title: Grumblers in the time of Diagnosis-Related Groups: sand in the gear or lubricating oil?
abstract: OBJECTIVE
  After the change from cost allowance to a German system of Diagnosis-Related Groups there has been much public discussion about how the new terms of employment within the health sector are increasingly in conﬂict with individuals’original motivations for their career choice. If such criticism remains unheard a further loss of employees might occur.
  
  
  METHODS
  Two decades of professional experiences have been reviewed. The results were personally assessed and summarized in a ﬁeld report.
  
  
  METHODS
  One senior physician, Department of Anesthesiology, University Hospital.
  
  
  RESULTS
  In total, a deliberate contact approach by management to address employees’ criticisms and grumbling about the terms of employment is essential for enterprise’s success.
  
  
  CONCLUSIONS
  While employees can introduce criticisms more constructively to contribute ideas that protect the enterprise’ssuccess, executives will have to position themselves in such a way as to be open to these perspectives. Constructive contact with “hospital troublemakers” should be implemented into the enterprise culture. Guidance is necessary to institute such changes.
authors.affiliation: Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103Leipzig, Germany. joerg.schnoor@medizin.uni-leipzig.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Schnoor
mesh_terms: D000776:Anesthesiology; D002321:Career Choice; D019955:Conduct Disorder / Q000517:prevention & control / Q000523:psychology; D003220:Conflict, Psychological; D003284:Contract Services / Q000331:legislation & jurisprudence; D003953:Diagnosis-Related Groups / Q000941:ethics; D004651:Employment / Q000331:legislation & jurisprudence / Q000523:psychology*; D056344:Executive Function; D005858:Germany; D006785:Hospitals, University / Q000941:ethics / Q000592:standards; D006801:Humans; D009935:Organizational Affiliation; D015279:Organizational Culture; D026684:Personal Autonomy; D010558:Personnel Loyalty; D010559:Personnel Management / Q000379:methods; D010560:Personnel Selection / Q000941:ethics / Q000592:standards; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000941:ethics / Q000523:psychology; D011361:Professional Competence; D017751:Safety Management; D000078329:Workforce