Value-based health care is a concept that opens up new prospects for the health care system: it focuses attention on the patient as the central figure, it exploits the opportunities offered by digitalization, and it combines disease prevention, treatment and convalescence.

In Hippocrates' footsteps

The most prominent medic of the ancient world played a key role in developing the holistic view of human health.
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About value-based health care

This new health care concept was devised by Michael Porter, an American economist. It advocates a new approach to treating diseases throughout the patient pathway.
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Example of a patient: Beatrice K.

Thanks to a minimally invasive gastric bypass operation, she was able to reduce her overweight and her secondary conditions were cured.
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Example of a patient: Christian G.

A conservative surgical intervention in his heart eliminated his cardiac arrhythmias.
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Example of a patient: Adrian T.

Thanks to a new hip joint, Adrian T. can again enjoy pain-free sport.
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In Hippocrate's

The History of Medicine

Medicine in the ancient world

Everyone wants to be healthy, and to stay that way. Today, medicine aims to heal the sick – just as it did 2,000 years ago. What has changed is the status accorded to the patient. Here are some insights into an ever-changing cultural history.

Your good health! Santé! We often wish other people good health. On their birthday, and on many other occasions. "To your health" is the typical French toast, and Germans say "Good health!" if someone sneezes. There has been a globally valid definition of health ever since 1948, when the Word Health Organization (WHO) was founded: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
The father of all medics: Hippocrates.
Since ancient times, we've known that the priceless asset of health is not predestined by fate, or even gifted to us by God. Hippocrates (460–370 B.C.), the Greek doctor known as the "father of all medics", urged all human beings to take charge of their own health. According to his teachings that have been handed down to us, this requires a healthy lifestyle combined with preventive actions. Illnesses and diseases, he believed, should be identified as soon as possible and treated medically so that their consequences can be nipped in the bud. He prescribed "therapeia" for his patients – and that Greek word certainly meant more to him than our modern understanding of therapy: "therapeia" includes not only healing, but also long-term aftercare following recovery. Hippocrates wanted to know how far his "therapeia" could have a sustained positive impact on his patients' quality of life. He was willing to learn from his mistakes.
"Nobody can enjoy full physical health if a part of the body is not healthy; on the contrary – all the organs, or at least the most important ones, must be in the same condition as the whole body."
Aristoteles (384–322 B.C.), Greek philosopher, pupil of Plato, teacher of Alexander the Great of Macedonia
"Nine tenths of our happiness is based solely on health. With it, everything becomes a source of pleasure: but without it, we cannot take pleasure in any external stimulus, irrespective of its nature."
Arthur Schopenhauer


The doctor, the therapy and the patient form a trinity where each of them must play their part in the success of the recovery process. The doctor has to arrive at the correct diagnosis; the therapy must produce results; and the patient needs to take on personal responsibility for the healing process. Hippocrates' appeal to the patient's personal responsibility was also echoed by other intellectual giants of the ancient Greek world. The philosopher Aristotle (384-322 B.C.) was convinced that a society could only function properly if it took a disciplined approach to health care. However, he assigned responsibility for a healthy lifestyle not only to society but also – and above all – to each and every individual.


The 19th century ushered in a dramatic change in the way health was perceived. The Industrial Revolution, coupled with triumphant progress in the natural sciences, opened the way for medicine to develop spectacular new treatments for illnesses. By introducing the division of labor in manufacturing, the Industrial Revolution encouraged a focus on the individual components of a production chain. Advances in the natural sciences prompted the invention of groundbreaking medicines and medical techniques. Taken together, these developments also impacted treatment methods: illnesses were no longer viewed in an overall context, as Hippocrates had suggested – instead, they were treated in isolation. Medicine took over the responsibility for the patient.

Broken down into individual components: car production at Volkswagen.
Medical breakthrough: penicillin.
From the 20th century onwards, researchers broke the human body down into individual components such as the organs, the extremities or the mind, and medical interventions now took place at these levels. Highly effective medicines developed in laboratories – such as penicillin – conquered bacterial infections such as cholera or plague. Medication has become more specific and individual since the turn of the millennium. Pharmaceutical companies are now talking about "personalized medicine".

In orthopedics, artificial joints help patients with conditions such as arthrosis of the knees, shoulders or hips to lead their lives free from painful symptoms. Highly effective medicines, optimized minimally invasive surgical interventions, and short periods of convalescence: cutting-edge medical services underpinned by technology and the vast reserves of knowledge in the pharmaceutical industry are delivering multiple benefits for patients.

Losing sight of the big picture

Medical care has made enormous progress. But even so, something has been lost amid the myriad of therapeutic options that are now available: the view advanced by Hippocrates of a human being as one holistic entity. Doctors specializing in different disciplines record the patient's medical history within their own particular fields. But this information is not pooled centrally to yield a holistic picture – leading to costly duplication of work. Both medics and economists are using modern technology to point us back towards a holistic approach to prevention, treatment and convalescence – you could even call it Hippokrates 2.0.

Value-based health care

Putting the focus back on the patient


The new world of medicine

A concept developed on the basis of science opens the way to enhancing the quality of patient treatment in the health care sector, and also makes it possible to cut costs.

When the American economist Michael Porter stepped onto the stage at the World Economic Forum (WEF) in Davos, Switzerland, in 2017, "Value-based health care" (VBHC) was already a globally established concept that advocates restructuring of the health care sector. This will have pleased Porter, who laid the foundations for VBHC with the research work he undertook back in the 1990s. This scientist and Harvard professor focused on the cost-effectiveness of health care systems. His conclusion: they are too expensive and inefficient. How, he asked, can a high standard of medical care be combined with lower costs?
Google hits for "health"
The father of value-based health care: Michael E. Porter.
"The concept of disease urgently needs to be replaced by a new concept of health."
Christa Schyboll, author and columnist
"Constantly worrying about health is an illness in its own right."
Plato, (428–348 B.C.), Greek philosopher, pupil of Socrates, teacher of Aristotle.
Porter investigated the economic processes in the American health care system; based on an analysis of their weak points, he developed "Value-based health care". The model devised by Porter works in a fundamentally different way than existing models. This is because the focus is no longer on the doctor, his or her instructions, findings and decisions: instead, the value that the treatment gives the patient is now the central factor. Porter's book on this subject was published in 2006: "Redefining Health Care".

"Quality comes at a price" is the usual justification given for the costs of existing health care systems. Porter adopts a radically different approach: a health care system has to achieve the best possible result for the patient – and it must do so at low cost. His call to restore the patient's status as the central focus of health care is in line with economic principles. Porter's analysis: amid competition between health insurers, hospitals and doctors, the patient's wellbeing is relegated to the background.

A key issue in the entire process is the value of treatment – measured in the currency of the patient's long-term quality of life. This should be ascertained with the help of surveys before and after treatment, including questions such as: What is life like two years after a hip replacement implant? How quickly can the patient return to work? How many follow-up treatments were needed?

Consistent tracking of the entire patient pathway is the only way to arrive at a qualitative analysis. Digitalization makes it easier to collect, record and evaluate all the personal data for this purpose. Patients themselves move from being passive participants to active players – just as Hippocrates advocated – and they have to take on personal responsibility.
Benefits for patients: Gregory Katz.

A revolutionary Concept

Health reformers have seized upon Porter's idea and continued to develop it; modern data processing systems make analysis easier. "Value-based health care works!" – that was the verdict of Gregory Katz at the annual congress of the European Institute of Innovation and Technology (EIT). Katz, who comes from France, is the Director of the EIT Health Trends Report. He is working on the publication of a report titled "Implementing Value-Based Health Care in Europe: Handbook for Pioneers".
Gregory Katz, Director of the EIT Health Trends Report

The EIT is an EU body where researchers work together on an interdisciplinary and international basis. "We measure quality of life before and after treatment, with the help of calibrated instruments: we use questionnaires to do this," according to Katz, who holds a professorship at the University of Paris.
He advocates results-oriented medicine with a strong focus on benefits for the patient. According to Katz, it is crucial for all health care institutions to engage in interconnected data exchange so they can respond more precisely to patients' specific needs. Medicine ought to be measurable by its results. Johnson & Johnson sees VBHC as the health care of the future. For many years, the company has joined with other health care providers such as clinical centers to carry out practice-based projects on VBHC. "Through its programs for value-based health care, J&J aims to offer patients a better quality of treatment, and to combat negative financial trends in the health care sector," says Roman Iselin, Country Lead Medical Devices at J&J Switzerland.

Roman Iselin, Country Lead Medical Devices at J&J Switzerland
”Mens sana in corpore sano”
Juvenal, Roman satirical poet (60–140 A.D.)
Experience gained thus far is encouraging. For example, costs for patients undergoing hip and knee operations at a Neuchâtel clinic were cut by 40 percent thanks to faster recovery and mobilization. For bariatric surgeries such as a gastric bypass operation at a defined phase of severe overweight, there was a drastic reduction in the costs incurred due to diabetes and high blood pressure in connection with severe overweight. Scarring of the heart during catheter ablation makes antihypertensive drugs obsolete. Roman Iselin views these cooperative approaches as "urgently necessary so that VBHC can revolutionize the health care system".

Three examples
of patients

These three stories are about patients. Whether they were suffering from cardiac arrhythmia, severe obesity or hip osteoarthritis, all three were spared a long period of suffering thanks to an surgery at the right time and efficient pre- and post-treatment.
Together through thick and thin: Beatrice K. and her bulldog Oskar.
"I've been going on diets for decades, but they never lasted."
Beatrice K.
"Obesity is a chronic condition."
Professor Ralph Peterli
of the Swiss population suffer from obesity.

Gastric bypass

"I'm active again."

Bariatric interventions show what can be achieved when an efficient and timely medical therapy brings about a definitive turning-point, so costs are cut on a long-term basis. For severely overweight individuals, a gastric bypass can prevent secondary conditions in the long term – or can even eliminate them completely.

Beatrice finally reached breaking point during an outing with her family, when even a gentle uphill slope left her out of breath and she could no longer manage without help from others: "I knew that the time had come for something to happen," says Beatrice (who is now 72). Back then, she weighed in at 96 kilograms – distributed over a body height of 1.50 meters. The consequences of being overweight were making her life difficult: joint pains, shortness of breath and type 2 diabetes. Beatrice K. numbered among the eleven percent of obese individuals in Switzerland.

"Obesity is a chronic condition," according to Professor Ralph Peterli. For many years, this surgeon has undertaken research on obesity and its consequences at the Obesity Center of Clarunis (the University Center for Gastrointestinal and Liver Diseases) on the Claraspital site in Basel. "The idea that obese individuals eat too much simply because they lack discipline and willpower is wrong," the specialist points out. In his day-to-day work, he sees that many factors are conducive to obesity: they include genetic and psychological factors as well as an unhealthy lifestyle or a metabolic disease. "Individuals with this condition can take as many slimming cures as they like – but through their own efforts, they rarely shed enough weight to restore them to normal levels."

Beatrice K. also had this experience. "I went on diets for decades," she says, "but they never lasted – I always put on weight again afterwards and became even heavier." And then the secondary conditions began to appear. A normal, active life was out of the question without medicines and therapies. The psychological strain kept on increasing. "You feel so ashamed," she recalls. "When you take your seat in a plane, you have to ask for an extension for the safety belt because it won't fit round your belly."
The story of Beatrice K. and her gastric bypass
According to the Swiss Federal Statistical Office (SFSO), 12% of men and 10% of women in Switzerland are obese. These figures have doubled over the last 25 years. And the Federal Office of Public Health (FOPH) also notes a breathtaking increase in the cost to the national economy over the same period: overweight individuals cost society CHF 8 billion in 2012. This makes it a matter of urgency to discover how obese individuals can be helped without a constant increase in costs.
Everything about obesity
Obesity (adiposity) is regarded medically as a chronic condition.

A body-mass index (BMI) of over 30 qualifies as obese; individuals with a BMI of over 35 are severely obese. The normal range for the BMI is between 18 and 25.

Those affected suffer dramatic consequences: morbid obesity curtails their quality of life and causes serious damage to their health. The consequences of obesity include (but are not limited to) type 2 diabetes, lipid metabolism disorders (increased cholesterol and triglyceride levels in the blood), cardiovascular diseases and joint pain.
During a gastric bypass operation: Professor Ralph Peterli
Gastric bypass
A gastric bypass is a surgical intervention that involves amputation of the stomach just below its entrance.

The small residual stomach is connected to the small intestine. Digestion then begins directly in the small intestine. As well as reducing the intake capacity and lowering the absorption of food, the operation has a positive influence on the hormones produced in the small intestine that control satiety (the feeling of being replete). For the vast majority of patients, all of these effects result in a loss of weight.

A gastric bypass is regarded as the last resort if conservative methods of inducing long-term weight loss fail to produce results. It is only performed on patients with a BMI of 35 or more. The period of the patient's stay in hospital after the operation is between three and five days.


Ralph Peterli sees surgical interventions such as the gastric bypass as a potential way of liberating obese individuals from their overweight on a long-term basis. He has already performed around 3,000 operations of this sort. The results are encouraging: in most cases, the bypass leads not only to a massive loss of weight but also to a reduction of the costs incurred due to obesity. "Even just a short time after the operation, diabetes is reduced and can even disappear in some cases; hypertension is brought under control, and there is less joint pain thanks to the loss of weight – the list of positive effects could go on."
Beatrice K. had read about the possibilities offered by a gastric bypass, and she had also learned that it could cure diabetes. At age 70, Beatrice was admitted to the Claraspital in Basel where she was examined by a team of nutritionists, psychologists and physicians to determine whether she was suitable for an intervention. She has nothing but positive experiences to recount: "I felt that I was being taken care of and understood. At last, I could take a positive view of the future, and I knew that everything would be all right," she recalls. The minimally invasive intervention, which involves massively reducing the size of the stomach and connecting it directly to the small intestine, takes about one hour. Even so, she points out, it is a serious operation – but she was happy to accept the inconvenience it entailed: "Staying fat wasn't an option for me." Everything went according to plan, and she was discharged after five days.

She has since lost 30 kilos. She is healthy. Her diabetes has vanished. She no longer gulps down medicines. She feels as if she has given herself the gift of a new life: "I'm active again, I often go for a walk with my dog, and I meet up with friends." Surgeon Peterli views the entire process as an interaction between the interdisciplinary medical treatment team, the patient, and the operating method. "In the preparatory phase, we investigate in detail whether the patient is ready to adapt his or her eating behavior and exercise patterns after the operation so that we can all collaborate to achieve the best possible result." He believes it is essential for patients to receive ongoing support from his team – for their entire lifetimes.
Actively enjoying riding again: heart patient Christian G.
"Atrial fibrillation, the most frequent type of cardiac arrhythmia, is a chronic condition that requires lifetime treatment with medications."
Professor Etienne Delacrétaz
"It happened while I was sitting in front of the TV after dinner – my heart suddenly started beating like crazy."
Christian G.


"I feel young again."

Cardiac arrhythmias are classified as chronic diseases of the heart, and various methods are available to treat them. When carried out promptly, catheter ablation of the heart can practically eliminate these conditions – and can also avoid follow-on costs. This is what happened in Christian G's case.

At breakneck speed, the cursor flits across the screen where little pink balls are turning red and something resembling a snake is prancing about. This is the computerized graphic view of a catheter during an intervention in the atrium of a patient's heart. A closer look reveals an outline that resembles a gray stone. "This", Charlotte Vivet explains, "is the 3D view of the inside of the heart." This 25-year-old engineer, a graduate of the École Polytechnique Fédérale de Lausanne (EPFL), has been working at Johnson & Johnson as a Clinical Support Specialist for well over a year. She is one of a team of 15 highly specialized staff in Switzerland who act as partners to doctors when they perform high-tech cardiac surgeries. This morning, she is working in tandem with Professor Etienne Delacrétaz at the Hirslanden, Clinique Cecil in Lausanne.

Behind Charlotte's screen, separated by a pane of glass, is the operating theater. On the table lies a young man, fast asleep. In front of him at waist level sits the doctor, whose quiet comments and instructions are relayed from the loudspeaker set up in front of Charlotte. Professor Etienne Delacrétaz is at work. This specialist in cardiology and electrophysiology is performing a catheter ablation of the patient's heart. This is a minimally invasive procedure that involves scarring of the heart tissue with the help of a catheter. It is an exceptionally efficient method of eliminating dangerous cardiac arrhythmias.
Clinical Support Specialist: Charlotte Vivet.


"Atrial fibrillation is the most frequent type of cardiac arrhythmia," Delacrétaz explains, "and it's a chronic condition that requires lifetime treatment with medications." There is no cure. Left untreated, it leads to disorders such as palpitations and shortness of breath; in extreme cases, it can even result in strokes and cardiac insufficiency. And the consequences for those affected can be dramatic – they may even become disabled. According to the Swiss Heart Foundation, about 100,000 people suffer from atrial fibrillation in this country – and the trend is upward.
people in Switzerland suffer from atrial fibrillation, according to the Swiss Heart Foundation. And the trend is upward.
Atrial fibrillation
Atrial fibrillation is the most frequent type of cardiac arrhythmia.

It is caused by the faulty transmission of electrical signals in the atrium of the heart. As a result, the atria and ventricles can no longer pump in unison, and they are usually too fast. The irregular pumping movements can cause more blood clots to form in the heart. If one of these clots is released into the bloodstream and blocks an artery in the brain, it will cause a stroke.

Many patients are therefore treated with anticoagulants as a precaution. Cardiac insufficiency can also develop as a delayed consequence of the permanently high heart rate.

As well as putting life at risk, cardiac arrhythmias are extremely frightening for the sufferer. That was the case for 56-year-old Christian G, so he underwent catheter ablation performed by Professor Delacrétaz. This was after his heart suddenly started beating irregularly from one day to the next. "It happened while I was sitting in front of the TV after dinner – my heart suddenly started beating like crazy." Christian, a heating fitter, went to consult his cardiologist. "We tried to calm my heart down with medications, but that didn't really help," he explains. Although he is normally quite athletic, Christian felt listless, constantly tired and somewhat depressed due to his condition. He was afraid that he would have to give up his hobby of riding. "But the worst thing of all was the fear," he recalls. He knew that his father and uncle had suffered from high blood pressure, and both of them had died before their 60th birthdays. He too had been taking antihypertensive drugs for years.
The story of Christian G. and his catheter ablation
A specialist in catheter ablations: Professor Etienne Delacrétaz.
Catheter ablation
The method of scarring heart tissue with catheters and high-frequency current was first used 40 years ago, since when it has been continuously refined.

Today, the intervention is quite short – it only takes one to one and a half hours. The doctor inserts a catheter through the vein into the atrium, locates the diseased tissue and then destroys it by heating.

The catheter ablation rate in Switzerland is increasing by eight to twelve percent every year, and the trend is upwards.
"I hardly felt any pain – but I could already feel the positive consequences on the second day after the operation."
Christian G.
A catheter ablation is an intervention involving targeted scarring of the tissue that causes heart arrhythmias. It is performed via catheters that are introduced into the heart through the vein. Etienne Delacrétaz has been performing catheter ablations for over 20 years. Catheter ablation is not a surgery on the heart, he explains: it is a minimally invasive intervention that leaves no external traces behind. The doctor treating the patient must have very nimble fingers – "but most of all, he must understand the technical procedures and have plenty of practice." The doctor concentrates his attention on the large screen behind the operating table to see the exact location of the tip of the catheter as he steers it with his hand. Charlotte, his supporter, provides him with all the data he needs to guide him. She rotates the 3D images so the doctor can see the places that he has to scar. In the graphic view, they are marked by dots that becomes redder as the scarring becomes more intense. Of course, the heart must never be damaged as the procedure takes place.


After well over an hour, the operation is over as far as the patient is concerned. He is wheeled out of the operating theater. With latest-generation catheters, the procedure takes no more than one and a half hours. Delacrétaz recalls that it wasn't always like this: "It used to take up to four hours." About five percent of all heart patients are currently treated with cardiac catheter ablations. As well as elderly patients, they include children and young people – who are often competitive athletes. After the procedure, the patient has to take a few medicines that drastically reduce the risk of cardiac insufficiency or a stroke, which could lead to irreparable damage. There is a spectacular improvement in the patient's quality of life, accompanied by a reduction of the subsequent costs that would be incurred without the intervention. Long-term chances of a successful outcome decrease with age, so patients should not be older than 70. It is now six months since Christian G. had his catheter ablation. The surgery passed off without any complications whatsoever. Christian's entire face is radiant: "I hardly felt any pain – but I could already feel the positive consequences on the second day after the operation." He was even able to resume work immediately. The atrial fibrillation has disappeared and although his blood pressure is still slightly high, he has it under control thanks to medications. He feels fit and vigorous, and he is taking part in equestrian competitions once more. "It's as if I was young again," he says.
Outdoor sports are his passion: thanks to a new hip joint, Adrian T. can again enjoy pain-free mountain climbing and skiing.
”Most of the time I forget that I ever had any problems with my hip.”
Adrian T.
± 20,000 to 25,000
replacement hips are implanted in Switzerland each year.

Hip replacement surgery

Winning in a walk

Digitally controlled interventions, minimally invasive operating methods and a consistently implemented treatment regimen: cutting-edge methods have made hip replacement operations both safer and more efficient. Adrian Tschannen is one of many who have experienced this type of surgery.

Slim and athletic, Adrian Tschannen was in his mid-50s when – all of a sudden – he felt a pain in his right hip. A stabbing sensation that was quite overpowering. "At first, I thought I'd pulled a muscle," Adrian Tschannen recalls. He isn't someone who pays heed to every little ache and twinge, so he ignored the pain. He also brushed aside his constant need to take several steps before he became able to carry on more or less normally. But then he reached the point where he couldn't manage any longer. A visit to the orthopedist shed light on the problem: the X-ray image clearly showed that he was suffering from arthritis of the hip. 

This came as something of a shock to Adrian, who is a business IT specialist. Most patients with this condition are not expecting such a diagnosis, even though about half of all people in Switzerland aged above 60 suffer from degenerative hip and knee disease. And it also raises a question: what should I do now? This is usually the starting point for a journey into unknown territory, because it is no longer possible to reverse arthritis caused by progressive breakdown of the joint cartilage. "We start out by trying to help the patient with conventional treatment," says Daniel de Menezes, a senior physician and consultant in orthopedic surgery and traumatology of the musculoskeletal system who specializes in knee and hip surgery. Conservative treatment methods include the administration of painkillers with anti-inflammatory properties, cortisone preparations and hyaluronic acid as well as physiotherapy. 
This meant that Adrian Tschannen was able to keep his hip pain in check for a while with the help of medication. "I'm an avid outdoor sports enthusiast," he explains, pointing to the rope and crampons hanging on the wall. Alpine mountain tours, deep-snow skiing and even skydiving and cycling: Tschannen is a man of action who engages in an almost endless list of sports. He took strong painkillers to fight the increasing agony caused by his hip, while continuing to take part in challenging winter ski tours. Until the day when he came to a realization: "I was suffering so much that I was no longer able to enjoy these expeditions." What had happened? The painkillers, which also have fever-reducing properties, brought his body temperature down so far that he was getting extremely cold in the freezing temperatures high up in the mountains. That day, he knew that he couldn't go on like this any longer. And when his pharmacist then suggested that he would actually be better off having the hip repaired, he reached the point where he had to admit to himself: he needed a new hip. 
How an artificial hip works
An artificial hip is used when conservative methods to treat hip joint disease have ceased to be effective and patients have to accept too many restrictions.

On the femur side, an artificial hip consists of a shaft with a ceramic or metal head at its end; this is inserted into the previously prepared bone. An acetabulum is implanted on the pelvis side; an inlay is pressed into this socket, enclosing the head and providing a surface for it to slide on.

The materials used are ceramic and highly crosslinked polyethylene, a plastic that exhibits very low degradation compared to materials used in the past.

Nowadays, the insertion of an artificial hip is a minimally invasive procedure that usually takes from one to one and a half hours. 
The story of Adrian T. and his hip replacement.
"It's entirely up to the patient to decide the appropriate time for a hip replacement", Daniel de Menezes notes. Nowadays, this hip surgery is a routine operation for this experienced orthopedist – thanks to improved materials, state-of-the-art minimally invasive operating techniques, and increased safety during the surgery with digital support from a modern navigation system. All these factors have helped to raise the safety of these interventions to an exceptionally high level in recent years. And by no means least, the materials used today are superior to their predecessors, as de Menezes explains: "The main factor that leads to good results is highly crosslinked polyethylene with minimal wear and tear, which we now use as standard in conjunction with a shaft prosthesis."
Daniel de Menezes during the insertion of a hip joint: The digital navigation system "Surgical Procedure Manager" supports the team during the procedure.  
”Minimally invasive operating techniques reduce post-operative pain, so the recovery process is ultimately shorter.” 
Dr. Daniel de Menezes,
Chefarzt Orthopädie Spitalzentrum Biel
During the operation itself, the surgeon relies not only on his team's abilities and his own medical skills, but also on support from a digital navigation system: the "Surgical Procedure Manager" (SPM). This audiovisual system uses sound and on-screen images to provide guidance throughout every step of the operation. Each member of the medical team knows what they have to do, when, and where. Moreover, every step is monitored and the operation can only be continued when each process has been completed correctly. "This system increases safety during an operation," de Menezes points out. "Everyone in the team takes the right step, at the right time and in the right place." No action is forgotten. What's more: valuable data is collected for analysis at a later stage. Using digital technology to ensure the safety of processes involved in performing operations is important, the specialist notes, because it means that human error can be almost entirely eliminated. "This has long been a mandatory requirement in other areas such as air traffic control," he adds. 

The hip joint: the hinge in our pelvis 
The hip joints are crucial for biomechanical alignment in the statics of the skeleton. They ensure that the pelvis is kept horizontal and the spinal column is positioned at right angles above the pelvis. This allows the body's weight to be supported optimally on the legs.

The femur and hip bones in the human skeleton are connected by a ball-and-socket joint. This consists of the femoral head, located at the end of the femur, and the acetabulum, a hemispherical depression in the pelvic bone. The hinge between the leg and the pelvic bone allows the thigh to move very freely.

To ensure that this works smoothly, the acetabulum and the femoral head are covered with a sliding layer of cartilage that cushions every movement – acting as a "shock absorber". Synovial fluid inside the joint also supplies the cartilage with the necessary nutrients and provides additional "lubrication" for the joint. 
The Biel Hospital Center generally follows a standardized procedure throughout the process – known as the clinical pathway (CPW). This means that the procedures carried out by a team of medical specialists are always identical. So that patients are as fit as possible for the operation and to ensure the fastest possible recovery afterwards, they benefit from a customized information and exercise program before and after surgery. This provides a sense of security. "Right from the outset, I felt that I was in good hands," Adrian Tschannen recalls. As the first step, he was invited to an informed consent discussion with other patients and family members; then he was assigned his own caregiver – so from the very beginning, he knew what he and his family could expect. "You have a lot of questions at first. But when Karin was assigned to me, I had the support of someone that I could contact at any time – she was with me throughout the process." Experiences gained with patients are collected digitally and analyzed so that errors can be eliminated with greater consistency. The costs are another positive point: it has been possible to reduce them thanks to the standardized procedure used at Biel Hospital Center. All things considered, this is a comfortable situation for the patients. 

The hip's enemies: arthritis and other diseases
There are many reasons why a hip causes pain. Arthritis is responsible in most cases: this is age-related degradation of the protective cartilage in the femoral head and acetabulum. Very advanced cartilage degradation leads to the two bones rubbing against each other with no protection: walking will then cause increasing pain.

Other potential causes of hip destruction include rheumatic and metabolic diseases, inflammations, congenital deformities and accidental injuries such as fractures.

Nowadays, permanent damage to the hip can be remedied by inserting an artificial hip joint. 
A huge surprise was in store for Adrian Tschannen immediately after the operation: "On the very first day, I was allowed to stand on the leg – and even walk!" But this comes as no surprise to Daniel de Menezes: "Minimally invasive operating techniques reduce post-operative pain, so the recovery process is ultimately shorter." This was also true in Adrian Tschannen's case: he was back home within a couple of days. Of course, he still needed several months to build up his strength and mobility with the help of physiotherapy. But his progress was constantly "onward and upward" – quite literally! After a little over five months, this keen amateur athlete was back amid his beloved mountains, balancing his way over the high ridges. One and a half years after the operation, he feels just as safe and free as he used to: "Most of the time, I forget that I ever had problems with my hip."
Surgical Procedure Manager: digitally controlled workflow in the operating theater
Surgical Procedure Manager (SPM) is a digitally controlled workflow that helps surgeons and the theater team to attain optimum medical standards. With this platform, medical procedures can be developed, digitized and implemented.

Every step taken during the surgery is illustrated and documented on a chronological basis. This guided working procedure ensures that human errors are avoided, and guarantees the highest quality standards. Another benefit: new medical specialists joining the team can turn to the SPM for information and guidance, so it is easier for them to settle into their work routine.

Recorded data makes it possible to measure the quality of treatment – allowing continuous optimization that shortens the processes.

The result: surgical interventions cost less and at the same time, they are safer – both for the patients and the hospital.