Lean hospital – how a clinical pathway manager helps optimize processes

May 25, 2021 | Lean Management, Operations Management, Operations Management, Operations Management

Just two years ago, clinics were being closed due to cost pressure and inefficient processes. The pandemic has temporarily pushed “clinic closures” as the sword of Damocles out of the media, but the topic will come up again as the pandemic fades. The ARCUS Clinics Pforzheim have found a way to continuously increase efficiency and quality in their daily clinic routine. Christian Sobau, M.D., an orthopedic surgeon for hips and knees and chief physician at ARCUS Clinics Pforzheim since 2010, has actively supported the introduction of so-called clinical pathway managers.

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Dr. med. Sobau, how did you approach the issue of increasing efficiency at your hospital?

ARCUS Clinics is a small privately owned hospital specializing in orthopedic surgical sports traumatology operations. Without a large hospital group supporting us, we have to operate very efficiently.

As a first step, we looked at processes in other hospitals. In doing so, we determined that we needed a higher-level “station.” A position that is not involved in the day-to-day operations of the clinic, but rather observes them from a bird’s eye view. A so-called clinical pathway manager.

In the outpatient area, there is now a practice manager, and in the inpatient area, there is an OP manager. Neither manager is involved in day-to-day operations. They analyze the processes from the outside and provide feedback to improve processes. In emergency situations, however, they must also be able to step in at times.

What were the challenges and obstacles in introducing the new “clinical pathway manager” position?

It was certainly helpful that the new positions were filled by employees who had already worked at the clinic for some time. Accordingly, the employees were acquainted with the organization and familiar with the processes at the hospital. These colleagues also had experience in various areas. For example, one colleague started as a medical assistant and then moved to the front desk for billing before becoming the practice manager and taking on the new, higher-level role.

However, it is crucial that all employees are themselves willing to analyze processes and structures they are familiar with, because someone suddenly begins to question what is being done and how. Simply pointing out that you always do something a certain way is not sufficient.

Clinical pathway managers must also demonstrate their standing here and not shy away from hierarchies. For example, a thirty-year-old had to say to a fifty-year-old chief physician, “It’s nice that you’ve always done it this way. But it could still be optimized.” That was and is not always easy on a personal level.

The underlying idea is that the physician hands over certain competencies without losing face or his or her core competence, namely medical work. It was a matter of conveying to the doctor that he would remain chief physician even if he only made rounds with two people instead of ten.

Letting go of what is familiar is scary for some at first. However, the physician also benefited from this, for example, by being able to focus more on his actual core competence. In nursing, employees can once again concentrate on care for patients because many small tasks have been handed over to specialized staff.

Do you have another practical example of this?

At a charity event, a dean at the University of Freiburg sat at a table with the former head of Audi, whom I will not name. The dean asked, “How are things going for you?” The boss from Audi replied, “Yeah, super. How about you?” The dean said honestly, “Not so good. We are not profitable, in fact, we in the red.”

The head of Audi offered support and sent his team of consultants over to look at all the processes. The consultants found that the hospital had 6.2 million instruments in its operating rooms, but only about 1.2 million of them were actually used. 5 million instruments, however, had to be sterilized as well because they were in large trays or sets. This meant there was a large amount of unnecessary washing, packing, and warehousing. The surgeons were asked which instruments were really needed for which operation. All other instruments were disposed of. In the end, only just under 800,000 instruments remained.

In industry, there are often CIP experts, similar to clinical pathway managers. They also pursue the goal of continuously improving processes. CIP experts are usually trained and educated for their tasks. How did your clinic train clinical pathway managers?

Unfortunately, we did not have any structured training at that time. We worked out many aspects during the project, so to say, “learning by doing.”

Fortunately, we had employees who were motivated to take on new challenges. For example, a clinical pathway manager previously worked as a senior orthopedic surgeon and a specialist in knee surgery. He was eager to retire from operating and do something else. As a result, he was ideal for this position.

However, structured familiarization with methods and tools would certainly help future clinical pathway managers take on their new position.


Olaf Scholle, Partner, STAUFEN.AG
Olaf Scholle started his career after his studies as a planning and process engineer in the Rastatt body-in-white plant of Daimler AG. Through project work and implementation, he acquired his know-how for quality assurance in automated trades. This was followed by a one-year training course to become an MPS expert. In the Mercedes Car Group he was responsible for the methodical management of projects in planning and production of various passenger car plants in Germany and abroad. This enabled Olaf Scholle to continuously expand his experience and lean knowledge. Projects in quality management expanded his competencies in process optimization of administrative areas. The introduction of Shop Floor Management furthered his coaching skills. Olaf Scholle has been with Staufen AG since 2012.


Dr. Christian Sobau

Dr. med. Christian Sobau, knee and hip specialist as well as specialist for orthopedics and trauma surgery, sports medicine as well as chiropractic and senior physician at ARCUS Clinics Pforzheim since 2010

Dr. Sobau was one of the first to be designated as a certified knee surgeon by the German Knee Society. In addition, he has been recognized as a specialist in sports orthopedics by the FOCUS list of physicians for several years. He has worked (with interruptions) at the ARCUS Clinics since 2000 and, in addition to his role as head physician of the ARCUS Sports Clinic, is also head of the MVZ.

More about Dr. med Sobau

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