28.11.2019

Martini-Klinik Hamburg – Competing on Quality

How listening to the patient’s perspective made the Martini Klinik the world’s largest centre for prostate cancer.

  • In just a few years, the Martini Clinic has become the largest centre for prostate cancer in the world
  • Patient-Reported Outcome Measures (PROMs) are at the heart of their strategy
  • Outcomes transparency enables surgeons to identify best practices and patients to know what to expect from their treatment
  • The results are also published on the Martini-Klinik website, allowing patients and payers to know what to expect from treatments.
Martini Klinik Hamburg
Creative Commons Zero (CC0) (Source: Wikipedia)

With approximately 2,400 prostatectomies per year, the Martini-Klinik holds the record for the most documented prostatectomy procedures – even though it was founded just over 10 years ago. Patient-Reported Outcome Measures (PROMs) are a crucial part of their routine clinical practice. They are systematically recorded during and after patient hospitalisation. This data is used to identify areas which require improvement while also pinpointing areas of excellence. Driving strategic decision-making, this process enables the Martini-Klinik to deliver excellent healthcare and lead on game-changing clinical innovation.

Pioneers of Patient-Reported Outcome Measurement

In 1994, Professors Hartwig Huland and Markus Graefen, practising physicians at the University Hospital Hamburg Eppendorf (UKE), began collecting clinical and administrative data as well treatment results of their patients in an Excel spreadsheet. Over the course of the project a systematic recording of measurements became a necessity.1 After Prof. Huland and several colleagues founded a specialised centre for prostate cancer, the Martini-Klinik in 2005, the collection of outcome measurements was upgraded to a new level2

Focusing on Quality of Life

At the Martini-Klinik, all patients complete extensive and standardised questionnaires at regular intervals before and after their treatment. Outcomes data are collected at three critical time points in the care pathway: seven days, six months and one year after surgery. These outcomes focus on what matters the most to patients and include incontinence rate, erectile dysfunction and complications.

Despite the initial increased effort, the follow-up rate is almost 90% even after several years (as of 2013).1 The overall results are not only published regularly, but are also evaluated internally and serve as an instrument of feedback for physicians to evaluate performance and their treatment successes.

Every 6 months the surgeons receive a detailed report of their individual treatment results. They openly discuss the outcomes to understand the cause of variations. If a doctor is particularly successful, his surgical modifications are gradually taught to and adopted by the entire team. Thus, the quality of the surgery continues to increase.3

Martini-Klinik Hamburg - Competing on Quality 1
Martini Clinic in Comparison. Source: Martini-Klinik4
Outcomes transparency leads to excellence

This system of comparison transparency works–without competitive pressure or a mallace working environment. Physicians, by their very nature, are competitive. When evidence is collected highlighting areas that could be improved upon, it spurs doctors to improve and enhance their treatments and/or skills. This progressive “atmosphere” is probably due to the “faculty system” imported from America, which allows for many equally-ranked chief physicians (12) with unlimited contracts at the clinic.5

In this way the operators are treated uniformly and have long-term security. In addition, all senior physicians receive quality-dependent bonus payments – good outcomes are therefore also financially worthwhile for everyone.6

The outcome survey is embedded in an interdisciplinary treatment concept with comprehensive, patient-centred care. Overall, the Martini-Klinik thus achieved above-average treatment results, which also make economic success possible.

Quality pays

With approximately 2,400 prostatectomies per year, the Martini-Klinik is now the leading centre for prostate surgery worldwide. Between 2005 and 2011, the number of cases increased by 18.5 % annually with a total German growth of 1.1%.1 According to Managing Director Dr. Detlef Loppow, this specialised clinic is also the UKE’s most profitable subsidiary. Since its founding, it has always generated a surplus, amounting to 23.5 million euros in 2015.7 In January 2018 the UKE announced the construction of a new building with an estimated date of completion in 2021 in order to cope with the increasing number of patients.8

Martini-Klinik and ICHOM

Experts from the Martini-Klinik are also involved in the research and development of other PROMs. For example, they participated in the International Consortium for Health Outcomes Measurement (ICHOM) questionnaire sets for localised and advanced prostate cancer.

In 2017, Heartbeat Medical became the first German company to become an ICHOM partner. With our outcome collecting software, we hope to inspire more clinics to adopt a Value Based Healthcare concept and enabling more success in the future, following the example of the Martini-Klinik.

Martini-Klinik Hamburg - Competing on Quality 2
written by
Léa Marais

Director of International Operations, UK-based with track record in PROMs delivery to healthcare providers, responsible for international operations at heartbeat

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Sources:

  1. https://www.martini-klinik.de/fileadmin/Dateien/PDFs/Veroeffentlichungen/HarvardBusinessSchoolReport_Zusammenfassung_dt.pdf (Accessed October 30th 2018)
  2. https://www.martini-klinik.de/die-martini-klinik/eine-einmalige-klinik/ (Accessed October 30th 2018)
  3. https://eiuperspectives.economist.com/healthcare/value-based-healthcare-germany-free-price-setting-regulated-market/white-paper/value-based-healthcare-germany-free-price-setting-regulated-market (Accessed October 14th 2019)
  4. https://www.martini-klinik.de/fuer-patienten/resultate/ (Accessed October 14th 2019)
  5. https://www.martini-klinik.de/die-martini-klinik/team/faculty-leitende-aerzte/ (Accessed November 14th 2018)
  6. https://www.ichom.org/portfolio/advanced-prostate-cancer/ (Accessed November 25th 2019)
  7. https://www.aerztezeitung.de/praxis_wirtschaft/klinikmanagement/article/889759/martiniklinik-juwel-hamburger-uke.html (Accessed November 25th 2019)
  8. https://biermann-medizin.de/mehr-aerzte-und-betten-fuer-die-martini-klinik/ (Accessed October 14th 2019)