Implementing Hospital Reform with Logistics

The Hospital Care Improvement Act (KHVVG), passed by the German Bundestag in October 2024, initiates a hospital reform that fundamentally changes planning, financing, and service delivery in hospitals. Clinics will specialize by service at their respective locations. Cross-sectoral healthcare facilities (Level 1i hospitals) will expand outpatient services. Patient pathways, material flows, and care processes must be reorganized across locations.

The Fraunhofer institute for Material Flow and Logistics is developing cross-location logistical operational concepts as a foundation for implementing these goals in a structured manner. The concepts leverage synergies and enable more efficient resource planning, thereby improving the quality of care and competitiveness.

The KHVVG aims to improve the quality of medical care and ensure comprehensive coverage. In the future, the KHVVG service groups will determine which medical services hospitals are permitted to provide. These groups are bound by mandatory quality criteria, such as those regarding personnel, technical equipment, or interdisciplinary collaboration.

For hospitals, this means in concrete terms: outpatient and inpatient care are becoming more closely integrated. Services are increasingly concentrated at specialized locations. Patient pathways and material flows must be reorganized in line with changing medical structures. In particular, hospital systems with multiple locations face the task of reorganizing medical services, space, material flows, and processes across all sites.

This is precisely where the cross-site logistical operational concept comes into play. Fraunhofer IML works with hospitals to develop a holistic concept tailored to specific requirements, infrastructural conditions, and organizational frameworks. This work draws on many years of experience in planning and organizing logistical operational processes in hospitals (support processes).

Our services in the planning of cross-site hospital logistics:

• Consideration of KHVVG-related impacts on locations, service groups, and process organization
• Development of a cross-site logistics operational concept from existing facilities or construction through to the target state
• Coordination of patient, material, and information flows for concentrated service offerings
• Support in planning logistical requirements for the creation of centers, outpatient services, and cross-sector care
• Definition of migration scenarios for implementation during ongoing hospital operations

Request a cross-site logistics operational concept

For hospital networks and multi-site operators, cross-site service delivery is coming into focus as part of the KHVVG. The Transformation Fund supports projects that consolidate acute inpatient capacities, establish cross-sector care facilities, or further develop regional hospital networks. In practical terms, this means: Hospitals need target models for service groups, medical functional chains, and care roles for each location.

Logistically, this affects virtually all support processes, service areas, and digital information flows. In particular, OR and bed logistics, as well as the management of emergency care, pose significant challenges for hospitals. Without a coordinated target operating model, implementation risks, operational friction, and additional costs during ongoing operations increase.

Our institute works with hospital operators to develop holistic, cross-site operational concepts. These concepts encompass process and information flows as well as technical and infrastructural requirements. Together, we examine which processes need to be consolidated, relocated, or reorganized to ensure that care, quality, and cost-effectiveness align.

“Future viability of hospital planning within the framework of hospital reform requires integrating logistics-related operational organization into the design process at an early stage. This ensures that medical target structures and architectural implementation remain aligned.”
Andrea Raida is Deputy Head of the Health Care Logistics Department at Fraunhofer IML and conducts research on hospital logistics.

An efficient, cross-site logistics operational concept integrates construction, operations, and technology. It makes dependencies between medical services, supporting processes, and infrastructure transparent. At the same time, it prioritizes measures for target sites and defines migration steps for implementation in existing facilities.

For hospitals in a network, this results in three key advantages:

First, the risk that the concentration of medical services fails due to procedural or structural bottlenecks is reduced. Second, investments, space, and resources can be aligned with a shared vision. Third, the formation of medical centers becomes operationally compatible because patient pathways, material supply, staff support, and cross-site interfaces are clarified at an early stage.

Logistics within the hospital network thus gains a structured, holistic foundation. It enables strategic decisions, supports building planning, and ensures operational implementation during ongoing operations.

Restructuring at Arnsberg Hospital: A Cross-Site Logistics Operations Concept

The project demonstrates how a cross-site logistics operations concept is preparing the structures at Arnsberg Hospital for a reorganization. Fraunhofer IML developed an integrated operational organization plan as well as a space and functional program for three sites. This program systematically maps out the emergency room, operating rooms, wards, service areas, transportation, and communication.

Cross-site logistics operations concept at Arnsberg Hospital

Are you planning the structural implementation of the KHVVG, the consolidation of services, or the development of a center model? Fraunhofer IML will work with you to develop a cross-site logistics operations concept that integrates the target medical structure with operational organization.

Contact us. Together, we’ll examine how to make your project logistically viable.