Less bureaucracy in nursing care: Research project analyzes new documentation system


A new research project examines the quality and efficiency of a documentation system introduced in Germany in 2015 to reduce bureaucracy in nursing care. The project “Evaluating increased efficiency in care documentation“ (EvaSIS) is being carried out on behalf of the National Association of Statutory Health Insurance Funds under the auspices of Professor Karin Wolf-Ostermann of the Institute for Public Health and Health Care Research (IPP) of the University of Bremen, in co-operation with the Martin-Luther University Halle-Wittenberg and the Fraunhofer Institute for Systems and Innovation Research ISI. Based on the findings, recommendations on how the further introduction and use of the documentation system can be optimized are to be developed.

In 2013 the German Federal Ministry of Health developed recommendations for increased efficiency in nursing care documentation. These were trialed in 2014 and on 1 January 2015 the federal government initiated the nationwide introduction of a new care documentation system. Since then roughly 10,000 care services and nursing homes all over Germany have changed to the new documentation system – which accounts for about 40 percent of all facilities.

However, so far there has been no insight into whether the introduction of the new care documentation has led to increased efficiency and improvements in the quality of care in nursing homes and nursing services. In order to find out, the EvaSIS project involves different groups of stakeholders and levels of analysis: The experience of nursing staff and care facility managers are taken into account as well as inspection authorities such as the Health Insurance Medical Service (MDK) and nursing home supervisory authorities. In addition, a comparison to other care documentation systems will be made.

Data will be collected using various research methods: Between October 2016 and May 2017, standardized surveys with stakeholders (care facility management, qualified nursing staff, home supervisory staff and the Health Insurance Medical Service of the Health Funds) will be carried out as well as focus group interviews with patients and their families. In addition, document analyses of care records will take place. The survey includes all facilities which have been using the new care documentation system for at least three months.  

Dr. Tanja Bratan, who leads the project at Fraunhofer ISI, lists important aspects of the investigation, “We are evaluating the influence of different framework conditions in  care facilities on the use of the new care documentation, for example their size or the staffing ratio. We are also investigating how practicable the system is for nursing staff. Not least we are considering whether the individuality and autonomy of patients can be appropriately taken into account.“

The project EvaSIS aims to gain insights into the changeover to the new documentation system and to establish the experiences made so far by the stakeholders involved. The results will be used to develop recommendations for the implementation process and the further development and optimization of the care documentation system. These recommendations will be available in summer 2017.

The Fraunhofer Institute for Systems and Innovation Research ISI analyzes the origins and impacts of innovations. We research the short- and long-term developments of innovation processes and the impacts of new technologies and services on society. On this basis, we are able to provide our clients from industry, politics and science with recommendations for action and perspectives for key decisions. Our expertise is founded on our scientific competence as well as an interdisciplinary and systemic research approach.