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The healthcare sector is subject to constant change. With the introduction of the DRG system in 2001, it was implicitly decided that health would become an economic commodity subject to market forces. Price competition, privatization, specialization, outpatient care expansion, and so forth are the logical consequences.

This marked the beginning of a new era for healthcare organizations. The transformation from “administrative bodies” with bureaucratic structures and no accountability for results to competitive, profit-oriented enterprises has been the task of stakeholders ever since. At the same time, the state intervenes. It regulates, shifts markets, and expands regulations and requirements – in short: hospitals and other healthcare facilities are subject to constantly increasing entrepreneurial pressure. Change and adaptation to new rules and market conditions are continuously required.

In the first years following the introduction of the DRG system, all hospitals adjusted their portfolios and precisely configured their medical staffing structures. Private – purely profit-oriented – providers have acquired more and more hospitals, while smaller hospitals have increasingly had to close or be converted into outpatient structures. In 2018, policymakers increased the pressure once again to achieve the openly stated goal of “cold structural change – reduction of ‘excess capacity’ in hospital beds.”

The optimization measures mentioned above are no longer sufficient – even for large hospitals. The hospital as an enterprise must operate with the highest level of professionalism in all areas to remain competitive. This applies particularly to hospitals under municipal and non-profit ownership, as these organizations assume additional responsibilities beyond purely economic tasks to which their respective owners are committed.