Differences in the implementation of diagnosis-related groups across clinical departments: a German hospital 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.


METHODS
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.


METHODS
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."


METHODS
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.


RESULTS
"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.
Ridder
Hans-Gerd
HG
Faculty of Economics and Management, Institute of Human Resource Management, Leibniz Universität Hannover, Königsworther Platz 1, D-30167 Hannover, Germany.
Doege
Vanessa
V
Martini
Susanne
S
D003953:Diagnosis-Related Groups / Q000145:classification* / Q000191:economics; D004465:Economic Competition; D017598:Efficiency, Organizational; D005568:Forms and Records Control; D005858:Germany; D006284:Health Plan Implementation; D006302:Health Services Research; D006748:Hospital Departments / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008499:Medical Records; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care; D016311:Outliers, DRG; D036301:Qualitative Research