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IInternational SSociety of OOrthopaedic CCenters

ENDO-Klinik, Hamburg/Germany

Bologna/Italy, April 29 – May 1, 2010

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Agenda

• Background of Sibylle Stauch-Eckmann

• German Health Care System

• Structure and data of ENDO-Klinik

• Teaching and research efforts

• Strategic plan

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Background

SIBYLLE STAUCH-ECKMANN,

Dipl. Wirtsch.-Ing.

• 39 years old, married, 2 sons (6 and 1.5 y.)• Studies of economics and mechanical

engineering at TU Darmstadt,1989-1995• Internat. Traineeprogramme Dräger Medical

(Germany, Belgium), 1995/96• Executive on sales and marketing within Dräger

Medical Germany, 1996-2001• Executive assistant of Damp Group, 2001/02• Administrative Director of ENDO-Klinik, 2002-

2005• Managing Director of ENDO-Klinik, since 2005• Honorary member of the Hamburg Chamber of

Commerce & Industry and delegate of DIHK, special focus on life sciences

• Member of Rotary Club Hamburg Steintor

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Agenda

• Background of Sibylle Stauch-Eckmann

• German Health Care System

• Structure and data of ENDO-Klinik

• Teaching and research efforts

• Strategic plan

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• Expenses on health services in Germany, 2009: € 280 billions– 10.5 % gross domestic product

– € 65 billions in the hospital sector

• > 5 mill. employees– of those 3 mio. female

– 1.1 mill. in the hospital sector

• Economic growth of 2 % p.a. up to 2030• International top position of special branches, e.g. medical technology

(patent pending and part of world trade)

• Health insurance system (app. 370 insurance companies)

– solidarity based system - compulsory insurance

– high competition between private and state health insurance companies

• 2,087 hospitals – 32% public, 38% non-profit and 30% private hospitals

– 17.2 mill. patients treated with 8.3 days of average stay in hospitals

• Since 1989 eight reforms of health care legislation• Since 2003 the hospital finance system is based on DRGs

(adoption and development of the Australian DRG-system)

• External state quality control for defined operations (e.g. hip and knee joint replacement)

German Health Care System

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Agenda

• Background of Sibylle Stauch-Eckmann

• German Health Care System

• Structure and data of ENDO-Klinik

• Teaching and research efforts

• Strategic plan

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Ostseeklinik Damp GmbHOstseeklinik Kiel GmbH Reha-Klinik Ahrenshoop GmbHReha-Klinik Damp GmbHReha-Klinik Lehmrade GmbHReha-Klinik Schloß Schönhagen GmbHTherapie Centrum Damp GmbHSCHLEI-Klinikum Schleswig FKSL GmbH

SCHLEI-Klinikum Schleswig MLK GmbHReha-Zentrum Harburg GmbHReha-Zentrum Norderstedt GmbHReha-Zentrum Lübeck GmbHENDO Reha-Zentrum GmbHSport-Reha Kiel GmbHTagesklinik am Kurpark Lüneburg GmbHZentrale Service-Gesellschaft Damp mbH

Ahrenshoop Service GmbHAkademie Damp GmbHDamp Holding AGDamp Sundhedscenter TondernDamp Touristik GmbHENDO-Klinik Hamburg GmbHHANSE-Klinikum Stralsund GmbHHANSE-Klinikum Wismar GmbH

SCHÖNHAGEN

DAMP

AHRENSHOOP

LÜBECK

TONDERN

SCHLESWIGKIEL

NORDERSTEDT

HAMBURG

HARBURG

LÜNEBURG

STRALSUND

WISMAR

LEHMRADE

Since 1998 ENDO-Klinik part of Damp-Group, which is the leading private hospital group in Northern Germany

Location

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Structure and data of ENDO-Klinik

2009 Turnover appr. € 450 mill.Employees: 7,800

2009 Turnover appr. € 450 mill.Employees: 7,800

GENERAL VIEW

Surgery and

HospitalTreatment

Beds: 2,100

RehabilitationBeds: 1,488

TourismBeds: 2,500

Damp Holding AGDamp Holding AG

Board: Dr. Claus-Michael Dill (Chairman)

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FactsPioneer of total joint replacement in Germany

Implantation of 115,000 prostheses since foundation

Long lasting scientific cooperation in development of hip- and knee-prostheses (Link Inc., Zimmer Inc.)

Strategic partnership with the Technical University of Hamburg in biomechanics

Education and Training of app. 400 medical specialists since foundation, 300 visitors p.a.

since 1976 focused in the field of total joint

replacement of knee, hip, shoulder and foot

Infected arthroplasty (400 cases p.a.)

Spine center (900 cases p.a.)

Blood bank and bone bank in-house

Turnover 2009: € 48 mill.

EBITDAR 2009: 12.8%

Employees: 413 (incl. all physicians)

Beds: 250 on 4 wards

Orthopaedic surgeons: 22

Other physicians: 52

Investments on buildings since 2007:€ 90 mill. thereof € 38.1 mill. contribution of the Hanseatic City of Hamburg

Figures

Specialities

Structure and data of ENDO-Klinik:Speciality center for bone, joint and spinal surgery

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New Building (since May 2009) restructuring of ambulance and reception center

8 innovative operating theatres (7,500 m2)

• 4 and 2 in open-plan and 2 singles• Recovery area [PACU] (20 beds)• Intermediate and Intensive Care Unit (19 beds)

sterilization center

radiology center (incl. CT, MRT, Teleradiology)

4 wards (64 or 48 beds) with standard double or single rooms

ecological technologies (concrete core cooling, photovoltaics, re-using of water) Old Building (refurbishment 2010-2012)

40 additional beds with special comfort

40 stationary rehabilitation beds in-house Rehab-Center on 2 floors out-patient Operating-Center

Teaching and Science Center (ENDO foundation)

Restaurant and bistro areas

Structure and data of ENDO-Klinik:Building structure

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Structure and data of ENDO-Klinik: Surgeries (2009)

TOTAL 5,973

Primary implants 3,165

Hip 1,770

Knee 1,277

Shoulder 62

Other joints 56

Implant exchanges 1,255

Hip 806

Knee 413

Shoulder and other joints 36

Other joint surgeries 493

Septic cases 399

Periprosthetic Infection - Algorithm of the ENDO-Klinik Hamburg

pathogendetected

signs of infection < 6 weeks after primary implantation / revision

Pathogen probable (e. g. Erysipelas, previous records)

Pathogen unknownno hints from patients history

High level resistance of pathogenLokal application of ABX impossible

Succion erigation:- revision, radical débridement - succion erigation- ABX systemically administered

One stage revision:- revision, radical débridement - removal of all foreign bodies- implantation of AJR using anti-

biotic loaded PMMA-bone cement- ABX systemically administerd

Multiple stage revision:- revision, radical débridement - removal of a foreign bodies- Entfernung allen Fremdmaterials- ABX systemically administered- re-implantation after infection is

controlled

persisting infection

SUCCESS

Special conditions - Arthrodesis of the knee: If function is impossible because of deficient ligaments or muscular disorder- Girdlestone’s arthroplasty: If function of the hip cannot be reconstructed or as temporary condition in multiple

stage revision - Amputation / exartikulation: If infection cannot be controlled otherwise

positive

nega

tive

- no

pat

hoge

n de

tect

ed SUCCESS

persisting infection

SUCCESS

persisting infection

signs of infection > 6 weeks after primary implantation / revision

• Average patients stay: 10.1 d

• Primary joints: 8.2 d

• Occupancy: 95 %

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Agenda

• Background of Sibylle Stauch-Eckmann

• German Health Care System

• Structure and data of ENDO-Klinik

• Teaching and research efforts

• Strategic plan

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Teaching

23 residents

4 fellows

5 interns (Hamburg University Hospital)

clinical focus (no in-house laboratories)

mainly on joint replacement

comparative outcome studies on TKA and THA implants

clinical database since 1968

large retrieval collection (> 7,000)

outcome of one staged septic revisions

2 attendings

1 fellow

4 residents

1 research assistant

4 students (actively involved)

Staff

Research

Teaching and research efforts

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Agenda

• Background of Sibylle Stauch-Eckmann

• German Health Care System

• Structure and data of ENDO-Klinik

• Teaching and research efforts

• Strategic plan

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Strategic Plan and major issues

STRATEGY• Local diversification and growth by refurbishing the old clinic building

– medical competence center (combining treatment of out- and in-patients AND clinical sector with rehab sector)

– growth in wards for private patients (1 bedroom)– offering high level services

• ENDO branding as an opportunity for external growth – first step in German locations– ENDO-inside-strategy versus franchise– standardization and training issues implicated

• More intensive cooperation with ENDO-charity and ENDO-foundation– fund raising mainly for financing research efforts and training issues

FUTURE CHALLENGES• Personnel development because of skills shortage (e.g. qualified nurses, physicians) !• Price competition: CAVE selective contract system for elective cases !• Quality competition: which are the right indicators or independant data collectors ?

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THANK YOU !