Volume Standards and Value based Network Structures: Reconfiguring Medical Care in Private Hospital Networks

Research Objectives: The objective of this research is to enhance hospital quality and efficiency of a complex hospital network organisation in Switzerland. The goal of this research, as derived from the healthcare as well the medical scientific literature, is to identify minimum case volume standards per complex medical condition in Switzerland as well as value drivers regarding the pooling of case volume per complex medical condition and per hospital in order to maximise hospital as well as hospital network performance. The value drivers to achieve this goal are represented through the patients', doctors' and hospital executives' behavioural expectations regarding a) medical outcome, i.e. improving the quality of medical care, b) economic efficiency and c) patient satisfaction in a hospital network organisation. The development of a preliminary model incorporating value drivers regarding the concentration of case volume of complex medical conditions in a for-profit (private) hospital network organisation is the overall goal of this thesis.Research Questions: As derived from the business problem and the research objective, the overall research question is: How can pooling of case volume per complex medical condition and per hospital maximise medical outcomes, economic efficiency and patient satisfaction in a hospital network organisation?� Due to the lack of a minimum case volume definition per complex medical condition in Switzerland, sub-question I of the thesis is: What are the required minimum case volumes for complex medical conditions in Switzerland�? Addressing this question required the examination of the National Swiss inpatient data set with regard to the relationship between hospital case numbers and medical outcome as measured by post-treatment mortality rates.