Schon Klinik is a private for profit clinic in Germany that has innovated new ways of service delivery despite the limitations and restrictions of the German health care system. The Schon Klinik has grown exponentially in the last few years. They have expanded to 15 clinics and now carry a staff of over 7600 individuals. Most of the Schon Klinik’s success has relied upon the design and implementation of a measurement and reporting system for the goal of improving value-based health outcomes. This measuring system has been in place throughout all of their hospitals.
Schon’s Overall Strategy for Growth and Value Improvement
The principal way that Schon ensures growth and value improvement is by its Quality Empowered by Documentation (QED) which was developed by Von Massaakers in 2006. Also, Schon’s overall strategy for growth and value improvement relies upon wrap around services that they offer their eating disorder patients. Another major value is that they offer longer hospital stays in a luxurious environment that counts upon the skilled care of many specialists including chief psychiatrist, an attending psychiatrist, two staff psychiatrists, four staff psychologists (two full psychotherapists and two trainees), and three nurses, art therapists, nutritionists, dieticians, social workers, physical therapists, and exercise physiologists (p. 9). This holistic care is one way they ensure value improvement.
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"Schon Klinik Success: Evaluating Outcomes and Strategy".
Schon’s outcome measurement system, Stakeholders and Success
Schon’s outcome improvement methods to benchmark their success and include the use of various data collection methods. They include Structured Interview for Anorexic and Bulimic Syndromes (SIAB-S), the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI), the Brief Symptom Inventory Global Severity Index (BSI-GSI), and the Patient Health Questionnaire for Depression (PHQ-Depression) (p. 12). In addition to these surveys and inventories, clinicians work with patients in weekly therapy sessions and note special needs and areas where they can improve patient satisfaction.
Amongst their stakeholders and management teams, Schon holds meetings or “grand rounds” twice a week to ensure that excellence in service delivery is being achieved. They also discuss ways to improve methods and orchestrate care. In these rounds, they discuss innovative approaches from other wards and are open and willing to adapt and change to implement what is working and eliminate what is not helpful. When new ideas are proposed, management forms small work group teams (e.g. Practice Group Meetings, Quality Review) to strategize how best to integrate changes into the curriculum. This management style seems to be another key to their success. It keeps their organization fluid and flexible enough to meet the complex needs of their patient and continue to grow as a team who is dedicated to superior care.
Schon’s Model for Delivering Care
Schon’s model for delivering care for patients suffering eating disorders is called the eating disorder cycle of care. Eating disorders care cycle is centered on three branches which encompass pre-admission, inpatient, and step down. Interval treatments and electronic weighing allow staff to monitor patient progress when they are released from care. Likewise, the step down program is an innovative approach to ensuring successful recovery of eating disorder patients. The program is designed to cater to individual patient needs and the challenges they may confront when re-entering home life and society at large. If the patient is not ready to go back to a home environment (where they will not be able to successfully deal with the pressures present there) are transferred to another unit to deal with their specific issues.
The follow up care offered during step down is yet another innovative approach to moving patients toward full recovery and maintenance of their health. For instance, follow up appointments can be set up with a host of outpatient providers who communicate with and operate under Schon’s standards of care. To this Schon piloted the Bad Staffelstein program to reduce the likelihood of relapse in post-discharge patients. These methods have been tested and proven to be effective for the long-term recovery of Schon’s patients. Due to these approaches, patients that have completed the 80 day stay are not left to their own devices but still can rely on the support of clinicians to continue receiving quality care.
Bundled Payment Model for Depression
The bundled payment model was a way for Schon to deal with the increasing costs of care and the higher demands for services because reimbursement was not being adjusted for different factors. Bundling the payment allowed Schon to streamline their services, reduce wait times and increase capacity to shift patients from one facility to another depending upon availability. This approach seems to be working as the Klinik was able to triple the amount of patients served in just two years from 38 to 130 individuals. Further, upon measuring outcomes, Schon was able to reduce wait times and length of stay and increase efficiency.
Deerberg should pursue bundled payments for eating disorder care because it would streamline costs and given the high number of eating disorder patients (approximately 1000 according to Exhibit 7, p. 22), it could prove cost effective. However, as of 2012, Deerberg was still facing challenges in on-boarding payors to apply this bundled payment model to eating disorder clients. Nevertheless, applying this model could improve and expand the approach to eating disorder care by increasing the quality of outpatient and follow up care because it would be included in the bundled payment, not something private clients would have to additionally seek later post-discharge. This is particularly important for those suffering with eating disorders because it is easy to relapse, making follow up services just as important as inpatient care.
In conclusion, being a private clinic, Schon has the utmost responsibility to provide complete excellence in care and continuing innovating new ways to improve the health care delivered in their 15 clinics. Benchmarking, quality improvement, patient satisfaction and orchestration of services across all facilities and wards is a must if they want to be competitive and continue expanding their brand and attracting clients.
