Original article
In order to successfully introduce innovations into complex adaptive systems, such as doctors' offices or hospitals, we need to understand how implementation processes and their contexts depend on each other. In particular, detailed knowledge of what actions actors take to give an innovation meaning and to integrate it into their work processes, as well as knowledge of contextual elements that influence actions, are an essential prerequisite for the transition of an innovation from model project status to model project status Everyday supply. The Normalization Process Theory (NPT), which is currently one of the most prominent theories in implementation research, can provide guidance in this context. It characterizes the introduction and embedding of innovations as a social process of collective action and less as an effort by individuals. As a medium-range theory, it describes a series of generative mechanisms of different types that motivate and structure the actions of those involved in integrating innovations into care.
23.03.2022
Although the system theory of Luhmann's style is considered “extremely complex, counterintuitive, difficult to understand, if not perverse” (Hörisch, 2010, p. 343), it also has properties that make it particularly relevant to scientific problem solving in general particularly attractive in relation to issues relating to health services research. On the one hand, it can be used universally as a so-called “super theory” (Berghaus, 2011, p. 24), which means that it can basically be applied to all social situations in which concrete questions or problems are considered. The reason for their diverse possible uses lies in the basic assumption that so-called functional systems have developed (and are still developing) in the modern world. These systems can differentiate themselves at the macro level (e.g. science, politics, economics), at the meso level (e.g. institutions or organizations) or at the micro level (e.g. family or school classes). The (social) environment of humans is characterized above all by increasing complexity.
23.03.2022
At the specialist conference “Theory Dare”, which “Monitor Health Services Research” held at the end of last year in cooperation with the Federal Association of Managed Care e. V. (BMC) conducted online, it quickly became clear: health services research needs not just one theory, but many that exist in different scientific areas. You just have to know them and use them. After the first day of the congress, which dealt with the basics of the theories and the results of which were presented in the first part of the report in MVF 01/22, the second day of the congress attempted to answer the question of how theories can be applied in practice and whether that – discussed using the example of pilotage projects – would make sense.
23.03.2022
At its meeting in November 2021, the board of the German Medical Association discussed and decided on a statement on “care in sparsely populated regions” on the recommendation of the board of the “Standing Working Group on Health Services Research”. After extensive discussion under the joint aegis of Prof. Dr. med. Wolfgang Hoffmann and Prof. Dr. med. Wilhelm-Bernhard Niebling, both leaders of the standing working group “Health Services Research”, has published part 1 of the statement on problem presentation and monitoring in the “Deutsches Ärzteblatt” (1). Here you can read the background as well as the most important results and facts.
23.03.2022
Comment from Dr. rer. pole. Ilona Köster-Steinebach, Sepsis Foundation
23.03.2022
In addition to the “theory of practice”, the habitus theory goes back to Pierre Bourdieu (1974), who examined how the subject and structural levels arise mutually and are reproduced in social interactions. The habitus is a central concept that connects all theoretical components in Bourdieu's “theory of practice”, the central concern of which is overcoming the opposition between subjectivism and objectivism. According to Bourdieu (1987), habitus stands for a person's “patterns of perception, thought and action” in which all incorporated, previous social experiences are expressed. The habitus is primarily shaped by the specific social position that members of a social group occupy within a social structure. More generally, the concept serves to convey individual dispositions (subject level) and social possibilities (structural level). According to Bourdieu, the actor (e.g. health workers) is understood as the bearer of a habitus (Reckwitz 2008).
23.03.2022
The platform - Charité Health Care Research, founded in 2019 on the initiative of the BMBF-funded research networks EMANet and NAVICARE, has now organized its 3rd Charité Health Care Research Congress - again in online format. Well over 100 participants followed the presentation of various Charité innovation fund projects from the funding area of “health care research” in the satellite symposium, as well as in the plenary session after the welcome by Prof. Dr. Christoph Heintze (speaker of the platform – Charité Health Services Research) and Prof. Dr. Elke Schäffner (Deputy Speaker of the Platform) was followed by greetings from Ulrike Gote (Senator for Science, Health, Care and Equality, Berlin) and Prof. Dr. Heyo Kroemer (Chairman of the Charité – University Medicine Berlin) and Prof. Dr. Martin Kreis (Board of Health Care Charité – University Medicine Berlin).
23.03.2022
In NRW's new hospital plan, planning is no longer based on the number of beds, but rather with 32 service areas, 64 service groups and four planning levels. Its practical implementation will be a major challenge for every hospital - with 400 hospital locations in North Rhine-Westphalia alone. It is planned that each head of administration must first analyze the service areas of his company and then those of all competitors in order to negotiate the new distribution of care on this basis - first with the competitors, then with the regional associations of health insurance companies. Data analysis could support hospital planning in North Rhine-Westphalia. How this works is explained in an interview with “Monitor Healthcare Research” Dr. Eberhard Hansis and Dr. Hannes Dahnke, two physicists who founded the Hamburg data analytics company Vebeto, which specializes in analyzing German hospitals using publicly available data.
23.03.2022
“Beyond camp thinking” was the title of the Alliance of Municipal Hospitals (AKG) in its “reform approaches for a sustainable and quality-oriented hospital landscape” presented in September last year together with the AOK Federal Association. “Rethinking health” called for the “Target Image 2030”, which many stakeholders from Saxony presented to State Minister Petra Köpping (Saxon State Ministry for Social Affairs and Social Cohesion) at the beginning of February this year. There have also been and are currently more reform proposals than ever before - such as from Barmer ("For the further development of inpatient care structures and hospital financing"), position papers such as those from the GKV National Association on ("Hospital care after the Corona pandemic 2020") , reports on the “future of medical care in Mecklenburg-Western Pomerania” (Health Care Business GmbH) and on the “hospital landscape of North Rhine-Westphalia” (Lohfert & Lohfert), theses papers such as that from the BKK umbrella association, vdek and VUD for “a targeted further development of hospital care”, Catalogs of demands such as “Change strategy now!” by the two authors Prof. Dr. Edmund AM Neugebauer and Dr. Dr. Klaus Piwernetz or individual statements such as “Securing good health care and care in the long term” from G-BA boss Prof. Josef Hecken. They all have one thing in common: They recognize that there is no alternative to the “need to address change” (Hecken) and that now is the time to “rethink our health system” (Neugebauer/Piwernetz).
23.03.2022
In its coalition agreement, the current federal government announced, among other things, the strengthening of the Public Health Service (ÖGD) and the establishment of a “Federal Institute for Public Health”, but has not (yet) elaborated on this. For this reason, the Federal Association of Managed Care eV (BMC) has taken on this task and, together with many fellow thinkers, published a paper entitled “Impulses for a Federal Institute for Public Health” and discussed how in a public webinar with over 100 participants such an institute could be set up.