Unused opportunities of practice management: KPI analysis shows expandable planning activities among general practitioners and specialists

What it’s all about

Practice management comparisons show that in German medical practices – across all speciality groups – on average only 53% of the regulations and instruments necessary for smoothly functioning practice management are used. The resulting patient satisfaction meets only 61% of the requirements and wishes. A deficient area of action in practice management with unused potential is planning. If it is activated, productivity, quality of work, patient loyalty and acquisition as well as the success of the practice will improve in the long term.

The Planning Management Score (PMS)

With the help of planning, doctors coordinate, steer and control the work of their practice enterprises. The following table shows the key performance indicator „Planning Management Score (PMS)“ for some specialities as an example, which results from the comparison of the requirements for professional practice planning, the best practice standard and the real conditions in the practices:

Fachgruppe PMS
General practitioners 23%
Ophthalmologists 46%
Gynaecologists 37%
Internists 42%
Orthopaedists 34%

Table 1: The Planning Management Score (PMS) of selected specialities

Depending on the extent of the activities, the score classifies planning as

  • complete
  • related to individual areas
  • superficial and
  • insufficient.

Considered across all German practices, the score indicates the planning activities of the average practice as superficial.

There is room for improvement in the following areas:

Practice goals

Goals are anticipated ideas that practice owners develop about the outcome of their practice activities.

They answer the question „What do I want to achieve with my practice work?“ and must be defined for each area of practice management, e.g. in the form of work objectives for female staff, taking into account the respective practice perspective (maintain, grow, reduce).

Goal setting

In order for practice goals to help coordinate, direct and control work, the goal definitions need a very specific form:

  • They must be specified in concrete terms for one or more reference objects. For example, it is not enough to formulate a goal like „The practice should run better“. Although a goal direction is given („run better“), the reference object („the practice“) is much too general for measures to be derived to achieve the goal.
  • Clear measures are needed with the help of which the intended results can be verified. Value parameters are suitable for this purpose (e.g. turnover, number of visits, number of patients per hour, etc.), but also qualitative parameters such as the degree of patient satisfaction, awareness, image or patients‘ attitudes towards the practice.
  • Targets require realism. If they are set too high, they will be rejected by the staff. If they are too low, they will not be taken seriously.
  • Furthermore, the definition of a goal needs a description of the intended change from the current situation and the time needed to achieve it. If this target horizon is long-term (one year or more), we speak of strategic general objectives. Due to their time horizon, these are kept general and serve as orientation aids for the general degree of goal achievement. The general objectives are composed of further operational-tactical sub-objectives that are designed for the medium to short term. With these, the sub-steps for achieving the strategic goals are defined. At the same time, they serve as a control instrument for the success of the short-term practical work.
  • It is indispensable to name a person responsible for achieving the goals. This applies less to the general goals than to the partial goals that are „passed on“ to the staff in the course of delegating tasks.
  • However, goals are not fixed values forever. They have to be reviewed regularly and adapted to internal and external changes. In some cases it is sufficient to modify one or the other sub-goal, in other cases it may also be necessary to change an entire global goal and all sub-goals.

Practice strategy

With the help of the qualitatively oriented practice strategy, the ways and means are described with the help of which the practice goals are to be achieved. The strategy – like the goals – is not a fixed construct, but must adapt to the development of the practice and the environment. To this end, it is necessary to carry out regular checks and adapt the strategy.

Two worlds of interpretation

Interpretations of the term „strategic thinking“ vary widely among practising physicians: for some it is a coffee-ground-based poking in the fog, for others an art that only a few have mastered.

Promoting proactive action

But both interpretations inadequately describe the essence and, above all, the implementation. Strategic thinking describes a forward-looking basic attitude. Here, an attempt is made to anticipate the consequences of actions or developments in perspective by forming assumptions, condensing them into hypotheses and deriving scenarios.

The aim is not to have to passively adapt practical work to the prevailing circumstances in each case, but to be able to act actively and with foresight.

Simple questions lead to success

Strategic thinking is pragmatically oriented towards day-to-day business and seeks answers to questions such as

  • What does the unchanged continuation of identified weaknesses in practice performance mean?
  • What influence does the current online reputation have on the future success of the practice and how should it be developed?
  • Are there target groups that have received little attention so far but could become more important for the range of services?
  • Are changes in the practice environment to be expected that will influence the work?

It is also possible without a strategy, but…

…in this case, the practice owner has to forego more than a third of the practice profit.

This average result is obtained by comparing the business results of comparable practices that do or do not have a business plan.

The reasons: Practice owners who do not develop an orientation framework for their work,

  • lack an optimised service structure and depth,
  • resources are wrongly dimensioned and inadequately deployed,
  • monitoring and controlling of input and output is not possible,
  • Success factors are therefore not identifiable, deficits cannot be consistently eliminated.

Less stress

The feeling of work pressure and stress is disproportionately higher among non-planners than among their colleagues who work with the system; team cohesion, work motivation and productivity of medical assistants are also better developed. And last but not least, a significantly larger proportion of patient requirements are also fulfilled in the long term.

Strategy Help SWOT

An instrument that is easy to use to identify the issues relevant to the strategy development of a practice, but which has so far only been used by fewer doctors, is the SWOT analysis:

  • „S“ stands for „Strengths“,
  • W“ for „Weaknesses“. In addition, there is an extension to include a perspective assessment of the opportunities of a company.
  • O“ stands for „Opportunities“ and its potential threats.
  • „T“ stands for „Threats“.

The information about strengths and weaknesses is related to the present and to all things that can be changed by a practice team, the assumptions about opportunities and threats are directed to the future and to those points that are beyond direct influence.

The SWOT analysis is so popular because it is not only uncomplicated to apply due to the form of a write-down procedure – one simply notes down the aspects that apply to one’s own practice, but above all because it makes the person who applies it to his practice enterprise think.

The aim of the SWOT analysis is to look at the practice work in its entirety and from a distance.

The analysis is particularly meaningful if the medical professionals are also asked to list SWOT aspects in order to arrive at an overall view.

Danger of assembly line operation

However, this only applies if the operational implementation of the strategy leaves enough room for individual patient orientation, because in some cases the intensity of planning is developed to such an extent that it displaces patient orientation as a guiding principle. Such practices still work much more profitably than those without a strategy, but they have a very high patient turnover, which has a significant influence on productivity due to its incalculability.


The positioning of your practice is the identity that doctors use to distinguish themselves from other practices in the eyes of their patients.

It consists of

  • tangible elements – e.g. the type of services offered or the design of the practice premises – and
  • immaterial elements, e.g. the friendliness of your staff or the intensity of your discussions with patients.

Target groups

Target groups are the patient groups to be addressed with your range of services.

They can be defined medically, e.g. according to clinical pictures, but also demographically (pensioners, young patients) or according to other criteria (willingness to pay for themselves, interest in natural therapies, etc.). The more precisely the target groups are defined, the better the practice strategy can be geared to them.

Unlocking Potentials

General practitioners and specialists who would like to examine not only the planning but also the other action areas of their practice management can use the Practice Management Comparison© for this purpose. The validated examination, which can be carried out without the need for an on-site consultant, requires only thirty minutes of medical working time and identifies an average of forty suggestions for improving practice work.