Address correspondence to Prof. Dr. Hans-Gerd Ridder, Faculty of Economics and Management, Institute of Human Resource Management, Leibniz Universität Hannover, Königsworther Platz 1, D-30167 Hannover, Germany. Dipl.-Oek Vanessa Doege and Dipl.-Oek Susanne Martini are with the Faculty of Economics and Management, Institute of Human Resource Management, Leibniz Universität Hannover, Hannover, Germany.
Differences in the Implementation of Diagnosis-Related Groups across Clinical Departments: A German Hospital Case Study
Article first published online: 11 APR 2007
Health Services Research
Volume 42, Issue 6p1, pages 2120–2139, December 2007
How to Cite
Ridder, H.-G., Doege, V. and Martini, S. (2007), Differences in the Implementation of Diagnosis-Related Groups across Clinical Departments: A German Hospital Case Study. Health Services Research, 42: 2120–2139. doi: 10.1111/j.1475-6773.2007.00723.x
- Issue published online: 11 APR 2007
- Article first published online: 11 APR 2007
- implementation process in hospitals;
- dynamic capabilities;
- case study
Objective. This article aims to examine the implementation process of diagnosis-related groups (DRGs) in the clinical departments of a German hospital group and to explain why some gain competitive advantage while others do not.
Study Setting. To investigate this research question, we conducted a qualitative study based on primary data obtained in six clinical departments in a German hospital group between 2003 and 2005.
Study Design. We chose the case study method in order to gain deep insights into the process dynamics of the implementation of DRGs in the six clinical departments. The dynamic capability approach is used as a theoretical foundation. Employing theory-driven categories we focused on idiosyncratic and common patterns of “successful coders” and “unsuccessful coders.”
Data Collection. To observe the implementation process of DRGs, we conducted 43 semistructured interviews with key persons, carried out direct observations of the monthly meetings of the DRG project group, and sampled written materials.
Principal Findings. “Successful coders” invest into change resources, demonstrate a high level of acceptance of innovations, and organize effective processes of coordination and learning.
Conclusions. All clinical departments only put an emphasis on the coding aspects of the DRGs. There is a lack of vision regarding the optimization of patient treatment processes and specialization. Physicians are the most important key actors, rather than the main barriers.