End of the interview
What the Numbers Cannot Capture
JLPdecryptage
A large-scale survey by the World Health Organization among doctors and nurses in the European Union, as well as in Iceland and Norway, revealed, among other things, that around one in ten respondents stated they had recently had passive thoughts related to death or self-harm. A hospital system measures costs, services, bed numbers, and medical outcomes. Does it, however, adequately capture the human consequences of its own functioning? And is there a credible way to integrate this dimension into economic decisions, without reducing human suffering to a mere financial indicator?
Tamara Stenger
I believe we must be very careful here not to try to convert everything into money.
Human strain must not become relevant only when we can calculate what a sick day costs.
Of course, large organisations need indicators. We must look at absenteeism, turnover, overtime, or staff retention. But these indicators most often only show the consequences.
The real question must be asked earlier. Under what conditions do people work sustainably over the long term? Can they perform their work in a way that meets their own professional standards? Do they have an influence on their working conditions? Do they receive effective leadership, support, and recognition?
From my time in intensive care, I know that healthcare professionals carry an enormous responsibility. Many situations stay with you mentally after a shift.
When this emotional burden is accompanied over time by organisational or economic pressure, it has consequences.
That is precisely why I consider an idea to be important, which I also associate with High Performance mit Herz ("high performance with heart"): high performance and humanity are not opposites.
A financially stable hospital needs healthy, capable staff. But people must nevertheless never be protected solely because their absence costs money. They must be protected because a responsible healthcare system also bears responsibility for those who keep it running every day.
Changing Just One Rule
JLPdecryptage
If you could change just one structural rule of German hospital financing to better align economic decisions with the daily reality of care—really just one, not a list—which would it be? And what concrete change would need to be noticeable for patients or for nurses, so that one could say: this reform is working?
Tamara Stenger
If I could actually change just one structural rule, I would systematically decouple the financing of medically necessary structures from the volume of cases. That sounds self-evident at first glance. But in daily reality, it is precisely there that a large part of the core tension lies.
Hospitals must maintain staff, technology, and medical expertise. Intensive care, emergency care, or other highly specialized areas cannot be scaled up and down at short notice. These structures must be there before they are needed.
Such financing should not, however, be a blank check. Necessity, quality, and transparency would need to be clearly demonstrated.
To know if the reform is working, I would not first measure it against a new financial indicator.
I would look at day-to-day life on the wards.
If a nurse, at the end of a shift, says: "I once again had more time for my patients today and less time lost due to avoidable structural and organisational problems," then something is actually changing.
If, at the same time, a patient can trust that the necessary treatment is available where it is clinically appropriate and quality-assured, then we have brought financial sustainability and patient care a little closer together.
For me, that would be exactly the benchmark of a successful hospital reform. Not whether the financing system has become more complicated or more modern on paper, but whether the change ultimately makes a tangible difference to people.
Background
About Tamara Stenger
Tamara Stenger works at the intersection of two worlds rarely united in a single career path: clinical practice and hospital financing.
Since December 2023, she has been Referentin Budgetmanagement (Budget Management Specialist) at Vivantes – Netzwerk für Gesundheit GmbH, in Berlin. Her responsibilities include preparing, conducting, and following up on budget and reimbursement negotiations, as well as work related to contracts and revenue compensation mechanisms.
Before joining Vivantes, she worked on issues of hospital financing, budgets, and reimbursement procedures within the Berliner Krankenhausgesellschaft. Her career also led her to the Deutsches Herzzentrum der Charité, where she combined her nursing experience with financial controlling, finance, and accounting responsibilities.
This economic knowledge of the hospital is based on substantial frontline experience. Tamara Stenger worked as a registered nurse notably in intensive care, anaesthesia, and cardiac and cardiothoracic intensive care, at the Charité, at Goethe University Frankfurt am Main, and at the Deutsches Herzzentrum der Charité in Berlin.
She also holds a Bachelor's degree in Business Administration (Betriebswirtschaftslehre) from the PFH Private Hochschule Göttingen.
Her background gives her a distinctive perspective on the hospital: that of a professional who experienced the reality of care first-hand before analysing its economic, budgetary, and organisational mechanisms.