@phdthesis{Lay2002,
  author    = {Lay, Alexander},
  title     = {Auswertung der Notarzteins{\"a}tze in Bayern auf dem DIVI- Protokoll als Basis f{\"u}r ein pr{\"a}klinisches Qualit{\"a}tsmanagement},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-5690},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2002},
  abstract  = {Die Analyse, basierend auf 200221 Protokollen, zeigt große Dokumentationsl{\"u}cken. Der NAW wurde in 43,9 \% und das NEF in 40 \% der Notfalleins{\"a}tze eingesetzt. Es dauerte 9,3 Minuten um den Patienten zu erreichen, 21,5 Minuten um ihn zu stabilisieren und 14,3 Minuten um den Patienten ins Krankenhaus zu bringen. Die meisten Patienten (57,4 \%) waren {\"u}ber 50 Jahre alt, davon bildeten die {\"u}ber 70 j{\"a}hrigen den Schwerpunkt. Jeder 2. Notarzteinsatz (55,6 \%), basierend auf der Notarztindikation (> NACA III), h{\"a}tte ohne einen Notarzt durchgef{\"u}hrt werden m{\"u}ssen. 8,3 \% der Patienten konnten nach der Notarztbehandlung zu Hause gelassen werden. Den gr{\"o}ßten Anteil unter den Notarzteins{\"a}tzen machten Erkrankungen gegen{\"u}ber den Verletzungen aus. Herz- Kreislauf- Erkrankungen stehen an erster Stelle, vor Erkrankungen des ZNS. Die am meisten durchgef{\"u}hrte Maßnahme war der intraven{\"o}se Zugang und die Sauerstoffapplikation.},
  language  = {de}
}
@phdthesis{Bauer2023,
  author    = {Bauer, Carsten},
  title     = {Learning Curve Effects in Hospitals as Highly Specialized Expert Organizations},
  doi       = {10.25972/OPUS-32871},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-328717},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {The collection at hand is concerned with learning curve effects in hospitals as highly specialized expert organizations and comprises four papers, each focusing on a different aspect of the topic. Three papers are concerned with surgeons, and one is concerned with the staff of the emergency room in a conservative treatment. The preface compactly addresses the steadily increasing health care costs and economic pressure, the hospital landscape in Germany as well as its development. Furthermore, the DRG lump-sum compensation and the characteristics of the health sector, which is strongly regulated by the state and in which ethical aspects must be omnipresent, are outlined. Besides, the benefit of knowing about learning curve effects in order to cut costs and to keep quality stable or even improve it, is addressed. The first paper of the collection investigates the learning effects in a hospital which has specialized on endoprosthetics (total hip and knee replacement). Doing so, the specialized as well as the non-specialized interventions are studied. Costs are not investigated directly, but cost indicators. The indicator of costs in the short term are operating room times. The one of medium- to long-term costs is quality. It is operationalized by complications in the post-anesthesia care unit. The study estimates regression models (OLS and logit). The results indicate that the specialization comes along with advantages due to learning effects in terms of shorter operating room times and lower complication rates in endoprosthetic interventions. For the non-specialized interventions, the results are the same. There are no possibly negative effects of specialization on non-specialized surgeries, but advantageous spillover effects. Altogether, the specialization can be regarded as reasonable, as it cuts costs of all surgeries in the short, medium, and long term. The authors are Carsten Bauer, Nele M{\"o}bs, Oliver Unger, Andrea Szczesny, and Christian Ernst. In the second paper surgeons' learning curves effects in a teamwork vs. an individual work setting are in the focus of interest. Thus, the study combines learning curve effects with teamwork in health care, an issue increasingly discussed in recent literature. The investigated interventions are tonsillectomies (surgical excision of the palatine tonsils), a standard intervention. The indicator of costs in the short and medium to long term are again operating room times and complications as a proxy for quality respectively. Complications are secondary bleedings, which usually occur a few days after surgery. The study estimates regression models (OLS and logit). The results show that operating room times decrease with increasing surgeon's experience. Surgeons who also operate in teams learn faster than the ones always operating on their own. Thus, operating room times are shorter for surgeons who also take part in team interventions. As a special feature, the data set contains the costs per case. This enables assuring that the assumed cost indicators are valid. The findings recommend team surgeries especially for resident physicians. The authors are Carsten Bauer, Oliver Unger, and Martin Holderried. The third paper is dedicated to stapes surgery, a therapy for conductive hearing loss caused by otosclerosis (overflow bone growth). It is conceptually simple, but technically difficult. Therefore, it is regarded as the optimum to study learning curve effects in surgery. The paper seeks a comprehensive investigation. Thus, operating room times are employed as short-term cost indicator and quality as the medium to long term one. To measure quality, the postoperative difference between air and bone conduction threshold as well as a combination of this difference and the absence of complications. This paper also estimates different regression models (OLS and logit). Besides investigating the effects on department level, the study also considers the individual level, this means operating room times and quality are investigated for individual surgeons. This improves the comparison of learning curves, as the surgeons worked under widely identical conditions. It becomes apparent that the operating room times initially decrease with increasing experience. The marginal effect of additional experience gets smaller until the direction of the effect changes and the operating room times increase with increasing experience, probably caused by the allocation of difficult cases to the most experienced surgeons. Regarding quality, no learning curve effects are observed. The authors are Carsten Bauer, Johannes Taeger, and Kristen Rak. The fourth paper is a systematic literature review on learning effects in the treatment of ischemic strokes. In case of stroke, every minute counts. Therefore, there is the inherent need to reduce the time from symptom onset to treatment. The article is concerned with the reduction of the time from arrival at the hospital to thrombolysis treatment, the so-called "door-to-needle time". In the literature, there are studies on learning in a broader sense caused by a quality improvement program as well as learning in a narrower sense, in which learning curve effects are evaluated. Besides, studies on the time differences between low-volume and high-volume hospitals are considered, as the differences are probably the result of learning and economies of scale. Virtually all the 165 evaluated articles report improvements regarding the time to treatment. Furthermore, the clinical results substantiate the common association of shorter times from arrival to treatment with improved clinical outcomes. The review additionally discusses the economic implications of the results. The author is Carsten Bauer. The preface brings forward that after the measurement of learning curve effects, further efforts are necessary for using them in order to increase efficiency, as the issue does not admit of easy, standardized solutions. Furthermore, the postface emphasizes the importance of multiperspectivity in research for the patient outcome, the health care system, and society.},
  subject      = {Lernkurve},
  language  = {en}
}
@article{AppelSchulerVogeletal.2017,
  author    = {Appel, Patricia and Schuler, Michael and Vogel, Heiner and Oezelsel, Amina and Faller, Hermann},
  title     = {Short Questionnaire for Workplace Analysis (KFZA): factorial validation in physicians and nurses working in hospital settings},
  series = {Journal of Occupational Medicine and Toxicology},
  volume    = {12},
  journal   = {Journal of Occupational Medicine and Toxicology},
  number    = {11},
  doi       = {10.1186/s12995-017-0157-6},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157510},
  year      = {2017},
  abstract  = {Background: In recent years, there has been an increasing interest in psychosocial workplace risk assessments in Germany. One of the questionnaires commonly employed for this purpose is the Short Questionnaire for Workplace Analysis (KFZA). Originally, the KFZA was developed and validated for office workers. The aim of the present study was to examine the factorial validity of the KFZA when applied to hospital settings. Therefore, we examined the factorial structure of a questionnaire that contained all the original items plus an extension adding 11 questions specific to hospital workplaces and analyzed both, the original version and the extended version. Methods: We analyzed questionnaire data of a total of 1731 physicians and nurses obtained over a 10-year period. Listwise exclusion of data sets was applied to account for variations in questionnaire versions and yielded 1163 questionnaires (1095 for the extended version) remaining for factor analysis. To examine the factor structure, we conducted a principal component factor analysis. The number of factors was determined using the Kaiser criterion and scree-plot methods. Factor interpretation was based on orthogonal Varimax rotation as well as oblique rotation. Results: The Kaiser criterion revealed a 7-factor solution for the 26 items of the KFZA, accounting for 62.0\% of variance. The seven factors were named: "Social Relationships", "Job Control", "Opportunities for Participation and Professional Development", "Quantitative Work Demands", "Workplace Environment", "Variability" and "Qualitative Work Demands". The factor analysis of the 37 items of the extended version yielded a 9-factor solution. The two additional factors were named "Consequences of Strain" and "Emotional Demands". Cronbach's α ranged from 0.63 to 0.87 for these scales. Conclusions: Overall, the KFZA turned out to be applicable to hospital workers, and its content-related structure was replicated well with some limitations. However, instead of the 11 factors originally proposed for office workers, a 7-factor solution appeared to be more suitable when employed in hospitals. In particular, the items of the KFZA factor "Completeness of Task" might need adaptation for the use in hospitals. Our study contributes to the assessment of the validity of this popular instrument and should stimulate further psychometric testing.},
  language  = {en}
}