Outstanding

Based in the German city of Bonn, the Steinbeis Consulting Center IfQO (Institute for Quality Management and Organizational Development) has built up a reputation for helping to found centers of excellence in the field of health care. In recent years, the center has focused on establishing centers to treat colorectal cancer in Germany. In parallel to this, a number of excellence centers to treat prostate, lung and skin cancer have also been created. The Steinbeis experts recently supervised the founding of a liver and gall bladder unit at the Karl-Olga Hospital in Stuttgart.

Under this system, hospitals that treat different types of tumors in separate organ units can now pool overarching responsibilities and processes in one oncology unit, thus leveraging synergies for further structural and procedural standardization and optimization. This drive to provide exemplary treatment is now being extended to the multi-organ treatment of benign conditions, and not just cancer.

Over the course of 2010, the Steinbeis Consulting Center IfQO has been working with specialists to establish and certify the liver and gall bladder unit at the Karl-Olga Hospital in Stuttgart. Before setting up the unit, three key issues had to be addressed:

1. The liver, gall bladder and bile ducts are part of the same anatomical and functional system. Diseases thus require complex treatment, taking several organs into account.
2. The rate of tumors in these three organs is rising sharply. This is why colorectal cancer centers need setting up.
3. Earlier market analysis and requirement planning showed that there is a significant need for oncological liver resectioning in Stuttgart, as there is no top-level expertise in this area in other local hospitals.

Given the fact that around a third of all patients go on to develop liver metastases after successful bowel cancer operations, there is a clear need for centers of excellence for liver treatment. The treatment offered by the liver and gall bladder unit at Karl-Olga Hospital in Stuttgart covers patients with benign and malignant conditions of the liver, gall bladder or bile ducts. As medical associations had not previously laid down certification criteria for either liver units or liver and gall units, in February 2010 the liver and gall bladder unit at Karl-Olga Hospital in Stuttgart became the first of its kind in Germany to undergo successful certification through the TUV Sud technical inspectorate.

Specialists from a variety of in- and outpatient backgrounds have joined forces in the new unit to offer comprehensive medical treatment in this area. By pooling skills across all specialist disciplines – medical testing, diagnosis, treatment and aftercare – the aim was to provide patients with optimum treatment outcomes. A special aspect of the liver and gall bladder unit are the weekly meetings attended by all specialists, which ensure close collaboration between disciplines. At these meetings, interdisciplinary treatment concepts are agreed individually for all patients. These are then monitored during treatment. A team specialized in the psychological and social welfare of tumor patients supports these patients during treatment of their condition.

Another aim with centers of excellence in the health care sector is to establish highly efficient structures and procedures. Here, an important role is played by information exchange at meetings and quality circles, and the resulting ongoing development of diagnostic and therapeutic procedures. Establishing interdisciplinary practice is an essential factor for these units that also requires support from outside the unit. After the initial phase, benchmarks must be applied according to criteria such as achieving minimum volumes. Units must also be open to second opinions from outside.

The lofty goals that the Karl-Olga Hospital liver and gall bladder unit has set for itself are reflected by the binding quality standards and key indicators the unit has introduced. These are based on evidencebased guidelines used by medical societies, although they sometimes go even further. Conformity is checked and evaluated during annual audits and reviews. Certification also stipulates that precise data should be captured and standards must be adhered to. As well as improving quality, this also makes it possible to gather data, particularly on the treatment of patients with conditions of the liver, gall bladder or bile ducts, and this can be used to optimize treatment. So as well as sharing knowledge between service providers, a common understanding of quality and agreed quality standards are also a binding part of the unit’s concept. Specialists at the unit plan, set up and carry out studies to further the development of treatment methods.

The liver and gall bladder unit at Karl-Olga Hospital in Stuttgart is considered a successful pilot project for setting up other liver units. The Bonn-based Steinbeis experts have now provided input on more than 50 centers of excellence in the health care sector. The team sees this as confirmation that by working with partners to set up centers of excellence, it has been possible to significantly boost the level of expertise and care offered by the organizations involved.

Dieter Barwitzki
Steinbeis Consulting Center Institute for Quality Management and Organizational
Development (Bonn)

Prof. Dr. med. Josef H. Fangmann, Dr. med. Eckhart Fröhlich
Karl-Olga-Krankenhaus (Stuttgart)
Josef.Fangmann@karl-olga-krankenhaus.de