To be taken seriously: Examples of quality criteria for medical practices from the patient’s point of view

Facts and Figures from the German Health Care System

What it’s all about

Patients‘ perceptions of medical practices and their services have changed considerably in recent years. In this context, the criteria by which quality is assessed have also changed considerably or have been supplemented by new ones. One such criterion from the „Top 10“ is to be taken seriously by the treating doctors.

It’s all about adherence

A doctor takes a patient seriously when

• he listens to him attentively,
• lets him talk,
• has a respectful dialogue with him at eye level,
• shows interest and understanding,
• advises instead of ordering,
• offers alternatives, and
• decides on a therapeutic procedure together with the patient.

In short: if he cares for the patient in an adherent manner. But GPs and specialists are still a long way from this.

Doctors operate in outlying areas

Up to now, the answer to the question of which practice management principle can achieve the greatest medical and economic success at the same time has been situated between two cornerstones: on the one hand, there is unconditional and comprehensive patient orientation, which leads to a high level of patient satisfaction and also to excellent treatment successes, but is only financially viable for practice owners to a limited extent. The opposite pole to this principle is the productivity-optimised medical practice, whose medical successes and patient loyalty are lost in the factory character (keyword „assembly line operation“). The associated, clearly limited patient satisfaction is accepted by some practice owners on the grounds of economic success. But there is also – as practice management comparisons show – an „intermediate solution“ that combines therapeutic and economic optimisation.

The adherence approach

The concept is called „adherence-centred practice management (AZP)“. It is based on empowering patients to take an active, self-responsible approach to their illness. This is done in close partnership with the treating doctor, involving all cooperation partners. The approach offers AZP practices a whole range of advantages compared to non-AZP practices:

• The adherence approach leads to significantly better therapy results. The patients served are therefore more satisfied than in other practice management models, and their turnover rate is extremely low.
• Fewer consultation contacts are needed per patient. Although the initial care and information effort increases, the frequency and intensity of follow-up contacts decrease. This creates noticeable room for manoeuvre for the acquisition and care of new patients or IGeL management.
• The first two points mentioned result in a higher willingness of patients to recommend the practice, which sustainably promotes the practice image and ensures a continuous increase in new patients. This is also supported by a better online reputation in doctor rating portals and higher awareness in the catchment area.
• Staff are more engaged due to motivation from satisfied patients, so overall productivity increases.
• These advantages are in turn reflected in a significantly better profit situation, which, among other things, also enables investments in the development of the practice.
• Just under 15% of medical practices, across all specialities, currently implement this approach. Against this background, practice owners who implement this concept obtain a unique selling point for their businesses compared to competing practices, an aspect that is primarily of essential importance in highly competitive inner-city areas.
• In addition: the adherence approach is future-proof, as it is not only in line with the trend of patient expectations, but is also followed and promoted by the health insurance funds, because the AZP is an active contribution to improving the quality of patient care, both medically and economically.

Checklist of the seven action modules for adherence-promoting patient communication

• Try to put yourself in your patients‘ shoes and point of view and imagine how you would like to be treated. By means of this simple but highly efficient role play, many of your colleagues have already found out how to „reconcile“ „good“ patient communication and organisational aspects.
• Use both verbal and non-verbal techniques to create the basic prerequisite of effective patient communication, namely a positive conversational atmosphere, and to build trust. Be a good listener and, above all, check whether the patient has also listened to you and understood everything. Simply nodding your head is a bad indicator for this. Conduct the conversation with questions in order to not only extract information for the treatment from the answers, but also to determine the degree of understanding on the part of your counterpart.
• Ensure the respect of your patients by respecting your patients yourself. Therefore, do not simply dismiss patients‘ opinions and do not immediately block their arguments. This behaviour promotes rejection and also damages your sovereignty. Instead, try to reach a common basis for discussion with facts and simple examples. Speak calmly and in a relaxed manner; in the same way, show the patient the „limits of what is possible“, e.g. in the case of special prescription requests.
• Keep a „close distance“, i.e. the right body distance from your counterpart, both in terms of room furnishings and sitting position. The control is simple: observe your patient’s reactions. Does the patient lean back? Then there is too much closeness. Does he move in your direction? Then he wants to be closer and feels that the distance is too great.
• Do not give instructions, but always seek the patient’s cooperation and ask him directly for it. Make it clear that only a joint, coordinated approach will lead to success. Always emphasise the patient’s responsibility for himself and make your role as a counsellor clear.
• Be sensitive to the individuality of your patients and do not try to use standard forms of communication for all your interlocutors. Make it clear to the reticent patient that he can only be helped optimally if he provides you with all the necessary information. Ask the talkative patient in a friendly but direct way to get to the point.
• Fix therapy goals and treatment strategies. This will not only give you a point of reference, but will also give the patient a perspective on what success is being aimed for with the treatment concept chosen for him/her. Define the possible goals together with the patient. The patient’s wishes, which are usually identical with the doctor’s goals (relief from or freedom from symptoms), are taken into account. This not only strengthens the relationship of trust between doctor and patient, but also improves cooperation. In addition, you create more „room for criticism“ if the patient neglects therapeutic measures. With regard to the determination of the treatment strategy, the preparation of a short written plan as well as the fixing of control appointments, if necessary supplemented by a patient diary, are suitable as an accompaniment to the conversation.

Information on the data basis

The information provided in this article is based on the results of the validated and representative practice management comparison conducted by our institute. While such studies normally serve to classify the economic situation of medical practices, a management comparison offers the opportunity to compare the type, intensity and effects of practice management with the representative conditions of the associated specialist group as well as the best practice standard, i.e. those regulations, instruments and behaviours that guarantee smoothly functioning practice activities.

This identifies strengths, weaknesses, threats and opportunities in the daily work. On average, a practice management comparison provides practice owners with 40 previously unused approaches for optimising practice management.