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Franziska Berger (57) has had a unique career: Originally a nursing specialist, she now serves as CEO of the Lachen Hospital in the canton of Schwyz. The next career move will happen from February 1, 2024. Later, as CEO, he heads Solothurner Spitäler AG with three acute hospitals and one psychiatric hospital.
Ms. Berger, you originally come from a nursing background. How can someone with this background become CEO of a hospital group?
Franziska Berger: I rose through the traditional methods from ward manager to director of nursing services and continued to receive further training in business management and leadership. A headhunter asked me about my position as CEO of Lachen Hospital. I have an advantage: I know what people need in the main business area, what they are talking about and what investments need to be made, for example, in purchasing equipment. An economist or a lawyer, as a CEO, would first need to be familiar with this topic to understand what is required to remove the gallbladder, for example.
So what’s the downside?
I don’t describe this as a disadvantage. But I’m not an economist and so I don’t have a commercial perspective, I’m primarily patient-focused. I understand that my role means that the patient must be given the best care and that I provide the framework conditions for this.
But your job is to run a hospital profitably.
Of course, but in the Swiss hospital system this is becoming an increasingly impossible task!
For what reason?
The flat rate per case was introduced in 2012. This means that inpatients, that is, patients who spend the night, receive a fixed fee per case, depending on the severity of the disease. This determines how much the health insurance company will pay for the “lawsuit.” You must then manage this money and use it to pay for investments.
So does this work?
Not at all.
From where?
All costs increased, such as wages, materials, medicine and electricity. There is also inflation. But the fixed rates per case remained the same or even decreased. The same problem exists in the financing of outpatient services, that is, for patients who do not spend the night. Health insurance companies keep this rate very low at 15-20 percent depending on the department. If I were a baker and had to pay more for flour, I would charge more for my breads, too. However, in the hospital system, it is not possible to pass on the costs to the customer as in the bakery, we have to negotiate directly with health insurance companies to increase the fixed rates per case.
How do such negotiations take place?
It’s hard and boring. Health insurance companies are careful not to adjust fixed rates according to given conditions as premiums increase.
But they will rise at the end of the year.
Yes, but that doesn’t help hospitals at all: The flat rates per case don’t increase at all. Premiums will actually have to go up much more for hospitals to cover their costs.
Who will ultimately bear these gaps?
In many cantonal hospitals, this is the cantonal. This is also a political issue that no one wants to address on two levels: To make up for the deficits, the cantons will need to increase taxes. This makes you unpopular as a politician; No one who advocates increasing taxes will be elected. But if you do this only through health insurance companies and increase the premiums, the number of people requesting a premium reduction also increases. Costs are rising again in the cantons and taxes also need to be adjusted. Nobody wants to burn their fingers on this issue.
So how do non-cantonal hospitals solve this?
This is an unresolved question. What is certain is that many people will not be able to continue operating as before for much longer. Individual hospitals have already gone bankrupt or are about to go bankrupt. When multimillion-dollar restructuring packages become necessary, everyone raises their hand!
So are hospitals like Hirslanden also financially successful?
Of course, there are also private hospitals that are not authorized to provide so-called primary care. They can choose patients with additional insurance. This makes it easier to operate profitably. Regional hospitals are subject to completely different restrictions.
As a former nurse: How did it make you feel when nurses were applauded and cheered during the Covid period?
Of course, it was nice to finally feel appreciated. Although many people think: I would rather get a decent wage or better working hours than get applause.
Has this resulted in any improvement for nurses when they are no longer in the spotlight?
To be honest, the whole thing was actually pretty inefficient in the long run. It has shed light on inequities in the profession so that fewer people now choose nursing education. It would be more important to strengthen the profession and show how interesting, versatile and future-oriented the nursing profession is.
In nursing, you always hear that many people leave the profession after a short period of time. Many positions remain unfilled. What would it take to make them stay longer?
In many places, nursing staff are poorly paid and have to work in shifts. They are highly specialized and very well trained: today every nursing specialist has a higher degree and can take on many of the tasks of junior doctors. But they still receive little support for further education. In some cases, things go even further abroad. A good team spirit is also very important in nursing teams: almost every second position in the hospital is filled by nurses. If people run away from you, you will have to reduce the number of beds, which will lead to economic disaster.
And? Have you ever had to do this?
No, not a single bed was dismantled in Lachen.
Junior doctors also complain about a lack of work-life balance.
Yes, interns work 48 to 50 hours per week. That’s too much. But you should know that the trend is moving in the right direction: Working 60 to 80 hours a week was the rule.
But you hear that it’s normal to work 60 hours a week instead of 50 hours. In fact, this is against the law. Why can’t this workload be split into part-time positions?
For several reasons: Part-time positions cost the employer more social security contributions. Patient care is also difficult. If two interns shared a position, they would always have to deliver cleanly all orders and administrative measures taken during the week. No health insurance fund will undertake the effort to discuss and reconcile all of this. So you encounter a gap there too.
So you’re essentially saying that as CEO you can’t change anything about working conditions?
Yes, we do our best to keep employment conditions competitive. For many employees, soft factors such as culture, team spirit and collegiality are also important.
But this often seems wrong: We read about a rigid, male-dominated hierarchy in hospitals. Do you know this from your own working life?
I have never or almost never had a sexist experience either. But the male-dominated hierarchy is true. This is because the air becomes very thin towards the top. As a CEO, you must take action and act with foresight because a strong team of individual departments and professional groups can move many small mountains.
How do you encourage this?
For example, I started leadership courses at Lachen, in which all staff will attend together. The senior doctor finds out that he has the same management problems as the head chef. This opened many people’s eyes. These days we spent together in solidarity are worth their weight in gold.
Keyword work environment: Chief physicians are mostly men. Are you doing anything to counter this?
I would love to but it is very difficult. We recently advertised for the position of chief surgeon at Lachen Hospital. Not a single woman applied.
What do you think causes this?
I actually think there is a gender difference: Women are more interested in specializing in their field and perhaps less interested in status. I would welcome more women applying for senior positions. But I don’t hire anyone just because they’re a woman. The qualifications need to be correct.
If you look to the future, based on your experience: What will the Swiss healthcare system look like and what will it need in ten years?
As a society, we need to openly ask ourselves uncomfortable questions: Do we want a healthcare system that offers everything to everyone, all the time? I think we must honestly ask ourselves who “deserves” what treatment, to the detriment of the public. Then we must be prepared to pay for it or cut back on services.
Wait a minute, are you advocating letting old people die to save money or giving addicts less treatment?
No, I advocate an honest debate. Our bodies are designed to live to about 70 years of age. Anything beyond that is a bonus. And it is expensive for society. Currently, all kinds of life-extending measures are being taken for everyone. For all the understanding of relatives, one has to ask oneself whether this makes sense anyway. In my opinion, the issue of basic insurance coverage is also included in this discussion.
What do you mean by this?
There are already examples of health insurance companies excluding certain benefits from supplementary insurance, for example in the case of addiction. But no one is making this argument openly because it involves difficult moral questions.
So how will our hospitals actually change? So what does this mean for us potential patients?
If we continue funding as we have done so far, patients will have to learn to wait as they do abroad. For example, we can no longer assume that we will get our new hip joint immediately. I also think that healthcare in Switzerland is analyzed and organized on a national level rather than on a cantonal basis. So for people in remote areas, care will be more difficult and less close to home. And of course the trend of moving from outpatient to inpatient care will continue, and more and more surgeries will be performed on an outpatient basis as long as it is possible and justified.
Source : Blick
I am Dawid Malan, a news reporter for 24 Instant News. I specialize in celebrity and entertainment news, writing stories that capture the attention of readers from all walks of life. My work has been featured in some of the world’s leading publications and I am passionate about delivering quality content to my readers.
