ABSTRACT
The need for a systematic analysis and organizational (re)design of clinical work processes and systems is obvious. But a system ergonomic work system improvement should not only focus on the release of a work system's existing optimization potential (= a "banal rationing" of resources), but also needs to establish a high treatment quality as well as a lasting staff motivation based on a sustainable reinvestment of the released resources into further system improvements on all system layers (a so called "balanced rationalization" - sec also Marsolek and
Friesdorf, 2007): 1. At the "management level" by finding the right management balance between the necessary medical, management, innovation and communication competence through an early initiation and careful monitoring of all necessary change projects. 2. At the "process level" by finding the right management balance between the definition of realistic goals for the release of the existing optimization potential (top-down) and an adequate staff enabling/qualification (bottom-up). 3. At the "staff level" by finding the right management balance between the release of the existing optimization potential (staff resources) and its re-investment for future system improvements (e.g. the development of new markets and innovative services such as integrated patient care, ambulatory surgery, home care etc.). For the realization of a "balanced rationalization" the work system's management vision and main strategy have to be successively realized (top-down) in welldefined optimization projects, which need to be consequently controlled (bottomup) with the help of according project benchmarks. While within the realization of each defined optimization project various common management techniques can be used for eliminating existing organizational weaknesses, it is of utmost importance that the same work system's characterizing organizational strengths are not being destroyed or neglected throughout the very same approach. Therefore all already existing (and well functioning) optimization approaches of a work system have to be systematically integrated into the "balanced rationalization" as well. (see also Marsolek and Friesdorf, 2007)
Especially for clinical work systems a typical organizational weakness can be found within the "in-transparency" of the work system's underlying work processes caused by the complexity of the patient treatment. Therefore a continuous analysis, redesign and control of clinical work processes (based on a Continuous Process Flow Management Cycle as shown in Figure l) has to be the fundamental basis for all other system improvements.
