readmissions, unplanned healthcare system. As a member of various bodies in the reoperations and falls. Moreover, Hirslanden also publishes field of quality improvement, Hirslanden is also making an data on infection monitoring and patient safety, plus data active contribution here. Among others, the Hirslanden on mortality in intensive care units and according to CH-IQI Private Hospital Group is a member of the National Association (Swiss Inpatient Quality Indicators; quality indicators for for Quality Development in Clinics and Hospitals (ANQ). Swiss acute care hospitals from the Swiss Federal Office of The association is funded by the H+ hospital association, Public Health). the cantons, the Association of Health Insurers (santésuisse), and the Swiss social insurance agencies. Its goal is to find ways of uniformly measuring quality results in Swiss hospi QUALITY OF MEDICAL CARE AT HIRSLANDEN tals and then using these results to establish approaches IN THE 2015/16 FINANCIAL YEAR for improving quality. Various quality indicators collected annually by Hirslanden are presented and discussed on the following pages. How The ANQ measurement plan includes the following indica ever, a brief summary of the key results should enable an tors for acute somatic medicine: overview to be gained in advance of the most important changes: In the ANQ survey of patient satisfaction, Hirslanden • Rehospitalisation rate (SQLape) has achieved a slightly lower score of 9.2 (previous year: • Reoperation rate (SQLape) 9.5). The figures for the indicators “unplanned readmissions”, • Postoperative wound infections (with Swissnoso) “unplanned reoperations” and “documented falls” have • Patient satisfaction fallen slightly compared with the previous year. In the area • Prevalence of decubitus (LPZ) of infection monitoring, the rate of catheter-associated • Prevalence of falls (LPZ) sepsis has increased. The other reported infection rates have • Implant register SIRIS improved further on the previous year. The effective mor tality rate of patients admitted to the intensive care unit has increased from 3.2 percent to 4.1 percent. The reasons for this lie in the rise in both the number of patients with concomitant illnesses and case numbers in heart medicine. 16 QUALITY PATIENT SATISFACTION

PATIENT SURVEYS ARE AN INTEGRAL PART OF QUALITY MANAGEMENT AT THE HIRSLANDEN PRIVATE HOSPITAL GROUP. THIS IS THE ONLY WAY TO ENSURE THAT THE HOSPITALS CONTINUALLY IMPROVE IN MEETING THE NEEDS OF PATIENTS AND THUS INCREASE PATIENT BENEFITS.

Surveys of patient satisfaction vary according to their scope Each year, the patient surveys illustrate the potential for and depth. While some surveys provide a global – and thus further improvements and developments in patient treat less detailed – analysis of patient satisfaction, other surveys ment and are thus an important element in increasing focus on qualitative aspects. These allow patients not only patient benefits. to award points, but also to freely express their opinions on their experiences. Both of these survey types have their The patient surveys in 2015 have revealed a slight change. advantages, which is why the Hirslanden Private Hospital The ANQ survey has achieved an average score of 9.4 Group combines both qualitative and quantitative methods (previous year: 9.5) and 83 percent of patients would “abso by using the “National Patient Survey” from the National lutely” recommend the Hirslanden hospital they visited to Association for Quality Development in Clinics and Hospitals family and friends (previous year: 84 percent). The results (ANQ) and the HCAHPS survey (Hospital Consumer Assess lie within the confidence interval. ment of Healthcare Providers and Systems). The answers to the few global questions asked by ANQ are combined with the detailed responses from HCAHPS to provide a compre hensive overview of patient satisfaction at the hospitals of the Hirslanden Private Hospital Group. Another advantage of integrating the HCAHPS questions is that they also high light the interactions between patients and nursing staff – a key aspect of patient welfare.

52 percent return rate for the ANQ patient survey out of 10 points at Hirslanden hospitals for the question “Would you come back to this hospital for 9.4 the same treatment?” percent of patients would “absolutely” recommend the 83 Hirslanden hospital they visited to their family or friends QUALITY 17

NATIONAL PATIENT SURVEY (ANQ) The National Association for Quality Development in Clinics The 2015 National Patient Survey was held last September. and Hospitals (ANQ) conducts the “National Patient Survey” Some 6,127 patients received the questionnaire after their each year in order to measure patient satisfaction. This discharge from a Hirslanden hospital; the return rate was consists of five questions, which are a binding part of the 52 percent. The responses to the first of the five questions ANQ measurement plan: are shown in the graph. The possible answers to all ques tions ranged from 0 (in the case of question 1 = “not at all”) 1. Would you come back to this hospital for the same to 10 (in the case of question 1 = “absolutely”). The figures treatment? arising from the responses to question 1 have proven to be 2. How do you assess the quality of the treatment you robust indicators of global patient satisfaction. received? 3. If you asked a doctor questions, did you understand the answers? 4. If you asked the nursing staff questions, did you understand the answers? 5. Were you treated with respect and dignity during your stay in hospital?

AA Hirslanden Klinik Aarau AK AndreasKlinik Cham Zug CC Clinique Cecil, Lausanne BE Klinik Belair, Schaffhausen BS Klinik Beau-Site, Bern LC Clinique La Colline, Geneva ST Klinik St. Anna, Lucerne SH Klinik Stephanshorn, St Gallen PM Klinik Permanence, Bern RO Klinik Am Rosenberg, Heiden MG Hirslanden Klinik Meggen HI Klinik Hirslanden, Zurich SA Salem-Spital, Bern BC Clinique Bois-Cerf, Lausanne BI Klinik Birshof, Münchenstein Basle IP Klinik Im Park, Zurich

ANQ, QUESTION NO. 1: “WOULD YOU COME BACK TO THIS HOSPITAL FOR THE SAME TREATMENT?” (2012 TO 2015) 9.6 10.0 9.3 9.7 9.5 9.5 9.5 9.5 9.6 9.6 9.4 9.4 9.3 9.1 9.4 9.5 9.2 9.5 9.2 9.2

9.0

8.5

8.0

7.5

7.0 AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Average Total Hirslanden popula- tion 2012 2013 2014 2015 Conﬁdence interval

For an explanation of the terms, see the glossary, p. 50 18 QUALITY

AN ADDITIONAL WAY TO MEASURE PATIENT SATISFACTION The ANQ survey is limited to five questions and thus only the USA. The HCAHPS questions allow for qualitative re gives a global view of patient satisfaction. Furthermore, sponses, which not only leads to a more nuanced picture of virtually all Swiss hospitals achieve a score of between 9 and patient satisfaction, but also provides valuable pointers 10, which reduces the significance of the results. Hirslanden for improvement. therefore supplements its survey of patient satisfaction with additional questions from the HCAHPS survey (Hospital The responses to the following question are shown in the Consumer Assessment of Healthcare Providers and Systems). graph: “Would you recommend this hospital to your family Pronounced “H-caps”, it is the first ever national, standardised and friends?” This question is comparable to the first and published survey of patient satisfaction at hospitals in ANQ question.

HCAHPS, QUESTION NO. 31: “WOULD YOU RECOMMEND THIS HOSPITAL TO YOUR FAMILY AND FRIENDS?”

100% 10.8% 4.6% 14.4% 13.9% 12.4% 14.6% 13.9% 14.9% 13.3% 13.9% 90% 16.8% 15.8% 15.2% 18.5% 20.6% 17.5% 22.8% 80%

70%

60%

50%

40%

30%

20% 83.9% 79.4% 85.2% 86.9% 82.7% 85.1% 92.4% 77.9% 82.7%

10% 83.0% 85.3% 80.8% 77.6% 88.0% 85.0% 85.0% 74.9%

0% AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Total

Yes, deﬁnitely Probably Probably not No, deﬁnitely not QUALITY 19

While the ANQ survey only has one question about nursing during your hospital stay?” Hirslanden hospitals scored care (question 4: “If you asked the nursing staff questions, a good to very good rating for most questions. However, did you understand the answers?”), the HCAHPS survey as in previous years a number of questions also showed contains around twelve questions for assessing the interac that there is still potential for improvement. tions between patients and nursing staff. Examples of such questions include “During this hospital stay, how often did nurses treat you with courtesy and respect?” or “How often did the nursing staff make every effort to relieve your pain

HCAHPS, QUESTION NO. 10: “DURING THIS HOSPITAL STAY, HOW OFTEN DID NURSES TREAT YOU WITH COURTESY AND RESPECT?”

100% 10.8% 13.9% 12.0% 10.3% 13.5% 13.0% 90% 17.3% 19.1% 19.2% 19.7% 17.6% 17.4% 18.6% 22.4% 20.4% 22.8% 23.4% 80%

70%

60%

50%

40%

30%

20% 78.8% 79.1% 80.9% 76.3% 85.7% 87.0% 89.2% 73.9% 79.6%

10% 81.2% 85.0% 86.4% 88.8% 77.3% 80.8% 80.2% 75.2%

0% AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Total

Always Usually Sometimes Never 20 QUALITY UNPLANNED READMISSIONS, UNPLANNED REOPERATIONS AND FALLS

BASED ON THE PRINCIPLES OF THE INTERNATIONAL QUALITY INDICATOR PROJECT, THE HIRSLANDEN PRIVATE HOSPITAL GROUP COLLECTS DATA ON THE MAIN INDICATORS “UNPLANNED READMISSIONS, UNPLANNED REOPERATIONS AND DOCUMENTED FALLS”, AND THUS MAKES AN IMPORTANT CONTRIBUTION TO EVALUATING QUALITY OUTCOMES IN MEDICINE.

The acquisition of the aforementioned indicators is based All three main indicators collected by Hirslanden improved on the International Quality Indicator Project (IQIP), in the 2015 calendar year. In other words, there were fewer which was developed in 1985 by hospitals in the US state of unplanned readmissions and reoperations, and fewer docu Maryland. With over 2,000 healthcare companies taking mented falls. part worldwide, the IQIP was the most important research project for evaluating quality outcomes in medicine. In When interpreting the measurements, it is necessary to bear Europe alone, 200 hospital companies announced their two points in mind. First, differences between hospitals intention to take part in the IQIP measurements. The project must also be construed within the context of the range of was terminated in 2013 following its acquisition by US services that respective hospitals provide. Second, a reliable research company Press Ganey. Nevertheless, Hirslanden statement about any trends is only possible after compar continues to apply the IQIP standard of its own accord. ing several years because the changes measured each year are smaller than the confidence intervals, which indicate While it is no longer possible to compare IQIP measure the bandwidth within which the true figure is in all likelihood ments internationally, both the comparison within the to be found (95 percent). The range of the confidence in Group and the analysis of how the individual results at the terval depends on a number of factors. The frequency of the hospitals have developed over time remain possible. type of incident in question is particularly significant. The These figures provide key pointers in specifying possible lower the frequency, the wider the confidence interval. improvement measures and thus ensure a continuous im provement process. This process comprises three steps: The responsible hospital boards first analyse and interpret the results, specific optimisation and prevention measures are drawn up, and these measures are finally exchanged during group-wide networking meetings while following best practice.

percent of patient discharges are made without 98.7 unplanned readmission percent of operations are carried out without 98.7 unplanned reoperations 998 out of 1,000 treatment days without falls QUALITY 21

UNPLANNED READMISSION The percentage score for the “unplanned readmission To guarantee the relevance of the “unplanned readmission” within 15 days” indicator is marginally up on the previous indicator, hospitals must, in accordance with guidelines, year. However, the survey is not risk-adjusted, and this differentiate precisely between unplanned and planned read hinders comparison. missions when carrying out the survey. For example, planned readmissions include several cycles of chemotherapy. As registration audits at Hirslanden hospitals have shown, such distinctions do not yet apply properly at all sites.

Unplanned readmission (<= 15 days) (2011–2015)

1.8 1.6% 1.6 1.4% 1.3% 1.3% 1.4 1.1% 1.2 1.1%

1.0 0.9%

0.8

0.6

0.4

0.2

n/an/a n/a 0.0 2011 2012 2013 2014 2015

Europe Hirslanden Conﬁdence interval

Unplanned readmission (<= 15 days), data 2015 AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Total

Number of discharges 10,258 6,620 3,463 9,885 4,166 3,837 3,898 3,592 3,853 11,977 1,180 3,269 1,431 7,313 18,963 7,021 100,726

Number of unplanned 125 153 19 108 44 63 29 45 54 269 6 15 14 75 217 52 1,288 readmissions

% 1.22 2.31 0.55 1.09 1.06 1.64 0.74 1.25 1.40 2.25 0.51 0.46 0.98 1.06 1.14 0.74 1.28 22 QUALITY

UNPLANNED RETURN TO THE OPERATING THEATRE The “unplanned return to the operating theatre” percentage In terms of the individual values measured for this indicator, score is slightly down compared to the previous year. the question also arises as to whether planned reoperations However, since the confidence intervals for the years 2014 were incorrectly included in the data. For example, regular and 2015 overlap considerably, one cannot conclude that dressing changes in the operating theatre should not be the value has improved. counted as part of the data.

Unplanned return to the operating theatre (2011–2015)

1.6% 1.4% 1.4% 1.3% 1.4% 1.2% 1.1% 1.1% 1.2% 1.0% 1.0%

1.0%

0.8%

0.6%

0.4%

0.2%

n/a n/a 0.0% 2011 2012 2013 2014 2015

Europe Hirslanden Conﬁdence interval

Unplanned return to the operating theatre, data 2015 AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Total

Number of operations 6,688 5,398 3,630 8,522 3,102 3,392 3,901 2,772 2,678 8,000 1,126 3,236 1,439 5,509 13,712 7,049 80,154

Number of cases of unplanned return to 142 168 16 69 36 44 17 6 37 118 6 11 14 65 264 69 1,082 the operating theatre

% 2.12 3.11 0.44 0.80 1.16 1.30 0.44 0.22 1.38 1.48 0.53 0.34 0.97 1.18 1.93 0.98 1.35 QUALITY 23

DOCUMENTED FALLS Hirslanden hospitals recorded a total of 1,051 falls on Patients can fall for a variety of reasons, which is why the 491,492 treatment days in 2015. This remains below the prevention of falls is a demanding task for every hospital, comparable European figure. and particularly for nursing staff. At Hirslanden hospitals, the nursing staff meet this challenge by repeatedly reassess ing the individual patient’s risk of falling during hospitalisa tion and adapting measures to prevent falls accordingly.

Documented falls Falls per 1,000 treatment days (2011–2015)

4.0 3.7 3.7

3.5

3.0 2.5 2.3 2.3 2.5 2.1 2.2 2.1

2.0

1.5

1.0

0.5

n/a n/a 0.0 2011 2012 2013 2014 2015

Europe Hirslanden Conﬁdence interval

Documented falls, data 2015 AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Total

Number of 46,086 35,890 10,409 42,760 19,399 19,421 16,036 17,233 21,807 61,682 4,170 12,992 6,439 34,986 106,147 36,035 491,492 treatment days

Number of falls 124 104 18 97 22 72 15 49 27 147 0 29 3 56 186 102 1,051

Falls per 1,000 2.69 2.90 1.73 2.27 1.13 3.71 0.94 2.84 1.24 2.38 0.00 2.23 0.47 1.60 1.75 2.83 2.14 treatment days 24 QUALITY INFECTION MONITORING AND PATIENT SAFETY

ALONG WITH PATIENT SATISFACTION, INFECTION MONITORING AND PATIENT SAFETY ARE AMONG THE KEY ASPECTS OF PATIENT BENEFITS. CONSISTENT HYGIENE MANAGEMENT IS THUS ESSENTIAL, ESPECIALLY IN HOSPITAL AREAS WITH AN INCREASED RISK OF INFECTION, SUCH AS INTENSIVE CARE UNITS.

Since 2008, the Hirslanden Private Hospital Group has been is set in relation to the number of patients with infections. using the Hospital Infection Surveillance System (HISS) of The resultant figures are compared with the “75th percentile”. the German Consulting Centre for Hospital Epidemiology This means that 75 percent of the hospitals report similar and Infection Control (BZH) for assessing hospital-associated results. Reference to this comparative figure is based on the infections. As the largest database on nosocomial infec frequency with which the respective catheter is used tions in the world, HISS offers the best possible opportunities within the patient group in question. for comparison. The HISS system collects data from two areas: first, how often catheters and ventilation machines For the 2015 calendar year, attention must be drawn to the (devices) are used in intensive care units and the associ‑ increase in septic conditions with treatments using a central ated number of infections; second, the infection rates for venous catheter. This figure lies above the 75th percentile typical routine procedures. The acquisition of data on for the first time in several years. As the table below the dia device-associated infections is highly relevant for improving gram illustrates, these are isolated cases. Further analysis quality in hospitals, and was therefore included in the revealed that the accumulation largely occurred in the first “High 5s” project that the WHO launched back in 2006. half of the year and that the measures consequently taken The aim of this project is to increase patient safety. are having an impact. In contrast, it was possible to fur ther reduce the number of urinary tract infections in con Device-associated infections in the intensive care unit in nection with urinary catheters and the number of cases of cludes the number of septic conditions associated with pneumonia in connection with mechanical ventilation. central venous catheters, the number of urinary tract infec tions in connection with urinary catheters, and the number of cases of pneumonia in connection with mechanical ven tilation. The number of days on which the devices are used

percent of treatments using a central venous catheter 98.8 are made without sepsis percent of treatments using a urinary catheter are 99.0 made without infection percent lower infection rate in ventilator-associated 19 pneumonia compared to previous year QUALITY 25

DEVICE-ASSOCIATED INFECTIONS IN THE INTENSIVE CARE UNIT The values for “catheter-associated sepsis” have increased first time in several years. The increase was observed in in comparison with the previous year. The total value for the first half of the year and the measures initiated displayed all Hirslanden hospitals is above the 75th percentile for the an impact in the second half of the year.

AA Hirslanden Klinik Aarau CC Clinique Cecil, Lausanne SH Klinik Stephanshorn, St Gallen IP Klinik Im Park, Zurich BS Klinik Beau-Site, Bern ST Klinik St. Anna, Lucerne HI Klinik Hirslanden, Zurich

Catheter-associated sepsis Cases per 1,000 user days (2008–2015)

5.0 Conﬁdence interval

4.5 3.1

4.0

3.5

3.0 1.9 1.8 2.5 1.6

2.0 1.0 1.4 1.5 0.6 1.0 0.2 0.2 0.5

0.0 2008 2009 2010 2011 2012 2013 2014 2015 75th percentile

Catheter-associated sepsis, data 2015 AA BS CC ST SH HI IP Total

Number of user days 1,704 3,033 1,521 1,004 472 3,620 1,256 12,610

Number of cases with sepsis 2 5 1 2 0 4 1 15

Infection rate 1.17 1.65 0.66 1.99 0.00 1.10 0.80 1.19 26 QUALITY

The values for “urinary catheter-associated infection” have be removed. When a catheter is removed, it is sent directly fallen slightly and thus improved accordingly on the previous to the laboratory where it is examined for bacteria. The year. Every day, specialist hygiene staff visit all patients who data that the specialist hygiene staff record and analyse are have been given a catheter and inspect them for signs of discussed by the hospitals’ hygiene committees, which, in infection. They also check how nursing staff insert and look turn, notify the responsible doctors and departments of the after catheters. The doctors, for their part, decide every results and, if necessary, give instructions on what mea day whether a catheter is still indicated, or whether it can sures need to be taken.

AA Hirslanden Klinik Aarau CC Clinique Cecil, Lausanne SH Klinik Stephanshorn, St Gallen IP Klinik Im Park, Zurich BS Klinik Beau-Site, Bern ST Klinik St. Anna, Lucerne HI Klinik Hirslanden, Zurich

Urinary catheter-associated infection Cases per 1,000 user days (2008–2015)

3.0 Conﬁdence interval

1.8 2.5

1.3 2.0 1.2 1.1 1.2 1.0 1.5 1.4 0.8

1.0 0.4

0.5

0.0 2008 2009 2010 2011 2012 2013 2014 2015 75th percentile

Urinary catheter-associated infection, data 2015 AA BS CC ST SH HI IP Total

Number of user days 1,843 3,071 1,687 1,380 995 4,013 1,402 14,391

Number of cases of urinary tract infection 5 0 1 0 1 7 1 15

Infection rate 2.71 0.00 0.59 0.00 1.01 1.74 0.71 1.04 QUALITY 27

The figure for “ventilator-associated pneumonia” was also down compared to the previous year and remains significantly below the 75th percentile. It should be noted that every single infection has a strong impact on the score because of the extremely low number of events on the whole.

AA Hirslanden Klinik Aarau CC Clinique Cecil, Lausanne SH Klinik Stephanshorn, St Gallen IP Klinik Im Park, Zurich BS Klinik Beau-Site, Bern ST Klinik St. Anna, Lucerne HI Klinik Hirslanden, Zurich

Ventilator-associated pneumonia Cases per 1,000 user days (2008–2015)

14 Conﬁdence interval 9.6

10 6.8 6.8

5.3 5.6 5.3 8 5.2

4.2 5.7 6

0 2008 2009 2010 2011 2012 2013 2014 2015 75th percentile

Ventilator-associated pneumonia, data 2015 AA BS CC ST SH HI IP Total

Number of user days 847 803 184 320 74 1,349 488 4,065

Number of cases of pneumonia 6 5 2 1 0 3 0 17

Infection rate 7.08 6.23 10.87 3.13 0.00 2.22 0.00 4.18 28 QUALITY MORTALITY IN THE INTENSIVE CARE UNIT

HIRSLANDEN CARRIES OUT A RISK-ADJUSTED MEASUREMENT OF MORTALITY IN THE INTENSIVE CARE UNIT AT ALL HOSPITALS WITH A CORRESPONDING INFRASTRUCTURE. FOR SEVERAL YEARS, RESULTS HAVE SHOWN THAT THE HIRSLANDEN HOSPITALS ACHIEVE SIGNIFICANTLY BETTER FIGURES COMPARED TO THE SWISS AVERAGE WHEN COMPARING THE EFFECTIVE AND EXPECTED MORTALITY.

Risk adjustment – in other words, the consideration of pa The effective mortality of all patients admitted to the inten tient-specific risk factors such as age or concomitant sive care unit is up compared to the previous year (2014: illnesses – is relevant when measuring mortality in the inten 3.2%; 2015: 4.1%). The mortality index remained stable, which sive care unit. The instrument used here is the Simplified points towards an increase in the severity of cases. Acute Physiology Score (SAPS). The medical condition of each patient is recorded using SAPS and its different pa rameters in order to calculate their mortality risk. The sum of all mortality risks calculated in this way constitutes the “expected mortality”. Setting this in relation to the “effec tive mortality” gives the “mortality index”. A sign of high-quality treatment is when the effective mortality is at most half as high as the expected mortality, with a correspondingly low mortality index.

7,861 patients were treated in the intensive care unit in 2015 times more patients than expected survived after being 5 admitted to the intensive care unit percent effective mortality for all patients admitted 4.1 to the intensive care unit QUALITY 29

MEASURING MORTALITY IN THE INTENSIVE CARE UNIT A comparison between expected and effective mortality rates in the ICUs of Hirslanden hospitals gives an extremely positive result that has remained stable for years. Effec‑ tive mortality is far lower than expected mortality. In contrast to the overall Swiss comparison, Hirslanden not only records effective patient mortality in ICUs but also includes pa tients who have been transferred from the ICU to another department – thereby making the good result particularly noteworthy.

Mortality in the ICU (2012–2015)

14% 13.5% 12.3% 12.0% 12% 11.5%

10%

6% 4.4% 4.1% 3.8% 4% 3.2%

0% 2012 2013 2014 2015

Expected mortality (SAPS) E ective mortality

Mortality in the ICU, Hirslanden Switzerland Hirslanden Switzerland Hirslanden Switzerland Hirslanden Switzerland data 2012–2015 2012 2012 2013 2013 2014 2014 2015 2015 Expected mortality (SAPS) 12.0% 10.0% 13.5% 11.0% 11.5% 9.0% 12.3% 11.0%

Effective mortality (all patients 4.4% 3.8% 3.2% 4.1% staying in ICU)

Effective mortality (died in ICU) 2.6% 4.0% 2.8% 5.0% 2.5% 4.0% 2.4% 4.0%

Mortality index 0.4 0.3 0.2 0.2

Mean age of patients in the ICU 67.4 63.0 67.4 62.5 67.1 65.0 70.0 61.5

Mean duration of stay in the ICU 2.1 2.4 1.9 2.6 1.5 2.3 2.1 2.5 (days)

Severity of the case (mean SAPS) 27.1 30.0 28.1 31.1 27.1 29.0 28.2 30.9

Percentage ventilated patients 37.1% 33.0% 38.2% 35.0% 39.1% 30.0% 33.3% 32.0%

Number of cases 5,989 6,907 7,948 7,861 86,754 30 QUALITY QUALITY MEDICINE INITIATIVE

THE QUALITY MEDICINE INITIATIVE (QMI) WAS FOUNDED IN 2008 IN ORDER TO PROMOTE FURTHER IMPROVEMENTS IN MEDICINE THROUGH INNOVATION AND EFFICIENT PROCEDURES AND THEREBY SET NEW STANDARDS IN QUALITY. OVER 250 HOSPITALS IN GERMANY AND SWITZERLAND ARE NOW PARTICIPATING IN THE INITIATIVE AND VOLUNTARILY SURPASSING THE EXISTING STATUTORY REQUIREMENTS RELATING TO QUALITY ASSURANCE.

QMI is founded on three principles: Measure quality on the 4. The resultant findings are then presented to the hospital basis of routine data, publish the results to promote trans management. The doctor involved is responsible for parency and improve quality with a peer review procedure. putting any ideas for improvement into practice. He is assisted in this process by the hospital management, In Switzerland, quality measurement using routine data is which, in turn, monitors implementation. based on the Swiss Inpatient Quality Indicators (CH-IQI). The current version of the CH-IQI includes 184 performance Two Hirslanden hospitals went through a peer review pro indicators for results, data sets and processes on 48 clinical cedure in the 2015/16 financial year. pictures and treatment forms. More and more hospitals in Switzerland are joining the Quality All figures for the named indicators are published by QMI Medicine Initiative (QMI). In view of this, the H+ hospital for all participating hospitals to ensure transparency. If results association has initiated a project to adapt the peer review are significantly above or below the relevant benchmark, procedure to Swiss requirements. There are two specific QMI will initiate a peer review procedure that investigates objectives in this regard: first, that of drawing up the proce the treatment cases that led to the conspicuous results. dure in the additional national languages of French and The peer review procedure is divided into four steps: Italian, to enable participation among hospitals in Western Switzerland and Ticino; second, that of integrating nursing 1. The responsible doctor carries out a self-review together staff into the procedure – which will be contingent on nursing with his team. staff also being trained up as peers besides doctors. The project is funded by an alliance between the H+ hospital 2. The doctor’s peers offer a constructive critique of the association, the Swiss Medical Association and the Swiss same treatment cases, visiting the hospital for this Nurse Leaders association. On account of its interprofessional purpose. The clearly defined procedure for analysing approach, the “Swissification” of the peer review proce relevant medical records is based on uniform criteria. dure is being followed with great interest in Germany.

3. This is followed by what is actually the key part of the review: an eye-level discussion between the peers and the responsible doctor. If the peers have identified quality-related problems, suggestions for solving them are included in the discussion. These frequently relate to standards, guidelines, documentation, processes or interdisciplinary interfaces.

percent of inpatient cases in terms of DRG are 40 covered by CH-IQI first hip TEP implantations were carried out at Hirslanden 2,831 hospitals in 2015 0.0 percent mortality rate for these operations QUALITY 31 THE PEER REVIEW PROCEDURE AT KLINIK HIRSLANDEN – A LIVE REPORT

SINCE 2013, 15 OF THE 16 HIRSLANDEN HOSPITALS HAVE BEEN MEMBERS OF THE QUALITY MEDICINE INITIATIVE (QMI). AS QMI MEMBERS, THE HOSPITALS RECORD AND ANALYSE VARIOUS INDICATORS IN ORDER TO CONSTANTLY IMPROVE QUALITY OUTCOMES AND THUS INCREASE PATIENT BENEFITS. PEER REVIEW PROCEDURES ARE AN INTEGRAL PART OF THE QMI, WITH ONE CARRIED OUT AT KLINIK HIRSLANDEN IN ZURICH IN 2015.

The goal of the Quality Medicine Initiative (QMI) is to establish Klinik Hirslanden then received an evaluation report within an open quality and error culture through the systematic two weeks following the peer review procedure. This report acquisition of routine data, an active incident management contained four potential improvements in terms of pro system and community capacity building. As QMI members, cesses, documentation and responsibilities. These potential the hospitals keep data on mortality rates, process indica improvements were then linked to concrete measures and tors, complication rates and absolute quantity information, the peer review process was successfully concluded. among others. 48 of the most important pathologies and procedures are taken into account here. From this acquired The procedure at Klinik Hirslanden also had a further posi data, 184 performance indicators with over 40 quality objec tive consequence: Thanks to the detailed explanation of the tives are derived and published in a summary of the results. system provider model at the Hirslanden Private Hospital Group and the presentation of the infrastructure for patient In the event of conspicuous results, a peer review procedure treatment, it was possible to reduce the reservations of the is initiated by QMI. In 2015, one of these procedures took external peer review team concerning private hospitals. place at Klinik Hirslanden in Zurich in the category “Indica tors in visceral surgery without bowel ischaemia (18.26) – However, alongside the extremely positive aspects associat deaths in surgical indications”. ed with the peer review procedure, there are also sub stantial administrative expenses associated with preparing The peer review procedure is an unbureaucratic instrument and carrying out the procedure. The experiences at Klinik for quality assurance in medicine that focuses on collegial Hirslanden also show that carrying out a peer review pro co-operation. The peer team consists of external doctors in cedure in an affiliated doctor system brings with it some the clinical field. Using the medical records of patients particular challenges. who have died, the team systematically analyses the pro cesses and structures within a hospital in terms of possi‑ Despite (or perhaps because of) these challenges, peer ble optimisation potential. All QMI peers are trained accord review procedures are a valuable experience for the Hirslanden ing to the “Medical Peer Review” curriculum of the German hospitals and also provide an opportunity for an in-depth Medical Association. In a peer review procedure, a maximum analysis and improvement of processes and structures. of 20 cases that have contributed to a conspicuous quality The Quality Medicine Initiative makes an important contribu result (for example, a high mortality rate) are analysed. The tion to improving quality outcomes and helps Hirslanden responsible heads of department or affiliated doctors in to increase patient benefits. the area under review receive questionnaires prior to the peer review, which they can use to carry out a structured self-assessment.

The day of the peer review at Klinik Hirslanden started with an analysis of the records by the peer team, which lasted around four hours. This was followed by the key part of the peer review procedure, a collegial discussion of the case between the peer team and the responsible affiliated doc tor that lasted around three hours. This discussion included all the departments involved in the reviewed treatments. 32 QUALITY

MORTALITY DATA ACCORDING TO CH-IQI One of the CH-IQI quality indicators is mortality data, which individually. The following table gives an overview by com the Swiss Federal Office of Public Health (FOPH) publishes paring the respective figures with their international bench together with other performance indicators in its quality mark. The patient numbers published here are more recent report. Hirslanden collected its mortality rate data using the than those included in the FOPH publication. The indicators CH-IQI method and consolidated these for the Hirslanden are determined using an algorithm that is also applied to Private Hospital Group as a whole and for each hospital the annual hospital statistics.

CH-IQI 2015 Total AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Myocardial infarction NC 710 94 202 1 6 8 6 0 0 38 61 0 0 0 5 212 77 A.01.01.M N 23 3 5 0 0 0 0 0 0 0 3 0 0 0 0 8 4 Main diagnosis myocardial infarction, percentage deaths N% 3.20% 3.20% 2.50% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 4.90% 0.00% 0.00% 0.00% 0.00% 3.80% 5.20% EV 5.60% 4.70% 5.66% 4.97% 15.39% 3.24% 5.87% 4.96% 6.15% 6.60% 5.85% 5.13% A.03.02.M NC 482 36 157 0 0 0 0 0 0 20 55 0 0 0 0 146 68 Cases with left cardiac catheter N 8 1 1 0 0 0 0 0 0 0 1 0 0 0 0 2 3 for myocardial infarction (main diagnosis), without heart operation, N% 1.70% 2.80% 0.60% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 1.80% 0.00% 0.00% 0.00% 0.00% 1.40% 4.40% (age >19), mortality EV 3.76% 3.37% 3.73% 3.86% 3.67% 3.82% 3.95% Heart surgery NC 621 101 157 0 0 0 0 0 0 94 0 0 0 0 0 225 44 A.07.12.M N 5 1 0 0 0 0 0 0 0 0 0 0 0 0 0 3 1 Operations on the coronary vessels alone without myocardial infarction N% 0.80% 1.00% 0.00% 0% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 1.30% 2.30% (age >19), mortality EV 1.37% 1.28% 1.70% 1.04% 1.32% 1.37% Removal of the gallbladder NC 1,028 131 207 14 42 36 52 0 0 61 170 4 0 33 81 157 40 E.01.01.M N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cholecystectomy for gallstones and cholecystitis, without tumour, N% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% mortality EV 0.14% 0.12% 0.17% 0.06% 0.24% 0.06% 0.08% 0.13% 0.15% 0.27% 0.07% 0.08% 0.14% 0.13% Removal of the colon NC 189 25 41 0 0 4 4 0 0 24 21 0 0 1 13 34 22 E.04.02.M N 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Colon resections for colorectal cancer, without complicating N% 1.10% 4.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 2.90% 0.00% diagnosis, mortality EV 3.32% 3.00% 2.41% 2.16% 2.60% 3.20% 4.14% 2.56% 3.04% 4.69% 3.14% Removal of the prostate NC 501 54 82 0 4 3 0 0 0 42 49 0 0 0 74 177 16 H.05.02.M N 3 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 Radical prostatovesiculectomy, mortality N% 0.60% 0.00% 1.20% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 2.40% 2.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% EV 0.10% 0.08% 0.12% 0.03% 0.15% 0.09% 0.12% 0.06% 0.11% 0.05% Total endoprosthetic NC 2,633 250 5 135 343 122 225 299 138 0 222 57 188 127 73 350 99 replacement N 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 I.01.01.M First hip TEP implantation N% 0.04% 0.00% 0.00% 0.00% 0.29% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% (not for fractures), mortality EV 0.38% 0.65% 0.65% 0.17% 0.13% 0.10% 1.42% 0.29% 0.08% I.01.03.M NC 2,831 241 8 276 354 122 204 296 212 0 225 85 254 126 76 269 83 First knee TEP implantation, N 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 mortality N% 0.00% 0.00% 0 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% EV 0.00% Spinal surgery NC 1,749 107 13 61 348 49 89 3 42 79 359 0 34 57 183 236 89 I.02.02.M N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Excision of intervertebral disc tissue (no accident, tumour, N% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% complex spinal surgery), mortality EV 0.06% 0.04% 0.10% 0.07% 0.04% 0.06% 0.07% 0.00% 0.07% 0.07% 0.06% 0.05% 0.02% 0.08% 0.08% 0.09% Sepsis NC 217 27 16 0 23 4 25 0 3 7 56 0 0 0 13 33 10 J.02.01.M N 52 9 4 0 5 1 0 0 1 1 14 0 0 0 2 11 4 Main diagnosis sepsis, mortality N% 24.00% 33.30% 25.00% 0.00% 21.70% 25.00% 0.00% 0.00% 33.30% 14.30% 25.00% 0.00% 0.00% 0.00% 15.40% 33.30% 40.00% EV 14.62% 14.25% 12.98% 16.25% 21.17% 15.83% 10.91% 14.24% 14.32% 13.12% 14.68% 13.72% QUALITY 33

NC Number of reported cases N Numerator N% Numerator (in %) EV Expected value

QUALITY MANAGEMENT AT THE HIRSLANDEN PRIVATE HOSPITAL GROUP IS BASED ON INTERNATIONAL STANDARDS AND TRIED- AND-TESTED MODELS. THE SYSTEMIC INTERPLAY OF THESE QUALITY MEASURES ENSURES THAT THE RESULTS BECOME PART OF A CONTINUOUS IMPROVEMENT PROCESS.

For several years, Hirslanden has carried out patient sur The new European standard EN 15224:2012 “Health care veys based on the ANQ and HCAHPS measuring principles. services – Quality management systems” has been in place The vast majority of the feedback we receive is positive – since 2012 and will be implemented as part of pilot projects. which bears testimony to the effectiveness of the quality measures and efficiency of the improvement process. In contrast to the ISO standard, the aforementioned EFQM Nonetheless, Hirslanden naturally wants to push the per model is used primarily for self-assessment purposes. The centage of positive feedback up further. model takes into consideration the quality of the key results, client and employer satisfaction and societal results (such as In addition to patient feedback, clinical performance indi sustainability), and attributes them to a clear strategic vision. cators such as IQIP and HISS also serve to ensure product and result quality. The latter is included in a professional process management system, the framework of which is set by the ISO 9001:2008 process standard for service pro viders. The process management system is part of the com prehensive quality management system at the Hirslanden Private Hospital Group, which is based on the “Business Ex cellence” model of the European Foundation for Quality Management (EFQM). This model helps us to evaluate and assess the situation of all hospitals and develop all areas of the business in a coordinated, result-oriented manner.

The aforementioned ISO 9001:2008 process standard for service providers applies to all Hirslanden hospitals and the Corporate Office, meaning all of these business units also have ISO certification. This does not include Clinique La Colline in Geneva, which joined the Group in 2014 and will be certified in 2016. The ISO 9001 standard defines the principles of quality management for service providers from various sectors. QUALITY 35

ISO 9001:2008 EN 15224:2012 It normally takes around 15 months to prepare for certifica The new European standard EN 15224:2012 applies to service tion – a period that involves analysing, documenting and providers in healthcare and uses industry-specific termi placing all business processes into context with each other. nology. Moreover, it formulates three particular requirements The result is a process-oriented representation of the for the healthcare industry: 1) clinical process and risk hospital. Establishing and documenting a continual improve management, 2) a staffing term to encompass all employees ment process is equally important. The ISO 9001:2008 involved in patient care, and 3) patient safety, which is standard is based on the “Deming circle” of planning, doing, defined as an “all-embracing” objective. Although compli checking and acting, i.e. a process is first planned and ance with this standard naturally centres around core then implemented. The outcome is subsequently reviewed, clinical processes, it also pertains to non-medical areas and the process is corrected or adjusted if necessary. such as administration.

Certification is confirmed annually by means of an external audit. The internal and external audits together also pro EFQM vide important pointers for optimising potential in our The “Business Excellence” model of the European Foundation hospitals, the exploitation of which forms part of the on for Quality Management (EFQM) offers a holistic view of going improvement process. the various interdependencies that exist within the corporate environment. It was borne of an initiative by 14 CEOs from well-known European companies in 1988 with the support of the European Commission. Its objective was – and still is – to strengthen the competitiveness of European compa nies. The EFQM model covers five “enabler” criteria and four “results” criteria that together reflect the intrinsic cau salities that exist within a company. The EFQM model is shown in the diagram below.

EFQM MODEL

Enabler Results

Staff-related Staff results

Client-related Management Politics and Processes Key results strategy results

Partnerships Company-related and resources results

Innovation and learning 36 QUALITY CRITICAL INCIDENT REPORTING SYSTEM (CIRS)

A SAFETY INFORMATION SYSTEM (SIS) HAS BEEN USED AT ALL HIRSLANDEN HOSPITALS SINCE 2008, OFFERING EMPLOYEES IN ALL OCCUPATIONAL GROUPS THE CHANCE TO FILE ANONYMOUS REPORTS ABOUT MISTAKES THAT MIGHT HAVE LED TO HARMFUL INCIDENTS, AND THUS ESTABLISHING A CONSTRUCTIVE ERROR CULTURE.

SIS is based on the statistical knowledge that every actual When analysing CIRS cases, a distinction is made between harmful incident is preceded by several hundred so-called erroneous factors and the incident itself. For example, critical incidents. Reported cases are recorded and cate two patients with the same name is a potentially erroneous gorised in the Critical Incident Reporting System (CIRS), patient factor. The resulting incident would be if the wrong before being analysed and processed by an interdisciplinary patient were then brought for an x-ray. All erroneous factors committee. This analysis is centred on two questions: that are uncovered are then linked to at least one funda “Why did the system allow this critical incident to occur?” mental countermeasure, which is scheduled accordingly with and “How can the system be modified or amended to pre responsible persons assigned to it. vent the same critical incident happening again?” To ensure that they can mutually benefit from their experiences and The advantage of the Ishikawa method is that it offers a insights, regular SIS meetings are held at which Hirslanden structured appraisal of complex patient cases. With the rele hospitals can present and discuss their own cases and re vant medical knowledge, the method is also easy to learn sultant preventive measures among each other. and enjoys wide recognition. A possible disadvantage is the human factor involved – the method requires complex Particularly complex CIRS cases that also have a high learning medical knowledge, together with excellent social skills and potential are analysed in more detail. A cause-and-effect empathy. As mentioned above, the Ishikawa method is diagram (also known as the Ishikawa method) is used here only applied in the event of particularly complex CIRS cases for systematic incident analysis. The goal is also to learn that also have a high learning potential – this is due to the as much as possible from potential incidents. amount of work involved in implementing the method.

If a particularly complex CIRS case arises that needs to be analysed in more detail, senior management assigns the task to a specialist analysis team that is set up for this pur pose. This team examines the case according to a wide range of factors, such as the patient factor, the institutional framework and the work environment. The first allocation of possible erroneous actions to these different factors is already made when studying the patient documentation. This is followed by interviews with the persons involved. At the heart of the analysis is the personal interview, where further potential incidents are uncovered – including those that are only latent in nature. QUALITY 37

CLASSIFICATION OF CRITICAL INCIDENTS, IN PERCENT 1.7% 1.2% 3.5%

5.9% 19.3%

14.3%

19.0%

17.0%

18.1% 19.3% Resource staff 5.9% Material/Equipment/IT

19.0% Communication/Information 3.5% Diagnostics/Treatment

18.1% Medication 1.7% Workplace

17.0% Processes 1.2% Patient

14.3% Behaviour 38 PERFORMANCE FINANCIAL YEAR 2015/16 IN FIGURES

INPATIENT CASE NUMBERS AND SPECIALTY FOR EACH HOSPITAL1 The low case numbers in some individual specialties are If he works in other specialties, these are not included in the attributable to three factors. First, many treatments do not statistics. Third, transfers during a period of hospitalisa- require hospitalisation. Instead, they are carried out on an tion are not included in this description either. outpatient basis and are thus not recorded in the table below. Second, a particular specialty is allocated according to the specialty of the doctor managing the case.

Hospital AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP Total

Orthopaedics/Sports medicine 2,127 12 2,433 3,819 1,876 2,174 3,029 2,603 5 2,226 647 2,838 805 2,128 3,457 1,297 31,476

Gynaecology/Obstetrics 1,441 – – 2,296 736 55 – – 1,077 1,246 68 – 45 1,392 2,316 1,099 11,771

Surgery/Visceral surgery 1,177 2,294 299 403 538 488 38 41 614 1,089 235 22 382 1,090 2,851 886 12,607

Cardiology 990 2,087 – – – – – – 522 1,001 – – – 15 2,543 1,659 8,817

Internal medicine 1,199 670 311 1,251 60 397 – 69 481 1,504 – – – 286 1,299 196 7,804

Urology 600 469 38 230 124 156 – 258 354 692 – – 25 915 1,075 236 5,172

Neurosurgery 136 104 171 954 167 220 – – 286 1,156 – 44 181 – 890 93 4,402

Oncology/Haematology 395 304 – 7 95 – – 297 22 281 – – – 49 444 166 1,979

Ear, nose and throat 266 – 133 – 58 14 85 92 – 339 190 30 – 233 444 19 1,903 medicine (ENT)

Hand surgery 227 – 30 – – – 603 162 5 232 24 455 9 74 131 157 2,109

Cardiac and thoracic 387 433 – – – 43 – – 262 – – – – – 928 202 2,255 vascular surgery

Angiology/Vascular surgery 480 75 – – 31 – – – 142 654 – – – 124 479 399 2,384

Gastroenterology 114 173 – 113 37 17 – – 7 213 – – – 53 368 61 1,156

Pneumology 31 5 – 102 – – – 7 – 128 – – – 5 266 77 621

Ophthalmology – – – – – 129 – 24 – 21 – – 8 – 161 167 510

Plastic surgery 144 – 135 75 – 45 28 26 76 150 55 48 – 300 115 42 1,239

Anaesthesiology/Pain – – – – – – – 19 – – – – – – 46 – 65 control medicine

Oromaxillofacial surgery 113 – 31 – – 46 – 15 – 29 – 28 – – 7 67 336

Rheumatology/Physical – – – 24 36 – – 5 – 27 – 7 – – 69 – 168 medicine and rehabilitation

Thoracic surgery – 119 – – – – – – 80 96 – – – – 160 16 311

Neurology 14 – – – – – – – – 135 – – – – 362 9 520

Other specialties 16 – 3 – 79 – 6 24 26 26 – – 11 – 19 3 213

Nephrology 11 17 – 49 – – – – 15 22 – – – 6 – 43 163

Radiology/Neuroradiology – 24 – – – – – 198 – 103 – – – 11 217 32 585

Radio-oncology/Radio‑ 34 – – – – – – 9 – – – – – – – – 43 therapy

Total 9,902 6,786 3,584 9,323 3,837 3,784 3,789 3,849 3,974 11,370 1,219 3,472 1,466 6,681 18,647 6,926 98,609

1 Inpatient admissions in the 2015/16 financial year, excluding newborns This classification of specialties is based on the specialty of the doctor managing the case, and not the classification of hospital service groups. Case numbers <5 are added together under “other specialties”. PERFORMANCE 39 RANGE OF SERVICES

SPECIALTIES Orthopaedics was again the Hirslanden Private Hospital of the range of services. This particularly applies to cardio Group’s strongest specialty in the 2015/16 reporting year. logy and neuroscience including the full series of interven The rankings of other disciplines – gynaecology/obstet‑ tional neuroradiology and neurosurgery treatments. rics, cardiology and internal medicine – also remained unchanged. The overview shows that relevant medical specialties at individual hospitals constitute a major part

2.4% Angiology/Vascular surgery 0.5% Ophthalmology

2.3% Cardiac and thoracic vascular surgery 0.5% Neurology

2.1% Hand surgery 0.3% Oromaxillofacial surgery

2.0% Oncology/Haematology 0.3% Thoracic surgery

1.9% Ear, nose and throat medicine (ENT) 0.2% Rheumatology/Physical medicine and rehabilitation 1.3% Plastic surgery 0.2% Nephrology 1.2% Gastroenterology 0.1% Anaesthesiology/Pain control medicine 0.6% Pneumology 0.2% Other specialties 0.6% Radiology/Neuroradiology

32.1% Orthopaedics/ Sports medicine

4.5% Neurosurgery

5.2% Urology

7.9% Internal medicine

12.8% Surgery/ 8.9% Cardiology Visceral surgery

11.9% Gynaecology/ Obstetrics 40 PERFORMANCE SWISSDRG

All inpatient services provided and covered by obligatory A shared service centre concentrating expertise and staff basic insurance (KVG) have been invoiced on a flat rate per resources is responsible for coding at Hirslanden. Under the case basis by Swiss hospitals since 2012. This means that supervision of specially trained coders, all treatment cases hospitals receive a flat rate for each case treated, irrespec are coded and grouped in accordance with SwissDRG tive of how long a patient actually stays in hospital. As a requirements. rule, hospitals cannot invoice for any additional services. The flat rate already covers the use of hospital facilities, the As part of a mandatory external audit, Hirslanden hospitals provision of medical and nursing care, and the use of con regularly review correct implementation of the basic cod‑ sumables and implant materials. ing principles. The quality of coding is assessed randomly and regardless of any suspicion. In the reporting year, all The objective of this nationwide flat-rate system is to pro Hirslanden hospitals underwent an audit for 2015. This in mote competition among service providers in terms of volved 2,340 spot checks out of a total of 98,600 cases quality and pricing, while guaranteeing performance-based invoiced according to the SwissDRG method. The auditor payment for different treatment cases and ensuring a concluded that Hirslanden is an accurate coder. high level of transparency and comparability from hospital to hospital.

Remuneration for inpatient hospital services by flat rates per case is based on the concept of “diagnosis related groups” (or DRG) – a classification system that divides all inpatient treatment cases into medically and economi‑ cally homogeneous groups, i.e. groups entailing the same expenditure. The central criterion for assigning a patient to a DRG is the main diagnosis upon discharge from hospital. Further criteria include secondary diagnoses, procedures, the degree of severity, the length of stay, and the patient’s age and gender. Birth weight is also a criterion for new borns. First, all diagnoses and procedures are recorded with their corresponding codes. Grouper software then assigns the hospital stay to a specific DRG. PERFORMANCE 41

MDC The major diagnostic categories (MDC) constitute an initial medicine (MDC 5). The SwissDRG system that came into level for describing the various treatment groups within effect on 1 January 2014 provides the basis for this analysis. DRG systems, normally classifying DRG by organ systems Since there is a change from one version to another at the and disease entities. The table gives an overview of the beginning of each year, the following statistics refer exclu most common MDC at the Hirslanden hospitals, again clearly sively to the 2015 calendar year. showing the high proportion of cases in orthopaedics (MDC 8), obstetrics (MDC 14 and 15), and cardiovascular

MAIN DIAGNOSIS CATEGORY (SWISSDRG)

MDC Description AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP 2015

8 Diseases and disorders 2,550 135 2,797 4,885 1,968 2,291 3,557 2,782 328 3,631 688 3,090 979 2,104 4,894 1,818 38,497 of the musculoskeletal system and connective tissue

5 Diseases and disorders 1,940 2,495 50 239 119 121 30 30 896 1,452 51 48 23 154 3,706 2,185 13,539 of the circulation

6 Diseases and disorders 1,012 2,016 131 485 389 383 67 473 1,252 52 7 262 797 2,041 483 9,854 of the digestive organs

14 Pregnancy, delivery 892 1,238 517 539 859 916 1,143 672 6,785 and puerperium

15 Newborns 753 1,155 475 523 836 832 1,004 598 6,176

13 Diseases and disorders 428 54 746 156 67 6 374 283 41 26 335 841 401 3,762 of the female repro ductive organs

11 Diseases and disorders 373 301 33 256 96 105 238 215 507 15 390 769 150 3,448 of the urinary organs

9 Diseases and disorders 329 71 42 351 79 125 50 60 200 403 74 28 23 509 558 171 3,073 of the skin, the subcu tis, and the breast

1 Diseases and disorders 232 94 38 177 61 123 96 67 103 456 23 123 20 89 982 152 2,836 of the nervous system

4 Diseases and disorders 301 289 44 262 47 88 62 146 492 81 643 126 2,582 of the respiratory organs

Case numbers <5 are not listed. 42 PERFORMANCE DIAGNOSES AND OPERATIONS

ICD AND CHOP A diagnosis related group (DRG) is determined according It is difficult to draw conclusions regarding superordinate to the coding of all diagnoses and treatments. The coding of totalling due to the high level of differentiation in both cata diagnoses and secondary diagnoses is based on the ICD logues. For example, the number of newborns does not catalogue (International Classification of Diseases), while correspond to the number of cases with the main diagnosis operations and treatments are coded on the basis of the Z38.0. This is because newborns are sometimes described CHOP catalogue (Swiss operation classification). on the basis of additional diagnoses. Given that the cata logues – and consequently the coding guidelines – change The first table gives an overview of the most common main slightly from year to year, a comparison of the diagnoses diagnoses and their breakdown across Hirslanden hospi and procedures described here with those of the previous tals. As in previous years, diagnoses relating to a birth or a year is also only possible to a limited extent. However, it is newborn are ranked top this year. apparent that documentation accuracy is constantly improv ing thanks to coding based on the SwissDRG catalogue. The second table shows the most common main treat ments at Hirslanden hospitals. All documented operations and interventions are used as the basis for analysis of the treatments. This excludes procedures that are not carried out in the operating theatre or cannot be constituted as interventions. Most operations and interventions at the Hirslanden hospitals are performed in orthopaedics and cardiology. PERFORMANCE 43

MAIN DIAGNOSIS (ICD)

ICD Description AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP 2015

M23 Internal derangement of the knee 185 887 496 173 150 389 460 160 87 313 48 196 456 111 4,113

M17 Gonarthrosis (arthrosis of the knee) 290 9 350 476 159 210 391 242 260 101 302 156 83 331 99 3,460

S83 Dislocation, sprain and strain, joints 202 292 238 214 112 506 231 206 70 307 94 90 530 125 3,217 and ligaments of the knee

Z38 Liveborn infants according to place 318 544 303 187 487 661 181 413 3,094 of birth

M16 Coxarthrosis (arthrosis of the hip) 234 131 337 117 183 291 138 219 55 179 126 72 343 98 2,529

I25 Chronic ischaemic heart disease 243 610 189 245 818 366 2,474

M51 Other intervertebral disc disorders 126 17 49 382 122 98 10 48 105 441 44 56 302 320 105 2,225

M75 Shoulder lesions 87 179 178 118 79 180 391 152 46 250 96 132 173 143 2,204

K40 Inguinal hernia 244 244 54 107 168 75 6 82 277 27 116 179 345 143 2,074

M20 Acquired deformities of the fingers 114 42 352 65 155 188 183 255 116 162 78 82 129 91 2,012 and toes

M48 Other spondylopathies 179 22 51 243 81 67 24 61 109 271 60 62 194 364 191 1,979

Case numbers <5 are not listed.

MAIN TREATMENT (CHOP)

CHOP Description AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP 2015

81.5 Joint replacement in the lower limbs 565 14 489 976 290 452 681 417 550 140 504 278 177 865 214 6,612

80.6 Meniscectomy of the knee 278 776 519 238 184 607 328 183 95 390 47 214 446 142 4,449

81.4 Other reconstruction of the joints of 152 442 290 160 105 401 413 186 71 260 109 104 594 109 3,396 the lower limbs

74.1 Deep cervical Caesarean section 351 405 245 239 317 400 625 318 2,900

79.3 Open repositioning of a fracture with 120 144 142 109 240 145 119 240 13 186 21 70 306 48 1,903 internal bone fixation

77.5 Plastic reconstruction of hallux valgus 96 41 334 57 106 155 137 249 117 152 67 76 123 84 1,794 and other deformities of the toes

81.0 Spinal fusion 78 12 20 274 207 57 46 26 256 20 72 210 261 172 1,715

78.6 Bone implant removal 80 10 92 152 96 196 206 79 128 20 155 16 76 225 78 1,611

80.5 Excision or destruction of an 89 13 45 295 38 88 41 85 330 31 50 168 218 66 1,560 intervertebral disc

81.8 Arthroplasty and plastic reconstruc 42 135 123 52 80 178 119 160 46 165 77 98 134 62 1,472 tion of the shoulder joint and elbow

Case numbers <5 are not listed. 44 PERFORMANCE DIAGNOSIS RELATED GROUPS (DRG) IN FIGURES

A four-character code and a text designation are used to diagnoses and procedures. Finally, the fourth character describe each of the 1,000 or so diagnosis related groups (one of letters A to H) refers to the severity classification, in the SwissDRG catalogue. The first character refers to with “A” denoting the highest severity. the aforementioned MDC, with the MDC digits translated into letters (A to Z). The next two characters are digits (01 to 99). As “basic SwissDRG”, they denote the relevant

FREQUENCY OF SWISSDRGS IN THE HIRSLANDEN HOSPITALS The most common DRG normally relate to cases that occur in large numbers and are relatively homogeneous, i.e. births and knee operations in Hirslanden’s case and in the case of many other hospitals. Other common DRG include heart treatment and joint replacements.

NUMBER OF DIAGNOSES/TREATMENTS PER CASE

AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP 2015

Treatment index 4.2 4.9 2.3 3.3 3.5 2.7 2.6 3.9 3.8 3.6 2.1 2.7 3.4 3.0 5.1 4.7 3.9

Diagnosis index 5.6 6.3 3.5 4.6 3.9 3.1 3.1 3.6 4.2 5.0 2.0 3.4 4.0 3.6 5.4 4.4 4.6

THE MOST COMMON SWISSDRG

DRG Total AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP 2015

P67 Newborn, weight at admission 714 1,079 447 482 773 788 949 561 5,793 > 2,499 g, without significant OR pro cedure, without ventilation > 95 hours

I18 Arthroscopy including biopsy or 307 981 691 294 214 704 378 223 115 506 68 264 552 171 5,469 other procedures on the bones or joints

I53 Other procedures on the vertebral 259 32 110 635 154 156 32 148 196 586 93 95 308 502 158 3,464 column without extremely severe complications, with complex proce dure or halo traction

O60 Vaginal delivery 375 704 217 243 455 404 345 264 3,007

O01 Caesarean section 359 414 249 240 357 418 627 319 2,983

I20 Procedures on the foot 146 63 491 123 254 314 213 346 118 270 96 120 195 154 2,904

I47 Revision or replacement of the hip 248 144 364 128 195 301 144 222 52 183 126 74 368 100 2,654 joint without complicating diagnosis, without arthrodesis, with complicat ing procedure or implantation or change of a radial head prosthesis

F49 Invasive cardiological diagnosis, ex 259 796 158 273 756 349 2,591 cept in the case of acute myocardial infarction

I43 Implantation or complete replace 225 229 308 113 194 301 172 143 69 243 119 75 231 78 2,505 ment of an endoprosthesis of the knee joint

I13 Procedures on the humerus, tibia, 131 166 275 146 131 223 114 177 56 254 41 112 439 109 2,374 fibula and ankle

Case numbers <5 are not listed. PERFORMANCE 45

CASE MIX INDEX To invoice hospital services on a flat rate per case basis, The figure only relates to economic expenditure and not a cost weight is assigned to each inpatient case. It is then to the types of procedure carried out. This is why two com possible to compare the various DRG in terms of their pletely different cases – such as an expensive implant on resource requirements. A hospital’s “case mix index” is the one hand and a complex process of patient treatment calculated by dividing the sum of the cost weights of all in in an intensive care unit on the other – produce a similar patient cases in one year by the total number of cases. cost weight.

CASE MIX INDEX

SwissDRG AA BS PM SA AK LC RO BC CC ST MG BI BE SH HI IP 2015

CMI result 1.2 1.6 0.9 0.9 0.9 1.0 1.0 1.0 1.3 1.1 0.9 1.0 1.1 1.0 1.4 1.2 1.1

Inpatient discharges in calendar year 2015 including newborns and patients with accident insurance

HEART MEDICINE As in previous years, in the case of specific indications in These high percentages underline the strong acute medical heart medicine, one in every five or even four adult patients focus of surgical and interventional treatment at Hirslanden in Switzerland was treated in a Hirslanden hospital in 2015. hospitals.

Number of cases at Hirslanden’s share of Procedures Hirslanden the frequency in Switzerland

Coronary bypass 1,092 33.7%

Heart valve operations 1,352 32.9%

Percutaneous cardiovascular procedures 3,098 17.5%

Implantation of an automatic cardioverter defibrillator 158 19.9%

Circulatory disorders with cardiac catheter 5,733 27.3%

Implantation and replacement of a permanent cardiac pacemaker 773 18.6%

Source: FSO – Federal Statistical Office 46 PERFORMANCE LIST OF SPECIALTIES AT EACH HOSPITAL Hirslanden Klinik Aarau Bern Klinik Beau-Site, Bern Klinik Permanence, Salem-Spital, Bern Cham Zug AndreasKlinik Geneva Clinique La Colline, Heiden Klinik Am Rosenberg, Lausanne Clinique Bois-Cerf, Lausanne Clinique Cecil, Anna, Lucerne Klinik St. Hirslanden Klinik Meggen Basle Münchenstein Klinik Birshof, Schaffhausen Klinik Belair, Gallen St Klinik Stephanshorn, Klinik Hirslanden, Zurich Zurich Klinik Im Park,

Anaesthesiology/Pain therapy × × × × × × × × × × × × × × × ×

Angiology/Vascular surgery × × × × × × × × ×

Surgery × × × × × × × × × × × × × × × ×

Gastroenterology × × × × × × × × × ×

Gynaecology/Obstetrics × × × × × × × × × × ×

Hand surgery × × × × × × × × × × × × × ×

Heart and thoracic vascular surgery × × × × ×

Infectiology × × × × × × × × × × × × ×

Internal medicine × × × × × × × × × × × × × × ×

Cardiology × × × × × × ×

Oromaxillofacial surgery × × × × × × × × × ×

Paediatric and adolescent medicine × × × × × × × ×

Nephrology × × × × × × ×

Neurosurgery × × × × × × × × × × × × × ×

Neurology × × × × × × × × × ×

Neuroradiology × × × × ×

Oncology/Haematology × × × × × × × × ×

Ophthalmology × × × × × × × × × ×

Orthopaedics/Sports medicine × × × × × × × × × × × × × ×

Ear, nose and throat medicine (ENT) × × × × × × × × × × × × ×

Plastic surgery × × × × × × × × × × × × × × × ×

Pneumology × × × × × × × × ×

Radiology × × × × × × × × × × × × × ×

Radio-oncology/Radiotherapy × × × Rheumatology/ Physical medicine and × × × × × × × × × × × × × rehabilitation Thoracic surgery × × × × × × ×

Urology × × × × × × × × × × × × × ×

Visceral surgery × × × × × × × × × × × × × PERFORMANCE 47 SPECIALTY IN THE SPOTLIGHT: HEART MEDICINE

WITH OVER 10,800 TREATMENT CASES AND SIX HOSPITALS OFFERING CARDIAC PROCEDURES, HEART MEDICINE IS ONE OF THE MOST IMPORTANT SPECIALTIES AT THE HIRSLANDEN PRIVATE HOSPITAL GROUP. THE SERVICES ON OFFER RANGE FROM HEART SURGERY TO RHYTHMOLOGY AND ARE BASED ON INTERDISCIPLINARY CO-OPERATION BETWEEN SITES.

In the case of specific indications in heart medicine, one care in the field – as also seen across the entire Group – is in every four adult patients was treated at a Hirslanden covered (with the exception of heart transplants and paedi hospital in 2015. In some disciplines this proportion was atric heart surgery). This includes coronary bypass surgery, even higher, with 31 percent of heart valve operations heart valve surgery and thoracic aortic surgery. With its and 29 percent of coronary bypass operations carried out heart surgery and cardiology departments, Hirslanden Klinik at Hirslanden hospitals. In this way, Hirslanden makes an Aarau guarantees comprehensive care in heart medicine important contribution to the basic care of patients with in the Swiss Plateau region. heart conditions. 2014 also saw the start of a successful co-operation between In order to ensure the quality of medical care and always the heart surgery department at Hirslanden Klinik Aarau keep up to date with the latest advances in medicine, and the cardiology department at the Aarau Cantonal Hospi Hirslanden promotes co-operation between qualified doctors tal (KSA). This resulted in the launch of the “Herzzentrum from different branches of heart medicine and combines Aargau”. Weekly meetings are now held between the cardiac this with a comprehensive system of medical treatment and teams at the KSA and joint daily visits are also made to a modern infrastructure. The system of medical treatment patients at Hirslanden Klinik Aarau. Special procedures such includes disciplines such as emergency care, anaesthesia, as TAVI (transcatheter aortic valve implantation) are car intensive care and general internal medicine, and allows for ried out by the cardiologists at the cardiac catheterisation optimal patient care. laboratory at Hirslanden Klinik Aarau in co-operation with the heart surgeons on site. However, co-operation not only takes place within the Group on an interdisciplinary basis, but also as part of collabora tions with external partners. A prime example of this is the co-operation of Hirslanden Klinik Aarau with Inselspital Bern and the Aarau Cantonal Hospital.

Since 2014, Prof. Thierry Carrel and PD Dr Lars Englberger have headed up the heart surgery department at Hirslanden Klinik Aarau in addition to their duties at Inselspital Bern. This means that heart medicine at Hirslanden Klinik Aarau now has a link to universities. The hospital can contribute to the medical training and research at Inselspital Bern and help in establishing joint medical standards. With the reorganisation of heart surgery in Aarau, the full range of

“In the cardiac field, the specialists in Aarau are achieving what everyone is talking about – quality through co-operation.”

PD Dr Lars Englberger 48 REFERENCES INFRASTRUCTURE OF THE HOSPITALS

Beds Hirslanden Klinik Aarau Bern Klinik Beau-Site, Bern Klinik Permanence, Salem-Spital, Bern Cham Zug AndreasKlinik Geneva Clinique La Colline, Heiden Klinik Am Rosenberg, Lausanne Clinique Bois-Cerf, Lausanne Clinique Cecil, Anna, Lucerne Klinik St. Hirslanden Klinik Meggen Basle Münchenstein Klinik Birshof, Schaffhausen Klinik Belair, Gallen St Klinik Stephanshorn, Klinik Hirslanden, Zurich Zurich Klinik Im Park, Total Beds total (inpatient) 155 111 47 168 56 67 62 68 86 196 20 48 28 109 330 126 1,677 Beds in single rooms 67 27 15 39 14 67 13 20 44 59 4 13 3 8 236 30 659 Beds in twin rooms 67 72 17 72 26 0 22 48 42 82 10 28 22 78 94 96 776 Beds in shared rooms 21 12 15 57 16 0 27 0 0 55 6 7 3 23 0 0 242

Beds in special departments Intensive care unit 8 12 0 0 0 0 0 0 7 6 0 0 0 6 22 8 69 Recovery room/Intermediate care 10 25 7 11 16 22 5 11 21 15 5 14 6 5 15 16 204 Day clinic 17 6 0 10 15 21 0 10 14 14 5 0 0 9 16 17 154 Accident and emergency × × × × × × × × × × ×

Operating theatres and labour suites Operating theatres 7 5 3 8 4 6 5 5 6 6 3 5 2 5 14 8 92 Labour suites 2 0 0 4 3 0 0 0 2 3 0 0 0 4 3 2 23

Medical technology MRI (Magnetic Resonance Tomography) 2 1 0 2 0 0 0 1 1 4 0 1 0 2 6 3 23 CT (Computed Tomography) 2 1 0 2 0 0 0 1 1 1 0 1 0 1 3 2 15 Heart catheter laboratory 2 3 0 0 0 0 0 0 2 1 0 0 0 0 5 3 16 incl. electrophysiology laboratory × × × × 0 0 ×

Nuclear medicine 0 0 0 0 0 0 0 0 1 2 0 0 0 0 2 0 5 LINAC (Linear Accelerator incl. CyberKnife) 1 0 0 0 0 0 0 1 0 0 0 0 0 0 4 0 6 Surgical robot 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 5 Dialysis beds 6 0 0 10 0 0 0 0 23 13 0 0 0 0 0 12 64

As of 31.3.2016 REFERENCES 49

Operating theatres and labour suites Operating theatres 7 5 3 8 4 6 5 5 6 6 3 5 2 5 14 8 92 Labour suites 2 0 0 4 3 0 0 0 2 3 0 0 0 4 3 2 23

Term Explanation

75th percentile Statistical term; 75 percent of all comparative values are the same or better

Acute somatic Inpatient treatment of acute diseases or accidents

German Consulting Centre for Hospital Epidemiology and Infection Control (BZH) BZH in Freiburg im Breisgau (Germany)

Case mix Sum of all cost weights at a hospital

Case mix index Average cost weight at a hospital

Swiss Inpatient Quality Indicators; quality indicators for Swiss acute care hospitals CH-IQI from the Swiss Federal Office of Public Health

CHOP Swiss operation classification; used for coding operations and treatment

CIRS Critical Incident Reporting System; system for reporting critical incidents anonymously

Statistically based estimate of the range within which a given parameter (e.g. an Confidence interval average figure) can be found

Corporate Office Headquarters of the Hirslanden Private Hospital Group in Zurich

Cost weight Average expenditure on a DRG

Decubitus Bed sore, pressure sore

Products in medicine that support the functions of the human body (e.g. urinary Device catheters, artificial respiration)

Diagnosis Related Groups; patient classification system that divides inpatients into DRG medically and economically homogeneous groups with the same expenditure

EFQM European Foundation for Quality Management

Flat rate payment Reimbursement for medical services for each case treated

HISS Hospital Infection Surveillance System

List of all hospitals in a canton that can invoice statutory basic insurance agencies Hospital list (KVG) for services provided REFERENCES 51

Term Explanation

HSM Highly specialised medicine

ICD International Classification of Diseases; used for coding diagnoses

ICU Intensive Care Unit

IQIP International Quality Indicator Project

ISO International Organization for Standardization

ISO 9001:2008 Quality management standard for service providers

International Prevalence Measurement of Care Problems; as developed by the LPZ University of Maastricht

MDC Major Diagnostic Categories; in DRG systems

Mortality index Ratio of expected mortality in a patient group to the effective (actual) mortality

Nosocomial infection An infection that occurs during a stay or treatment in a hospital

Simplified Acute Physiology Score; classification system for assessing the physiological SAPS condition of a patient, including the individual mortality risk of a patient in intensive care

SIRIS Swiss implant register

SQLape Analysis algorithm for acquiring readmission and reoperation data

SwissDRG Swiss DRG system since 2012, derived from the German DRG system G-DRG

Association of doctors in senior positions; draws up recommendations against nosocomial infections and resistance to antibiotics in the Swiss healthcare system, adapts international Swissnoso guidelines according to national demands and provides information on the latest develop ments in the field of infection prevention. Swissnoso also carries out a prevalence study across Switzerland that provides valuable data on nosocomial infections 52 REFERENCES THE HOSPITALS AND CENTRES OF THE HIRSLANDEN PRIVATE HOSPITAL GROUP

1 CLINIQUE LA COLLINE 9 KLINIK BIRSHOF Hospital Manager: Stéphan Studer Hospital Manager: Daniela de la Cruz Avenue de Beau-Séjour 6 Reinacherstrasse 28 CH-1206 Geneva CH-4142 Münchenstein T +41 22 702 20 22 T +41 61 335 22 22 F +41 22 702 20 33 F +41 61 335 22 05 [email protected] [email protected]

2 CLINIQUE BOIS-CERF 10 HIRSLANDEN KLINIK AARAU Hospital Manager: Cédric Bossart Hospital Manager: Philipp Keller Avenue d’Ouchy 31 Schänisweg CH-1006 Lausanne CH-5001 Aarau T +41 21 619 69 69 T +41 62 836 70 00 F +41 21 619 68 25 F +41 62 836 70 0 1 [email protected] [email protected]

3 CLINIQUE CECIL 11 KLINIK ST. ANNA Hospital Manager: Jean-Claude Chatelain Hospital Manager: Dr Dominik Utiger Avenue Ruchonnet 53 St. Anna-Strasse 32 CH-1003 Lausanne CH-6006 Lucerne T +41 21 310 50 00 T +41 41 208 32 32 F +41 21 310 50 0 1 F +41 41 370 75 76 [email protected] [email protected]

4 SALEM-SPITAL 12 ST. ANNA IM BAHNHOF Hospital Manager: Norbert Schnitzler Hospital Manager: Dr Dominik Utiger Schänzlistrasse 39 Zentralstrasse 1 CH-3013 Bern CH-6003 Lucerne T +41 31 337 60 00 T +41 41 556 61 80 F +41 31 337 69 30 F +41 41 556 61 60 [email protected] [email protected]

5 KLINIK PERMANENCE 13 HIRSLANDEN KLINIK MEGGEN Hospital Manager: Daniel Freiburghaus Hospital Manager: Andrea Bazzani Bümplizstrasse 83 Huobmattstrasse 9 CH-3018 Bern CH-6045 Meggen T +41 31 990 41 1 1 T +41 41 379 60 00 F +41 31 99 1 68 01 F +41 41 379 60 95 [email protected] [email protected]

6 KLINIK BEAU-SITE 14 ANDREASKLINIK CHAM ZUG Hospital Manager: Dr Christoph Egger Hospital Manager: Dr Urs Karli Schänzlihalde 11 Rigistrasse 1 CH-3013 Bern CH-6330 Cham T +41 31 335 33 33 T +41 41 784 07 84 F +41 31 335 37 72 F +41 41 784 09 99 [email protected] [email protected]

7 PRAXISZENTRUM AM BAHNHOF 15 KLINIK IM PARK Hospital Manager: Dr Christoph Egger Hospital Manager: Stephan Eckhart Parkterrasse 10 Seestrasse 220 CH-3012 Bern CH-8027 Zurich Geneva T +41 31 335 50 00 T +41 44 209 2 1 11 F +41 31 335 50 80 F +41 44 209 20 11 [email protected] [email protected]

8 PRAXISZENTRUM DÜDINGEN 16 KLINIK HIRSLANDEN Hospital Manager: Dr Christoph Egger Hospital Manager: Dr Conrad Müller Bahnhofplatz 2A Witellikerstrasse 40 CH-3186 Düdingen CH-8032 Zurich T +41 26 492 80 00 T +41 44 387 2 1 1 1 F +41 26 492 80 88 F +41 44 387 22 33 [email protected] [email protected] REFERENCES 53

17 KLINIK BELAIR 19 KLINIK STEPHANSHORN Hospital Manager: Dr Peter Werder Hospital Manager: Andrea Rütsche Rietstrasse 30 Brauerstrasse 95 CH-8201 Schaffhausen CH-9016 St Gallen T +41 52 632 1 9 00 T +41 71 282 7 1 1 1 F +41 52 625 87 07 F +41 71 282 75 30 [email protected] [email protected]

18 PRAXISZENTRUM AM BAHNHOF 20 KLINIK AM ROSENBERG Hospital Manager: Dr Peter Werder Hospital Manager: Alexander Rohner Bleicheplatz 3 Hasenbühlstrasse 11 CH-8200 Schaffhausen CH-9410 Heiden T +41 52 557 11 00 T +41 71 898 52 52 F +41 52 557 11 0 1 F +41 71 898 52 77 [email protected] [email protected]

Schaffhausen

Müchenstein Basle Zurich

Heiden Aarau St Gallen

Cham

Meggen

Lucerne

Bern

Düdingen

Lausanne

Hospitals Outpatient clinics Radiology institutes Radiotherapy institutes REFERENCES 54

STRATEGIC PARTNERSHIPS – FOR THE WELL-BEING OF OUR PATIENTS The close co-operation between the Hirslanden Private Hospital Group and its strategic partners forms the basis for the development of innovative processes, services, and products.

MEDCARE First Quality in Ophthalmology

COMPANY DETAILS

Publisher: Hirslanden Private Hospital Group, Corporate Communications Photography: Gian Marco Castelberg Production: Detail AG Printing: Kromer Print AG

This annual report is published in German together with French and English translations.

The 2015/16 annual report of the Hirslanden Private Hospital Group covers the financial year from 1.4.2015 to 31.3.2016.

In all the articles people of both sexes are always meant analogously. ANNUAL/QUALITY REPORT 2015/16 AS DOWNLOAD: WWW.HIRSLANDEN.CH/ANNUALREPORT

ANNUAL/QUALITY REPORT 2015/16 WITH DETAILED QUALITY DATA: WWW.HIRSLANDEN.CH/QUALITYREPORT

INFORMATION ON INDIVIDUAL HOSPITALS: WWW.HIRSLANDEN.CH/LOCATIONS

JOBS AND CAREERS: WWW.HIRSLANDEN.CH/CAREER

HIRSLANDEN SEEFELDSTRASSE 214 CH-8008 ZURICH T +41 44 388 75 85 [email protected]