Managing the medical mindshift: „Trust and track“ instead of „command and control“

Data, facts and instruments on the German health system

What it’s all about

The employees are the most important „production factor“ of the medical practice as a service provider. They not only play a central role in the medical care of patients, but are also responsible for the atmosphere of care. A decisive part of the quality and efficiency of a medical practice depends on the know-how, the skills and above all the commitment of the staff. However, the management mentality that has prevailed in medical practices up to now does not do justice to this importance.

What leadership achieves

In addition to the training of knowledge and skills, it is therefore important – in order to achieve the practice’s goals – to give the staff a framework for action. This should be structured in such a way that

  • on the one hand, organises and systematises the work of the staff,
  • but at the same time leaves them enough freedom to carry out their work independently.

Order, systematisation and the creation of free space are created with the help of leadership. Leadership is the conscious control of staff behaviour in order to achieve practical goals easier, faster and better.

Internal and external effects of personnel management

Leadership consists of a mixture of guidelines and regulations on the one hand and motivation and encouragement on the other. The result is staff satisfaction. It has two effects for a practice:

  • The internal effect is that satisfied staff identify with their practice to a high degree and thus show a very high willingness to perform. This is expressed not only in commitment, but also in the quality of work. Diligence, reliability, but also cost-consciousness and thinking along with others are effects that can be noted here. Through the mechanism described above, employee satisfaction has a direct effect on labour productivity.
  • The external effect is a direct positive impact on patient satisfaction. If the working atmosphere is right because the employees feel good, this is directly transferred to the patients. This also has a lasting effect on the image of the practice and achieves a clear profile.Leadership is closely related to organisation. Both areas are mutually dependent and lead – depending on how they are organised – to positive or negative effects.

Leadership styles

The way in which this mixture of guidelines and regulations on the one hand and motivation and encouragement on the other is conveyed to the employees is the leadership style. It reflects your personal attitude towards your employees.

Command & Control

This management principle is the standard in German medical practices: if the guidelines and regulations are communicated in the form of instructions and if motivation, encouragement and freedom of action are of little importance, one speaks of a „command & control“ management style. The main characteristics of practices managed in this way are low job satisfaction among staff and a high degree of inflexibility. This management style is based on guidelines and the control of their compliance. It „rewards“ independence and sanctions autonomy. The result is that staff literally „work to rule“, i.e. they wait for work instructions and ask for the instructions to be applied in all situations that are not regulated. For a practice owner who uses the command & control principle, this also results in a high workload, since everything depends on him and nothing happens that he has not initiated himself.

Trust & Track

The opposite of the command & control style of leadership is trust & track-based staff leadership, which is preferred above all by doctors of the younger generation. Here, apart from a few essentially important guidelines, all regulations are developed by the team itself and – jointly decided – implemented. The practice owner only sporadically asks whether things have been done and whether he can provide support. Staff who work within such a framework show a high level of commitment. Practice owners who manage their practices in this way report that they are relieved of many small tasks in their day-to-day work.

Teamwork as a goal of leadership

One of the goals of Trust & Track staff leadership is to create team-based working. However, due to the dominance of the command & control approach, staff in GP and specialist practices predominantly work together in groups. This collaboration 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, collaboration is often characterised by unresolved conflicts. Although every medical assistant strives to do her job well, there is no sustained commitment to continuous improvement.

Necessary Team Insights

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

  • 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 (see above) 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 employee’s point of view that contribute to further improving teamwork?

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.