title: The impact of economic rationalization, prioritization and rationing on job satisfaction, motivation and team cohesion in hospitals: a survey among retired physician executives in Germany.
abstract: BACKGROUND
  The growing economization of the health care system and implication of market principles in the medical field have risen new and serious questions on the meaning of the medical profession, the doctor-patient relationship and the orientation of medicine itself. The impact of the dynamic clinical structures on the doctor-doctor and the doctor-patient interaction appear even unpredictable. Therefore, the impact of market-based methods, i.e. rationalization, prioritization and rationing, on job satisfaction, motivation and team cohesion should be quantified.
  
  
  METHODS
  The experiences of former and now retired physician executives in numerous hospitals in Saxony were determined. For this purpose, an anonymously written survey using a standardized questionnaire was conducted in the first quarter of 2016.
  
  
  RESULTS
  Rationalization measures were confirmed by 88% of respondents. In more than a third of cases, former executives also experienced prioritization and rationing. The impact of these management techniques on job satisfaction, motivation and team cohesion was carried out in a differentiated manner. There was a tendency to regard rationalization and prioritization measures indifferently to rather disadvantageous, while rationing was predominantly rated negatively.
  
  
  CONCLUSIONS
  In addition to rationalization, prioritization and rationing measures have now been part of working strategy at the hospitals. On one hand, the conceptual distinction between the terms still seems imprecise; on the other hand, a creeping and imperceptible medico-ethical transgression of the prioritization to rationing seems to have already taken place.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103 Germany.
authors.forename: Joerg
authors.identifier: 0000-0002-2768-0128
authors.initials: J
authors.lastname: Schnoor
authors.affiliation: Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Braehler
authors.affiliation: Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103 Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ghanem
authors.affiliation: Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103 Germany.
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Heyde
keywords: Economization; Job satisfaction; Prioritization; Rationalization; Rationing; Team cohesion