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Article ; Online: Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study.

Kleine, Joan / Köppen, Julia / Gurisch, Carolin / Maier, Claudia B

2024 Volume 24, Issue 1, Page(s) 440

Abstract: Background: Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key ... ...

Abstract	Background: Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals. Methods: Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach. Results: Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader's presence, accessibility, and rapid responsiveness, fostering adaptability. Conclusions: The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment.
MeSH term(s)	Humans ; Leadership ; Hospitals ; Qualitative Research ; Organizational Innovation ; Motivation ; Nurse Administrators
Language	English
Publishing date	2024-04-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-024-10862-y
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Article ; Online: Drivers of patient perceptions of health system responsiveness in Germany.

Achstetter, Katharina / Köppen, Julia / Hengel, Philipp / Blümel, Miriam / Busse, Reinhard

The International journal of health planning and management

2022

Abstract: Background: Health system responsiveness (HSR)-the ability of a health system to meet the non-medical legitimate expectations of patients-is a key to patient-centred health systems. Although responsiveness is essential to provide equitable and ... ...

Abstract	Background: Health system responsiveness (HSR)-the ability of a health system to meet the non-medical legitimate expectations of patients-is a key to patient-centred health systems. Although responsiveness is essential to provide equitable and accountable health care, little is known about patient-side drivers of HSR. This study aims to narrow this gap. Methods: A survey among 20,000 Germans with substitutive private health insurance included questions on HSR and patient characteristics such as health literacy (HL), experienced discrimination, and sociodemographic information. Survey data were linked to patient-level claims data. Logistic regression was applied to assess the association between HSR and patient characteristics. Results: The sample (age 54.0 ± 16.1; 60.5% male) contains 2951 respondents with outpatient physician care in the past year. Of the nine HSR items, eight are rated as (very) good (74.4%-94.3%), except for coordination between providers (60.2%). Patient characteristics highly influence HSR: patients with high HL, for instance, are more likely to assess responsiveness as (very) good (e.g., clear explanations from physicians: OR 4.17). Poor assessment of responsiveness is seen among users who experienced discrimination. Conclusion: This study revealed new associations between HSR and patient characteristics. Incorporating this knowledge in practice would help strengthen patient-centred health services by considering patient experiences and expectations. This highlights that HSR can be used as a tool to evaluate and promote patient-centred health services. Future research should investigate additional drivers of HSR, both on the patient and the provider sides.
Language	English
Publishing date	2022-10-03
Publishing country	England
Document type	Journal Article
ZDB-ID	632786-2
ISSN	1099-1751 ; 0749-6753
ISSN (online)	1099-1751
ISSN	0749-6753
DOI	10.1002/hpm.3570
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Article ; Online: Health workforce response to Covid-19: What pandemic preparedness planning and action at the federal and state levels in Germany?: Germany's health workforce responses to Covid-19.

Köppen, Julia / Hartl, Kimberly / Maier, Claudia B

The International journal of health planning and management

2021 Volume 36, Issue S1, Page(s) 71–91

Abstract: Introduction: The Covid-19 pandemic has required countries to prepare their health workforce for a rapid increase of patients. This research aims to analyse the planning and health workforce policies in Germany, a country with a largely decentralised ... ...

Abstract	Introduction: The Covid-19 pandemic has required countries to prepare their health workforce for a rapid increase of patients. This research aims to analyse the planning and health workforce policies in Germany, a country with a largely decentralised workforce governance mechanism. Methods: Systematic search between 18 and 31 May 2020 at federal and 16 states on health workforce action and planning (websites of ministries of health, public health authorities), including pandemic preparedness plans and policies. The search followed World Health Organisation (WHO) Europe's health workforce guidance on Covid-19. Content analysis was performed, informed by the themes of WHO. Results: The pandemic preparedness plans consisted of no or limited information on how to expand and prepare the health workforce during pandemics. The 16 states varied considerably regarding implementing strategies to expand health workforce capacities. Only one state adopted a policy on task-shifting despite a federal law on task-shifting during pandemics. Conclusions: Planning on the health workforce, its capacity and skill-mix during pandemics was limited in the pandemic response plans. Actions during the peak of the pandemic varied considerably across states, were implemented ad hoc and with limited planning. Future action should focus on integrated planning and evaluation of workforce policies.
MeSH term(s)	COVID-19 ; Databases, Factual ; Germany ; Health Policy ; Health Workforce/organization & administration ; Humans ; Pandemics ; Public Health ; SARS-CoV-2 ; World Health Organization
Language	English
Publishing date	2021-03-18
Publishing country	England
Document type	Journal Article
ZDB-ID	632786-2
ISSN	1099-1751 ; 0749-6753
ISSN (online)	1099-1751
ISSN	0749-6753
DOI	10.1002/hpm.3146
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Article ; Online: Assessment of health system performance in Germany: Survey-based insights into the perspective of people with private health insurance.

Achstetter, Katharina / Blümel, Miriam / Köppen, Julia / Hengel, Philipp / Busse, Reinhard

The International journal of health planning and management

2022 Volume 37, Issue 6, Page(s) 3103–3125

Abstract: Introduction: The World Health Organization (WHO) defined intermediate and overall goals to assess the performance of health systems. As the population perspective becomes more important for improving health systems, the aim of this study was to gain ... ...

Abstract	Introduction: The World Health Organization (WHO) defined intermediate and overall goals to assess the performance of health systems. As the population perspective becomes more important for improving health systems, the aim of this study was to gain insights into the perspective of people with private health insurance (PHI) in Germany along the predefined WHO goals. Methods: A cross-sectional survey was conducted in 2018 among people with PHI in Germany. The questionnaire included items on all intermediate (access, coverage, quality, and safety) and overall WHO goals (improved health, responsiveness, social and financial risk protection, and improved efficiency). Descriptive analyses were conducted for the total sample and subgroups (gender, age, income, and health status). Results: In total, 3601 respondents (age 58.5 ± 14.6; 64.7% male) assessed the German health system. For example, 3.3%-7.5% of the respondents with subjective needs reported forgone care in the past 12 months due to waiting time, distance, or financial reasons and 14.4% suspected medical errors in their care. During the last physician visit 94.2% experienced respectful treatment but only 60.6% perceived coordination of care as good. Unnecessary health services were perceived by 24.2%. For many items significant subgroup differences were found, particularly for age groups (18-64 vs. 65+). Conclusion: Conducting a health system performance assessment from the population perspective gained new and unique insights into the perception of people with PHI in Germany. Areas to improve the health system were seen in, for example, coordination of care, financial risk protection, and quality of care, and inequalities between subgroups were identified.
MeSH term(s)	Humans ; Male ; Adult ; Middle Aged ; Aged ; Female ; Cross-Sectional Studies ; Insurance, Health ; Germany ; Health Services Accessibility ; Surveys and Questionnaires
Language	English
Publishing date	2022-08-12
Publishing country	England
Document type	Journal Article
ZDB-ID	632786-2
ISSN	1099-1751 ; 0749-6753
ISSN (online)	1099-1751
ISSN	0749-6753
DOI	10.1002/hpm.3541
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Article ; Online: Financial risk protection in private health insurance: empirical evidence on catastrophic and impoverishing spending from Germany's dual insurance system.

Hengel, Philipp / Blümel, Miriam / Siegel, Martin / Achstetter, Katharina / Köppen, Julia / Busse, Reinhard

Health economics, policy, and law

2023 Volume 19, Issue 1, Page(s) 3–20

Abstract: Financial risk protection from high costs for care is a main goal of health systems. Health system characteristics typically associated with universal health coverage and financial risk protection, such as financial redistribution between insureds, are ... ...

Abstract	Financial risk protection from high costs for care is a main goal of health systems. Health system characteristics typically associated with universal health coverage and financial risk protection, such as financial redistribution between insureds, are inherent to, e.g. social health insurance (SHI) but missing in private health insurance (PHI). This study provides evidence on financial protection in PHI for the case of Germany's dual insurance system of PHI and SHI, where PHI covers 11% of the population. Linked survey and claims data of PHI insureds (
MeSH term(s)	Humans ; Poverty ; Health Expenditures ; Insurance, Health ; Family Characteristics ; Germany
Language	English
Publishing date	2023-09-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2214936-3
ISSN	1744-134X ; 1744-1331
ISSN (online)	1744-134X
ISSN	1744-1331
DOI	10.1017/S1744133123000105
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Conference proceedings: Nurse-sensitive quality and benchmarking in German hospitals: a qualitative study

Maier, Claudia Bettina / Gurisch, Carolin / Köppen, Julia / Kleine, Joan

2023 , Page(s) 23dkvf470

Event/congress	22. Deutscher Kongress für Versorgungsforschung (DKVF); Berlin; Deutsches Netzwerk Versorgungsforschung; 2023
Keywords	Medizin, Gesundheit
Publishing date	2023-10-02
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/23dkvf470
Database	German Medical Science

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Article ; Online: Methodische Herausforderungen und Lessons Learned bei der wissenschaftlichen Nutzung von Daten eines privaten Krankenversicherungsunternehmens im Rahmen des Projekts IPHA.

Achstetter, Katharina / Köppen, Julia / Hengel, Philipp / Nimptsch, Ulrike / Blümel, Miriam

Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany))

2021 Volume 85, Issue S 02, Page(s) S135–S144

Abstract: The 11% of people with private health insurance (PHI) in Germany have so far been underrepresented in health services research. The scientific use of PHI data is rare. The aim of this research was to examine the scientific usability of PHI data and to ... ...

Title translation	Methodological Challenges and Lessons Learned in the Scientific Use of Data from a Private Health Insurance Company within the IPHA Project.
Abstract	The 11% of people with private health insurance (PHI) in Germany have so far been underrepresented in health services research. The scientific use of PHI data is rare. The aim of this research was to examine the scientific usability of PHI data and to highlight challenges and lessons learned in the process of data preparation and analysis using a linked dataset (n=3,109) of survey and claims data of one PHI company. Challenges were identified in the terminology of the PHI insurance, in the processing and validity of the data, and regarding insured persons without submitted billing receipts. With thorough preparation of the data and presentation of the limitations, PHI data can be used for health services research.
MeSH term(s)	Humans ; Germany ; Insurance, Health ; Health Services Research ; Private Sector ; Surveys and Questionnaires
Language	German
Publishing date	2021-11-19
Publishing country	Germany
Document type	English Abstract ; Journal Article
ZDB-ID	1101426-x
ISSN	1439-4421 ; 0941-3790 ; 0949-7013
ISSN (online)	1439-4421
ISSN	0941-3790 ; 0949-7013
DOI	10.1055/a-1658-0584
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Article ; Online: Health Literacy of People with Substitutive Private Health Insurance in Germany and Their Assessment of the Health System Performance According to Health Literacy Levels: Results from a Survey.

Achstetter, Katharina / Köppen, Julia / Haltaufderheide, Matthias / Hengel, Philipp / Blümel, Miriam / Busse, Reinhard

International journal of environmental research and public health

2022 Volume 19, Issue 24

Abstract: Health literacy (HL) is a competence to find, understand, appraise, and apply health information and is necessary to maneuver the health system successfully. People with low HL are, e.g., under the risk of poor quality and safety of care. Previous ... ...

Abstract	Health literacy (HL) is a competence to find, understand, appraise, and apply health information and is necessary to maneuver the health system successfully. People with low HL are, e.g., under the risk of poor quality and safety of care. Previous research has shown that low HL is more prevalent among, e.g., people with lower social status, lower educational level, and among the elderly. In Germany, people with substitutive private health insurance (PHI) account for 11% of the population and tend to have a higher level of education and social status, but in-detail assessments of their HL are missing so far. Therefore, this study aimed to investigate the HL of PHI insureds in Germany, and to analyze their assessment of the health system according to their HL level. In 2018, 20,000 PHI insureds were invited to participate in a survey, which contained the HLS-EU-Q16, and items covering patient characteristics and the World Health Organization health systems framework goals (e.g., access, quality, safety, responsiveness). Low HL was found for 46.2% of respondents and was more prevalent, e.g., among men and insureds with a low subjective social status. The health system performance was perceived poorer by respondents with low HL. Future initiatives to strengthen health systems should focus on promoting HL.
MeSH term(s)	Male ; Humans ; Aged ; Health Literacy ; Surveys and Questionnaires ; Educational Status ; Insurance, Health ; Germany/epidemiology
Language	English
Publishing date	2022-12-13
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph192416711
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Article ; Online: Recruiting and retaining bachelor qualified nurses in German hospitals (BSN4Hospital): protocol of a mixed-methods design.

Maier, Claudia B / Köppen, Julia / Kleine, Joan / McHugh, Matthew D / Sermeus, Walter / Aiken, Linda H

BMJ open

2023 Volume 13, Issue 8, Page(s) e073879

Abstract: Introduction: Many countries in Europe are facing a shortage of nurses and seek effective recruitment and retention strategies. The nursing workforce is increasingly diverse in its educational background, ranging from 3-year vocational training (diploma) ...

Abstract	Introduction: Many countries in Europe are facing a shortage of nurses and seek effective recruitment and retention strategies. The nursing workforce is increasingly diverse in its educational background, ranging from 3-year vocational training (diploma) to bachelor and master educated nurses. This study analyses recruitment and retention strategies for academically educated nurses (minimum bachelor), including intention to leave, job satisfaction and work engagement compared with diploma nurses in innovative German hospitals; it explores recruitment and retention challenges and opportunities, and identifies lessons on recruitment and retention taking an international perspective. Methods and analysis: The study will apply a convergent mixed-methods design, including qualitative and quantitative methods. The qualitative study will include semistructured interviews among hospital managers, nurses, students and stakeholders in Germany. In addition, expert interviews will be conducted internationally in countries with a higher proportion of bachelor/master nurses in hospitals. The quantitative, cross-sectional study will consist of a survey among professional nurses (bachelor/master, diploma nurses) in German hospitals. Study settings are hospitals with a higher-than-average proportion of bachelor nurses or relevant recruitment, work environment or retention strategies in place. Analyses will be conducted in several phases, first in parallel, then combined via triangulation: the parallel analysis technique will analyse the qualitative and quantitative data separately via content analyses (interviews) and descriptive, bivariate and multivariate analyses (survey). Subsequently, data sources will be collectively analysed via a triangulation matrix focusing on developing thematic exploratory clusters at three systemic levels: microlevel, mesolevel and macrolevel. The analyses will be relevant for generating lessons for clinical nursing, management and policy in Germany and internationally. Ethics and dissemination: Ethics approval was obtained by the Charité Ethics Committee.Several dissemination channels will be used, including publications and presentations, for the scientific community, nursing management, clinical nurses and the wider public in Germany and internationally.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Employment ; Nursing Staff ; Hospitals ; Nurses
Language	English
Publishing date	2023-08-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-073879
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Article ; Online: Integrating the Population Perspective into Health System Performance Assessment (IPHA): Study Protocol for a Cross-Sectional Study in Germany Linking Survey and Claims Data of Statutorily and Privately Insured.

Blümel, Miriam / Röttger, Julia / Köppen, Julia / Achstetter, Katharina / Busse, Reinhard

International journal of health policy and management

2020 Volume 9, Issue 9, Page(s) 370–379

Abstract: Background: Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a ... ...

Abstract	Background: Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system. Methods and analysis: A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography. Discussion: The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective.
MeSH term(s)	Cross-Sectional Studies ; Delivery of Health Care ; Female ; Germany ; Humans ; Insurance, Health ; Male ; Surveys and Questionnaires
Language	English
Publishing date	2020-09-01
Publishing country	Iran
Document type	Journal Article
ZDB-ID	2724317-5
ISSN	2322-5939 ; 2322-5939
ISSN (online)	2322-5939
ISSN	2322-5939
DOI	10.15171/ijhpm.2019.141
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