In this study, we report on the development and validation of a questionnaire measuring job satisfaction in rehabilitation centres. The questionnaire "Fragebogen zur Mitarbeiterzufriedenheit in Rehabilitationskliniken" ("MiZu-Reha") consists of 75 items. Three scales measure work climate, leadership and work organisation/communication. Further items assess weak points of work organisation and job satisfaction with several predefined aspects (e. g., career opportunities and salary). The scales have good internal consistency with Cronbach's alpha between 0.86 and 0.94. The dimensionality of the scales was established by confirmatory factor analyses. Correlations between the MiZu-Reha scales and independent satisfaction measures indicate the validity of the questionnaire. Correlations between the MiZu-Reha scales and indicators of patient satisfaction, process quality and outcome are in all cases positive (the higher the job satisfaction, the better the quality of rehabilitation), though weak and statistically not significant. Rehabilitation centres differ clearly from each other regarding job satisfaction of their employees. This shows the usefulness of clinic comparisons based on the MiZu-Reha. The questionnaire can be utilized in external quality assurance programmes, in the context of internal quality assurance measures (e. g. the Business Excellence Model of the European Foundation of Quality Management, EFQM) and in the use of management instruments such as the Balanced Scorecard.

Effects of Treatment in Mother-Child Rehabilitation Centres. The study aims at an external evaluation of mother-child rehabilitation centres in Germany. The centres taking part in the project will get detailed information about their present state of quality in the dimensions of structure, process and outcome as well as patient satisfaction and job satisfaction of the employees. This article focuses on quality of outcome. Two main questions are addressed: How do women treated in mother-child rehabilitation centres assess their health problems at admission, and what are the effects after three weeks of inpatient treatment? The results show that in comparison with a German norm population, 55 % to 75 % of the women in the present study reported intense distress in all dimensions of health (somatic, functional and psychosocial). The analysis of effects after treatment confirms a distinct improvement of health status reported by patients as well as by doctors and therapists. Data of a follow-up after 6 months will show whether these positive effects can be maintained.

No abstract

Visitations (audits) are considered an instrument of external quality assurance by which the structural and organizational set-up of health facilities can be assessed on site by external experts. The Deutsche Rentenversicherung Bund (including the former Bundesversicherungsanstalt für Angestellte, BfA, the statutory pension insurance agency for white collar employees) is the largest body responsible for rehabilitation in Germany, and it regularly carries out visitations in the approximately 650 rehab centres it sends its patients to. The project presented in this article aimed at developing a manual with detailed descriptions of the procedures and criteria of the assessment, as well as at checking the inter-rater-reliability of the assessment. The manual was developed in cooperation with experts of the Deutsche Rentenversicherung Bund. It contains a description of the areas to be assessed during a visitation as well as leading questions and criteria for the evaluation of single features. The manual was examined in "test visitations" in 10 centres, each of which was visited by three visitation teams (1 medical and 1 administrative expert) simultaneously. When the resulting 30 assessments were compared, the criterion "overall quality of the centre" (which was assessed on a 10-point scale) showed precise agreement in 47 %, and a deviation by 1 point in 33 % of the cases. Single features assessed on a three-point scale (no improvement needed/improvement recommended/immediate improvement obligatory) resulted in precise agreement in between 80 % ("medical and therapeutic processes") and 86 % ("structural features") of the cases. Two-point scales (condition fulfilled or not fulfilled) showed an agreement between 89 % ("internal quality management") and 97 % ("single structural features"). In order to maintain and further develop this good inter-rater-reliability, the visitors of Deutsche Rentenversicherung Bund are continually trained in applying the visitation manual. In addition to transferring knowledge, these internal training courses are aimed at exchanging views and experience in order to enhance consensus among the visitors. This approach of Deutsche Rentenversicherung Bund could be regarded as "internal quality assurance" of its visitation procedure.

No abstract