Facts and Figures from the German Health Care System
What it’s all about
The Key Performance Indicators (KPI) for the management area show that hardly any real teams work in medical practices, only groups. Their collaboration, however, lacks essential aspects that ensure the efficiency and productivity of the work. One reason for this is the lack of practice meetings or their poor implementation.
KPI-based team management in medical practices
KPIs are parameters that are created by comparing (benchmarking) the practice management data of a practice with objective and representative measured variables.
In this way, it is possible not only to record the type and intensity of the regulations used for practice management, but also their effects.
If you want to lead your staff successfully as a team in the long term, you need knowledge – and not assumptions – about the following facts and KPIs:
- 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 employees 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 is the quality of cooperation in the sense of implementing „real“ teamwork developed? Often the members interact only as a community, group or 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 employee’s point of view that contribute to further improving teamwork.
TQS as a central variable
If one relates the employees‘ assessments of the quality of collaboration to the best practice standard, i.e. the basic requirements for optimally functioning collaboration, an assessment of the collaboration quality of your staff can be derived from the resulting Teamwork Quality Score (TQS). The following criteria apply:
- TQS > 80%: Team
Teamwork is characterised by common goals, largely autonomous task completion, mutual complementation and support, as well as self-directed problem solving and self-initiated measures to improve work results.
- TQS > 60% to <= 80%: Community
It is a mix of the characteristics of the group and the team, but still lacks crucial aspects of cooperation to achieve a full synergy of working together, which is what makes a team productive and efficient
- TQS > 40% to <= 60%: 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. In addition, the 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.
- TQS 0 to 40% Special-purpose association
Here, work performance is characterised by „service by the book“ and „lone wolf behaviour“.
In medical practices, the current average Teamwork Quality Score (TQS) – the indicator that describes the relationship of medical assistance satisfaction with the determinants of cooperation and its requirements – is 43.7% (optimum: 100%), i.e. team harmony is only slightly pronounced.
One reason for this is the lack of or poor implementation of practice meetings.
Meetings ensure quality of work
Meetings between medical assistants and doctors are indispensable for the work in medical practices in order to be able to adequately cope with the organisational requirements and to optimise patient care in the long term. Their effect depends – as with all meetings – on the quality of the meetings.
Empty Container vs. Intensive Meeting
If one examines meetings in medical practices with the Meet & Rate system, an easy-to-use evaluation procedure with the help of which meeting participants can document and quantify their impressions of the meetings, an interesting picture emerges:
the Meeting Quality Score (MQS, the ratio of satisfaction with a meeting in relation to expectations, 100% = optimum) is on average 38.6% from the perspective of the medical assistants, but 78.4% on average from the perspective of the practice owners.
According to the Meet & Rate classification
- greater than 80%: Productivity booster,
- 60% to 80%: Intensive meetings,
- 40% to 60%: Empty containers,
- 0% to 40%: Disaster events
the assessments of disaster events and intensive meetings thus contrast with each other.
The reasons leading to the assessment of the medical assistants are largely identical across all practices:
- too little consideration of the topics considered important by the assistants,
- little opportunity to contribute to the organisation and content of the meetings,
- little commitment to what is discussed,
- more medical monologues than team dialogues,
- dominance of negatively coloured topics of the doctors (mistakes, annoyances, etc.)
- hardly any consideration of suggestions for change and improvement.
The practice owners, however, do not see these problems: for them, meetings are successful when they have dealt with their points and the meetings are ended as quickly as possible afterwards so as to lose as little working time as possible.
Planning and conducting productive team meetings
The practice meeting is both an organisational and a management tool because it enables,
- to discuss in a timely and concrete manner all points that are important for the smooth running of the practice,
- to jointly develop solutions to problems, if necessary, which are supported by all and are binding for all,
- to use the knowledge and skills of the staff in a targeted way,
- to increase job satisfaction and motivation by involving the staff and to optimise the working atmosphere.
In addition, the workload of the practice owner is reduced, as he has to make significantly fewer decisions „by virtue of his office“.
The building blocks of professional practice meetings
With the help of the following regulations, the advantages mentioned can be used in a targeted manner:
A fixed schedule, e.g. every four to six weeks, is crucial for success. If a meeting only takes place when it can no longer be postponed, problems usually dominate the meeting content. Such negative omens, however, have an immediate effect on the motivation of the participants and on the basic mood of the meeting. This effect can only be avoided through fixed institutionalisation. In addition, it is ensured that the practice meeting has a close temporal relation to the practice work. It is best to schedule a meeting for half a year in advance, supplemented by the determination of a responsible meeting leader for each meeting, who prepares, leads and minutes the meetings (rotation procedure).
Integration of the entire practice team
It is essential that everyone – doctor/doctors and staff – is present. Exclusions, e.g. of trainees, lead to a „two-class team“ and also have a negative influence on the cooperation climate. Only if everyone participates can the goals of meetings – optimisation of the flow of information and active participation of everyone in shaping the practice processes – be achieved.
Create an agenda
A lot of time is wasted unproductively in practice meetings if the participants only start thinking about possible topics for discussion at the beginning of the meeting. It is therefore better if the person in charge of the meeting collects the content deemed important from all participants one week before the meeting or if a list is laid out in which the issues to be addressed are entered.
This automatically results in an agenda that structures the content of the meeting. It is helpful if the participants also assign a priority to each topic (e.g.: A = urgent, B = important, C = has time) so that if there is a lack of time, less urgent items can be postponed to future meetings.
This agenda is then handed out to all participants as a programme or transferred to a flipchart poster on which the respective completed items can be ticked off.
A fixed time frame, e.g. a maximum of 1.5 hours, makes it possible to focus concentration on working through the agenda and also to avoid possible discussions that get out of hand. In addition, it enables all participants to plan the meeting time within their respective working framework. The meeting leader is responsible for consistent adherence to the schedule.
Creating a discussion atmosphere
To create an open atmosphere, the meeting can take place in the waiting room (circle seating), for example. There should also be some drinks available. Under no circumstances is it advisable to combine the practice meeting with the lunch break, as concentration is then significantly reduced.
Ensure that there is no disturbance
The meeting must not be disturbed by telephone calls (practice and mobile), and individual participants should be prevented from leaving the meeting temporarily to complete tasks.
Discussion in the team
All staff members, including shy ones, must be included in the discussion; if necessary, they can be asked in a friendly way to express their opinion.
Address problems and mistakes appropriately.
- Unpleasant points should always be introduced neutrally and openly; direct accusations and arguments should be avoided.
- Tensions can be reduced through humour and friendliness.
- Criticism should always be factual, not emotional, and balanced with praise and recognition.
- Do not „hunt“ for the guilty party, but look for the cause (motto: „Every mistake is an opportunity to become even better.“).
Protocol of results
Team meetings lead to improvements in everyday work if each agenda item is concluded with a concrete result, i.e. if it is documented for each topic who is to do what by when with which result. The meeting leader summarises all results in writing in minutes, a copy of which is given to each participant and which is binding on everyone. At the beginning of the next follow-up meeting, a check is then made on the execution.
GPs and specialists who would like to examine their team management, 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.