>> "The term "last mile" of the healthcare system refers to the concrete medical and healthcare provision in hospitals, doctor's offices, and other healthcare facilities, within which the crucial services are provided together with the patient." To this day, the definition of the "last mile" developed by Pfaff and his colleagues remains unchallenged; on the contrary: it remains as consistent as ever.
The definitional work undertaken at the time, held at the "First German Congress of Health Services Research," must be seen and understood. The conference proceedings of this very textbook, "Health Care and Disease Management," published by Huber Verlag, served as the conference proceedings. Both the conference and the book popularized the somewhat more cumbersome term "health services research" with the more memorable slogan "Last Mile."
This was an "umbrella formulation," as Pfaff calls this term; because naming a research field requires a comprehensive, connectable, and not overly narrow term. Pfaff: "So that, on the one hand, everyone immediately understands roughly what it is about, while still leaving some room for interpretation so that enough researchers can gather under this umbrella term." This is precisely what the Cologne nucleus—which can be seen as the prime meridian of German health services research—not only understood, but embedded in a carefully developed—albeit never written—concept. An important point in this was that the Cologne initiator group – from which the Network for Health Services Research (DNVF) later emerged – organized the “First German Congress of Health Services Research” in order to underline from the outset that the prefix “First” almost inevitably requires a “Second” and “Third” – right up to the now 16th Congress, which will take place again this year from October 4th to 6th in the Urania in Berlin.
Secondly, the non-profit association "German Network for Health Services Research" (DNVF), founded on May 2, 2006, in Berlin by the Standing Congress Commission of the German Congress for Health Services Research (DKVF), explicitly accepted medical professional societies (initially 26, now 51) in addition to natural persons. To underpin this active collaboration with medicine, the first 14 DKVF congresses were also held as add-on events to the major congresses of these professional societies. While this minimized the media impact of a dedicated congress (and continued until 2015), the most important goal was achieved: to establish health services research as a system-supporting component of medicine.

Shortly after the administrative scientist, who had been trained at the Technical Universities in Konstanz and Berlin – with interdisciplinary training in economics, law, sociology, and psychology, supplemented by political science – was appointed professor of medical sociology in Cologne, he received a call from Schrappe, then quality manager at Cologne University Hospital. His problem at the time (which remains relevant to this day): inadequate application of evidence-based guidelines. The question was how social science knowledge could be used to increase guideline compliance. "With this call, medicine extended its hand to public health," Pfaff recalls, recalling the starting point of the collaboration. This was the "nucleus" of the institutionalization of health services research "made in Cologne." Of course, this discipline already existed elsewhere in our country at the time, but not under the explicit heading of "health services research."
This research activity, triggered by Schrappe's call, initiated a collaboration that culminated in the founding of the Center for Health Services Research Cologne (ZVFK) in 2001 and the holding of the first German Congress for Health Services Research. Years later, in 2009, following two calls for positions and subsequent negotiations to retain the position, the opportunity arose to establish the "Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR)." The stated goal of the IMVR, a joint scientific institution for the humanities,
Scientific Faculty and the Medical Faculty of the University of Cologne: Ensuring high-quality and at the same time efficient health care for the population throughout their lifespan, which represents one of the central future problems of our society.
According to the institute's portal, science can contribute significantly to solving this problem if relevant disciplines such as medicine, rehabilitation science, special education, psychology, and sociology pool their resources and collaborate purposefully. The Faculty of Humanities and Medicine were and are aware of this particular problem and, with the establishment of the IMVR, sought to create a closer, problem-oriented network between their disciplines. Among other things, this goal was to be given concrete expression through the establishment of a bridge professorship and the bridge institute "Institute for Medical Sociology, Health Services Research and Rehabilitation Science" (IMVR).
The IMVR consists of the departments of Medical Sociology, Health Services Research, and Rehabilitation Science, as well as the office of the Center for Health Services Research Cologne (ZVFK). The institute's working groups have many years of experience in the field of empirical social research (survey methods, study designs, analysis methods, evaluation methods) and are characterized by high expertise in the planning, organization, implementation, and evaluation of studies in health care facilities (e.g., hospitals or rehabilitation facilities) as well as in surveying patients, employees, and managers.
Various research programs are also being conducted, such as one on "Interaction and Organization in Healthcare," which is located in the Department of Medical Sociology. The goal of this research program is to generate knowledge about the individual and organizational prerequisites for patient-centered care. On this basis, it aims to contribute to improving care that will enable the psychological, physical, and social well-being, as well as the health literacy of those affected, to be restored, maintained, or increased.
A second research program, this time from the Department of Health Services Research, focuses on the "Performance of Health Care Organizations." The focus is on the organizational design of service provision in the healthcare system. Care structures and processes, as well as the resulting quality of outcomes, are examined. In addition to the cross-professional and disease-specific analysis of organizational behavior (e.g., quality behavior, implementation behavior, innovation behavior, leadership behavior), suitable research instruments are developed and validated for this purpose.
The Department of Rehabilitation Science is also dedicated to a research program on "Work, Health, and Rehabilitation." This research program examines the influence of work-organizational, personal, and social factors on health, focusing equally on preventive and rehabilitative issues. Previous studies have examined, for example, personal and organizational resources and health determinants such as work-life balance, social capital, and work engagement. One goal of the research program is to identify health-promoting protective factors and strategies that help maintain or restore employees' employability in the long term. In addition, comparative organizational analyses are used to identify differences and similarities and demonstrate relationships with health-related outcomes.
With the receipt of BMBF-based structural funding in 2017, the IMVR assumed leadership of the newly established Cologne Network for Health Services Research (CoRe-Net), thus reaching another important milestone. Within the BMBF-funded CoRe-Net, three faculties and nine institutes/departments of the University of Cologne are collaborating under the coordination of the ZVFK and the IMVR to advance healthcare in the Cologne area through innovation and establish it as an innovative model region.
by: MVF Editor-in-Chief Peter Stegmaier <

Citation information: doi:10.24945/MVF.02.17.1866-0533.2008