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Objective: An initiative by scientific societies of psychiatry, child and adolescent psychiatry, psychosomatic medicine, and further associations established the Platform-Model for the development of a needs-based system for adequate personnel allocation in psychiatric inpatient and day clinic units. We present the development of the instrument and a pilot study to identify feasibility and limitations. Methods: The basis of the study was a threefold methodological approach. Paradigmatic case vignettes adequately reflecting symptomatology and circumstances were described and validated, working profiles were generated and validated, and a matrix representing different needs-based dimensions was developed. Through reference date surveys, patients were assigned to needs-based clusters and Psych-PV categories. The required treatment effort under consideration of guidelines or expert consensus was estimated in several rounds of expert panels (Delphi method). Results: The pilot study proves the feasibility of the Platform-Model . Methodological findings as well as limitations of the model were identified in order to further develop the Platform-Model. Conclusions: The Platform-Model cannot serve as a tool to describe clinical pathways, but it appears to be an adequate and practical tool for assessment of the required staffing level based on patient needs independent of diagnosis and setting.

Treatment clusters and personnel assessment in psychosomatic medicine and psychotherapy - results of a feasibility study of the platform model Objectives: In accordance with the legal requirements of the PsychVVG, it is necessary to develop criteria for inpatient and day-care psychosomatic psychotherapeutic care, which can be used to determine the appropriate staffing for different treatment areas and different care structures. For psychosomatic medicine and psychotherapy a model with four treatment clusters was developed, which is oriented on the one hand to the psychotherapeutic intensity and on the other hand to the medical expenditure. Method: In three consecutive rounds with up to 30 experts, representative selected from the three institution types university hospital, departmental psychosomatic medicine and specialized clinic, the minute values per patient required for a treatment according to the guidelines were determined using the Delphi method. Newly developed activity profiles for the six occupational groups were used, which allow the recording of all patient- and setting-related activities. Results: With the results of the feasibility study, an instrument has been developed for the first time to determine the requirements of staffing in psychosomatic medicine. Convergent minute values could be formulated for three of the four treatment clusters. Conclusions: The provision of care in psychosomatic medicine and psychotherapy is complex, so that a limitation to four treatment areas is only possible if significantly more generous equivalence rules are applied between the professional groups than those laid down in the PPP Directive.

Background and Goal: According to § 136a (2) SGB V (volume V of the German Social Security Code) the German legislator instructed the Federal Joint Committee (G-BA) to specify binding minimum standards for the staff needed for the treatment in inpatient psychiatric and psychosomatic facilities. This induced the expert associations/organizations to develop their own conceptional approach as to the future organization of staffing., Method: Organization of regular expert workshops, the results of which were systematically documented and validated by the experts., Results: The essential elements of the concept are: the starting points for the calculation are the needs of all patients treated in the institution. The need for treatment has three dimensions: (a) psychiatric psychotherapeutic/psychosomatic psychotherapeutic/pediatric and adolescent psychiatric-psychotherapeutic, (b) somatic and (c) psychosocial needs. The model developed by the platform distinguishes between staff requirements being directly related to the treatment of the individual patient, staff requirements caused by the treatment setting and such staff requirements arising at an institutional level. Minimum staff requirement is understood as the staff structure which is, among others, needed to guarantee the multiprofessional, physician-led treatment and the required medical care services for all patients specified by the existing guidelines or an expert consensus as well as to ensure the protection of the patient, fellow patients and the employees working in the facility against hazards., Conclusion: This model considers the medical progress within the meaning of the evidence-based guidelines and the modified healthcare practice including sociopolitical standards aimed at the patients' self-determination.

Objective: To elucidate organizational and human resource management-related drivers of community mental health services and home treatment in Germany., Methods: Systematic review of psychiatric and organizational science literature, additional manual search., Results: Relevant driver variables in community mental health services and home treatment have mostly been addressed. However, only a few have been evaluated and complex cause-and-effect models are missing so far., Conclusions: The proposed drivers, moderators, and throughputs should be integrated into an evaluation system that should be able to estimate effects of organizational and human resources on care-related and economic outcomes., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The aim of this pilot study was to estimate the share of working time that staff in psychiatric hospitals theoretically spend on obligatory activities, such as training and further education, organizational and documentation tasks as well as statutory lecturing duties without patient contact. A total of 47 physicians, 39 nurses, 34 psychologists and 35 social workers from eight psychiatric hospitals were interviewed. The results reveal that the theoretically remaining time for direct patient contact is low. The ratio of time spent with versus time spent without patient contact was even worse for senior physicians and leading nurses as well as part-time employees; however, all activities without direct contact to patients seemed to be indispensable in terms of quality of treatment and care. Hence, employees in German psychiatric hospitals regularly have to make decisions on which of their duties they prefer to neglect, to which they are actually obligated.