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Evidence Base

Ten manuscripts. Seven years.
One dataset.

The frameworks on this site are the operational output of a seven-year research programme on roughly 9,000 patient episodes at the reference deployment in Schlüchtern. Five anchor manuscripts are summarised below. The full programme of ten is in preparation or under peer review.

Academic Collaboration

The research programme is a formal academic collaboration with Prof. Dr. Rainer Sibbel, Chair of Health Care Management at Frankfurt School of Finance & Management, and an internationally recognised authority on operations management in healthcare. The partnership brings the Schlüchtern operational dataset into peer-reviewed academic literature.

i.
FLOW™ Manuscript complete — collaboration with Prof. Dr. Sibbel

The FLOW Method: A Quality Improvement Framework for Reducing Length of Stay in Geriatric Care While Maintaining Functional Outcomes.

The flagship paper. Seven years. 8,355 patients. The operating system’s foundational evidence.

Documents the development and seven-year evaluation of FLOW (Find-Lean-Optimise-Wire) as a systematic operational framework for geriatric care. Demonstrates sustained reduction in length of stay with a concurrent increase in throughput, Charlson Comorbidity Index stability ruling out cherry-picking, and a capacity equivalent of thirteen to seventeen beds freed without construction. Reported per SQUIRE 2.0 with an interrupted time-series model. This is the paper every other framework and every case study on this site ultimately points back to.

Samplen = 8,355
DesignSeven-year ITS
ReportingSQUIRE 2.0
ii.
PRIME™ + ANCHOR™ Manuscript complete — collaboration with Prof. Dr. Sibbel

Evolution of the Geriatric Admission Process: A Time-Driven Activity-Based Costing Analysis of Task Redistribution.

The methodologically most sophisticated paper in the portfolio. The causality chain from FLOW to ANCHOR, made quantitative.

Applies time-driven activity-based costing to three admission models — physician-centric, Aufnahmeteam, and a PA-augmented projection — with sequential reductions in physician time from 52.5 minutes to 22.5 to a projected 7.5. Uses published TV-Ärzte/VKA and TöVöD tariffs, fully reproducible by any German hospital. First TDABC-based evidence for admission-specific task shifting in German geriatric medicine and a direct response to the SVR 2024 Gutachten and KHVVG policy calls for multi-professional models.

Samplen = 8,770
MethodTDABC with three-way sensitivity
Policy anchorSVR 2024 · KHVVG
iii.
CAPTURE™ + FLOW™ Manuscript complete — collaboration with Prof. Dr. Sibbel

Cost-of-Delay Analysis for Inter-Departmental Transfers: A Seven-Year Retrospective on Hidden Capacity Leakage.

The paper that puts a euro figure on what every hospital administrator suspects but nobody has measured.

Quantifies the operational and financial cost of inter-departmental transfer delays across seven years of geriatric rehabilitation episodes. Establishes a cumulative cost-of-delay figure of 7.35 million euros attributable to transfer friction alone, and decomposes the total into pathway-specific components that can be individually addressed. Demonstrates that the commercially significant revenue recovery in CAPTURE does not depend on changing clinical work — only on removing the structural friction between departments.

Samplen = ~9,000
Headline€7.35M quantified
DesignSeven-year retrospective
iv.
FLOW™ · methodological Manuscript complete — collaboration with Prof. Dr. Sibbel

The Weekend Admission Effect Is a Confounding Artifact: Evidence from Seven Years of Geriatric Rehabilitation Pathways.

A contrarian methodological contribution. The weekend-effect literature gets a thorough challenge.

Demonstrates that the widely cited weekend admission effect in geriatric rehabilitation disappears — and partially reverses — once admission pathway is adjusted for as a confounder. Ninety-three percent of weekend admissions arrive via inter-departmental transfer, compared with twenty-nine percent on weekdays. After pathway adjustment, the coefficient reverses direction and Langlieger risk becomes non-significant. Simultaneously documents that weekend discharge expansion from six to twenty-one percent correlates strongly with length-of-stay reduction. A methodological argument paper that reframes an established finding as an artifact.

Samplen = 9,061
MethodPathway-adjusted regression
ContributionContrarian · literature-challenging
v.
ORBIT™ + FLOW™ Manuscript complete — collaboration with Prof. Dr. Sibbel

The Two-Layer Irreducible Minimum: A Novel Conceptual Framework for Long-Stay Patient Benchmarking in Geriatric Rehabilitation.

The only genuinely novel concept in the portfolio. Benchmarking parameters other geriatric units can use.

Introduces the two-layer irreducible minimum as a conceptual framework for understanding long-stay patients (Langlieger) — an operational floor of approximately seven percent driven by compositional effects and a clinical floor of approximately thirteen percent among non-transfer patients. Uses Kitagawa decomposition to separate process improvement from case-mix composition shift, with quarterly ITS confirming the plateau. Decomposes residual long-stay patients into intercurrent complications, discharge-destination conflicts, and insufficient rehabilitation potential. Provides the first quantitative benchmarking parameters other geriatric units can apply to their own populations.

Samplen = 9,061
MethodKitagawa decomposition · quarterly ITS
ContributionNovel conceptual framework

Five additional manuscripts from the same seven-year research programme are in preparation — including the Complexity-Outcome Paradox analysis (diagnostic-domain methodology), a multi-year COVID impact study on geriatric pathway disruption, and papers on DRG discharge-timing patterns, the economic burden of inpatient falls, and seasonal capacity planning.

Titles, positioning summaries, and pre-print access are available on request from the scoping call.

Phase A · Operational Scoping

Ten consultation slots per quarter.

Phase A is a focused operational scoping engagement. It runs four weeks, produces a structural diagnosis across the five layers, and ends with a specific recommendation. Ten engagements per quarter — currently booking Q3 2026.

Request a Scoping Call Complete the Self-Diagnostic