German Ethics Council calls for anchoring patient welfare as a standard for hospitals

For decades, hospital care has been the object of controversial political debates. These are sparked, for example, by the general development of costs in healthcare, by innovations in medicine, by patients' changed expectations and by demographic development. Increasing economic pressure, especially on the hospital sector, increasingly raises questions about the guiding normative standard of hospital care.

The German Ethics Council centres its deliberations on patient welfare as the crucial ethical guiding principle. Three criteria determine patient welfare: care for patients in a manner that enables self-determination; good treatment quality; and fairness in terms of equal access and distributive justice.

With a view to these three criteria, various fields of conflict arise. These concern especially the dwindling opportunities for an adequate communication in doctor-patient, nurse-patient and therapist-patient relationships as well as the increasing difficulty for those working in hospitals to adhere to their professional ethical duties. Additionally, with a view to patient groups with specific needs, it is proving increasingly problematic to ensure for them an equal access to hospital services and fair distribution of resources. This affects children and adolescents, elderly patients, patients with geriatric-related illnesses, with dementia or disability, and patients of immigrant background.

The German Ethics Council presents 29 recommendations for anchoring and ensuring the orientation towards patient welfare in hospital care.

First, the Ethics Council recommends ensuring better communication in hospitals. Part of this entails support for the communicative and intercultural competency of all those employed in the hospital. Professional training, advanced training and continuing education should be developed to this end. In addition, the expense in terms of time and organization should be taken into account in specifying compensation within the DRG (diagnosis related group) system. This concerns both communication with patients and communication between professionals.

Furthermore, the situation of care in hospitals should be sustainably improved. Among other things, nursing staff ratios should be developed for hospitals as a function of station and area size, and conditions for personal continuity in the care of patients should be established.

To develop the DRG system further, the Ethics Council recommends working against misdirected incentives that are opposed to patient welfare, for example, when they motivate a premature or delayed release or transfer of a patient. In this context, the simultaneous billing of two or more DRG's for a single hospital stay should be enabled for multimorbid patients. For very elderly patients, patients with rare diseases or patients with special behavioural disorders, new possibilities for agreeing on additional charges should be established. To avoid unnecessary interventions and procedures, compensation models should be developed and reviewed that honour the justified omission of possible measures.

To upgrade quality-assurance structures, a federal programme should support the establishment of multidisciplinary centres oriented towards certain disease patterns.

The obligations for documentation should be simplified in order to gain more time for patient care. For this purpose, models of digital support should be developed and tested, for instance.

For better hospital care of patient groups with specific needs, the Ethics Council recommends, among other things, the introduction of child-specific DRG's or the decoupling of paediatric care from the DRG billing system. For people with a disability, hospitals should be designed in a handicapped-accessible manner in accordance with the UN Convention on the Rights of Persons with Disabilities, and conditions should be created that satisfy their special concerns. Moreover, access to the provision of additional care services in the hospital should be facilitated for all persons with a disability. For patients with dementia, dementia-sensitive care structures should be supported.

Furthermore, the German Ethics Council suggests developing transparent criteria for hospital planning, which are centred primarily on patient welfare. It also recommends to introduce nationally recognized standards for hospital planning, as well as to systematically analyze and evaluate once again from the perspective of patient welfare the interfacing problems between the in-hospital and outpatient sectors.

The complete text of the opinion in German can be found at here. An English version will be available in due course.