Teamwork in the medical practice: The stumbling blocks

Facts and Figures from the German Health Care System

What it’s all about

Teamwork offers practice owners, staff and patients a multitude of advantages. However, only very few GP and specialist practices have „real“ teams. This article describes which problems of everyday practice lead to this from the perspective of medical assistants and which implications can be derived for practice management.

Team Insights

If you want to lead your staff successfully as a team in the long term, you need knowledge – and not assumptions – about the following issues:

Team Experience Portfolio (TEP)

What is the current self-image of the team members, broken down into a description of strengths, weaknesses, threats and opportunities as a result of previous cooperation experiences?

Overall Team Satisfaction (OTS)

How do the team members generally rate their framework of action in comparison with their requirements?

Team Harmony Balance (THB)

How pronounced is the degree of agreement among team members in evaluating their working framework? The information can also be used as an

This information can also be used as an indicator of the potential for conflict within the team.

Teamwork Quality Score (TQS)

How far has the quality of cooperation been developed in the sense of implementing „real“ teamwork? Often the members interact only as a community, a group or an alliance of purpose.

Return on Management (ROM)

What impact do team building measures have on teamwork quality?

Team Development Options (TDO)

What ideas and suggestions exist from the staff perspective that contribute to further improving teamwork?

TQS finding: most practices work in groups, not teams

If one examines the satisfaction of medical assistants with the conditions of teamwork in their practices across all speciality groups and practice types, the average Teamwork Quality Score (TQS) is just under 45% (optimum: 100%), i.e. this important practice success factor is only insufficiently developed.

Within the framework of the KPI teamwork classification, values between a TQS of 40% and 60% characterise the cooperation form of the group. Cooperation that falls into this range is characterised by a low synergy of individual activities: people work together, but always only within the framework that is given. Individual initiative or helping out with problems are rather rare. Moreover, cooperation is often characterised by unresolved conflicts. Although every medical assistant strives to do her job well, there is no sustained commitment to continuous improvement.

What staff members specifically criticise

The „grievance box“ is a free counselling service offered by our Institute for female practice staff, which aims to help them cope better with work situations that are particularly disruptive. Within the framework of the campaign, which has been running for several years, more than 5,000 enquiries have been answered so far. Overall, three central problem areas with various subgroups can be identified from the enquiries that hinder team-building:

interaction processes between practice owners and their teams (52% of enquiries):

inadequate division and coordination of work.
lack of work objectives, unclear work assignments, lack of priorities
little opportunity to work independently
no exchange of information between practice owners and team
hardly any praise and recognition, reprimands in front of patients
No possibility to implement suggestions for improvement

Conflicts within the teams (29% of enquiries)

Exclusion of individual colleagues because of anti-team behaviour, mobbing
Disputes between newly recruited colleagues and staff who have been with the practice for many years
„Hostile camp formation“ in practices with several doctors
Problems with doctors‘ wives who work in the practice

Problems with patients (19% of enquiries)

Excessive demands, primarily when patients appear unannounced (e.g. demand for immediate treatment)
General unfriendliness towards staff (e.g. condescending behaviour)
„Abuse“ of practice staff as an „annoyance valve“ (practice fee, medication costs, restriction of health insurance benefits)

Qualitative overall evaluation

The response and above all the contents of the enquiries are evidence of a high level of suffering on the part of many female staff members, which has already led to deeper demotivation in about one third of the enquirers.

One point becomes particularly clear in the analysis of the enquiries: more than two thirds of the problems described would not exist at all if the practice owners spent more time on staff management and „team building“. With a few exceptions, all the inquirers made it clear that they basically enjoy working in their practices, but cannot cope with the framework conditions. Strengthened leadership management would therefore not only solve the problems of the staff, but at the same time, through increased job satisfaction, also significantly increase work productivity and thus the success of the practice.

The framework for action for practice owners

The following framework for action for practice owners can be derived from the information provided by the staff:

Establishment of a professional organisation in the practice (who does what, who represents whom, who has what competences, etc.).
Definition of work objectives for the staff (what performance is expected, what criteria are used to assess performance, what skills must be available, etc.).
Qualification of the staff for the tasks assigned to them, complete delegation of these tasks to the staff, control by means of spot checks.
regular individual praise and criticism talks on the work objectives and their achievement
development of information routines within the practice team (who has to pass on which information to whom, which information has which priorities)
Regular team meetings to achieve a uniform level of information within the team.
Use of motivationally effective instruments (profit-sharing, practice meals, visits to the cinema, etc.)
Avoiding team conflicts by developing common rules within the team (how do we want to deal with each other, which values guide us, etc.)
Solidarity of the practice owners with the staff towards patients (same rules of language and action).

Is your team a „real“ team?

GPs and specialists who want to make full use of the success principle of „teamwork“ for their operations must first know the teamwork status of their staff. A validated and simple way is to use the Valetudo Check-up© „Teamwork Medical Practice“, a procedure that is also very accepted because no staff member has to „come out“. The associated expertise then describes in detail which measures and instruments should be used if team status has not yet been achieved.