[Hospital management: quality and economy as management challenges for the physicians].

As a consequence of the Gesundheitsstrukturgesetz (GSG-Health Structure Act) hospitals are called upon to organize the processes of medical, nursing care and administrative services more economically, without there being any reduction in either the social quality or the quality of the process or result of the task of caring for patients. Fulfilling the task of caring for patients professionally entails providing medical efficiency and economy (section 109 SGB V). The hospital management is called upon to harmonize supposedly conflicting objectives such as "increasing the quality whilst reducing the costs" through intelligent organization and leadership concepts. The maxims up to now were: "quality costs money", "innovations need time and money", "a shorter stay can only be guaranteed with additional capacity" etc. The new management paradigm demands: "higher quality and patient-effective innovations (e.g. minimally invasive procedures, out-patient operations) can be realized in a shorter time with a tendency towards falling costs" and "a shorter stay is achieved with less capacity through better organization". To guarantee these standards the doctor in particular is required to be a high performer because the responsibility for medical quality cannot be separated from the responsibility for economical work processes to achieve this quality. Every senior doctor when making his decision about the type and intensity of diagnosis and treatment automatically also makes a decision about executing these processes of medical services in a way which is tailored to suit the needs and economical requests. This management challenge for the doctor presents itself in several areas: --as a manager of the care cascade --as a manager of the services in the regional health network --as a manager of standardization in the field of logistics (e.g. steering of medical products like heart catheters from the point of manufacturing to the point of use) --as a manager who knows how to mobilize the problem-solving knowledge of his employees through delegation-orientated leadership; the concept of the management of wastefulness as an organization and management approach is particularly suitable for hospitals.