Mindshifting: why GPs and specialists need to focus more on the quality of practice organisation

Data, facts and instruments on the German health system

What it’s all about

Patients judge poor organisation as incompetence of the practice team, because well-functioning processes are expected to the same extent as good medicine. But in reality, the expectation is disappointed.

How doctors deal with organisation

Probably the most important assessment variable of organisational quality for patients is the length of waiting time. The decisive factor for satisfaction is not the absolute length of the wait, but the relationship to the length and quality of the doctor’s contact. However, only very few practice owners take this law into account. If one compares the length of the waiting time and the duration of the doctor-patient conversation, a typology for practice owners can be developed that excellently describes the reality:

The optimisers (approx. 5% of doctors).


  • have systematically developed and structured their processes,
  • are in a position to meet the different time requirements of patients and at the same time
  • achieve their practice goals at the same time.

They keep their organisational systems in shape through continuous analysis and control.

The Indifferent-Planless (approx. 40%).

They do not care about organisational efficiency or patient needs, but react actionistically to the daily scheduling demands of practice work. Even their personal time management does not follow rules, but spontaneous input, e.g. in the form of lengthy private conversations with patients.

The piecework therapists (approx. 25%)

These are optimisers without patient orientation. They try to do what is medically necessary in as short a time as possible. Patients hardly receive any information from them.

The disorganised caretakers (approx. 30%)

Doctors in this group again focus on the patients, but neglect the organisation of the practice. Those who go to them have to put up with excessively long waiting times, but in return receive maximum attention, care and help.

Teams are also stressed by faulty organisation

Frustration about a lack of free time, stress, burn-out: for a large number of doctors, these terms – as studies show – are not empty phrases but agonising reality. At the same time, a fatal negative spiral develops from these phenomena, because in the long run, staff and patients also get caught up in the downward pull of doctors‘ low moods. When researching the causes, external factors dominate. However, practice analyses show that about 2/3 of doctors‘ stress and burn-out problems are caused internally by incorrect practice organisation.

With best practices hardly any stress

The less the best practice design factors that ensure a smoothly functioning practice are implemented, the greater the sense of stress among practice owners:

  • many practice owners do not plan their activities, work without priorities and do their work on an as-needed basis; this systemlessness creates chaos and dissatisfaction,
  • only a few doctors have ever carried out a work analysis and consistently eliminated all „time wasters“, most practice owners allow themselves to be passively steered through the day-to-day running of the practice instead of becoming active themselves.
  • Often the working hours of the doctor and the scheduled consultation times differ, i.e. the doctors only come after the official start of consultation hours, which means that every working day already starts with delays that cannot be made up for,
  • there are rarely clear agreements with the staff in which cases a consultation may be disturbed; for the most part, the definition of the importance of an occasion is left to the staff. This results in a multitude of „minor“ annoyances, since only in very few cases does the opinion of the staff coincide with that of the doctors,
  • quite a few doctors are „counter tourists“: they come to the reception desk an average of 56 times in the course of a day to do administrative work. With an average time spent there of about one minute, they lose almost an hour of working time for tasks that mostly clearly belong to the staff’s area of responsibility,
  • others are involved daily in searching for documents or files, answering the ringing telephone or solving other problems of the staff („How much postage should we put on this letter?“),
  • the consistent delegation of work is a fundamental problem in medical practices anyway: only a small percentage of doctors take a „clear line“ here and consistently relieve themselves of all tasks that do not fall within their scope of work. Most, however, fear that without their constant intervention and presence, nothing will function properly. The result: the female staff members are frustrated because of the „constant control“ and the doctors are overworked.

100 Best practice tips for even better practice organisation

Irrespective of whether practice owners and their teams are concerned about

  • acutely to reduce work pressure
  • to increase efficiency and patient satisfaction in the medium term, or
  • to be able to react flexibly to changes in the long term and to ensure the success of the practice,

The organisation of the practice is always a key factor in achieving these goals. In addition, the degree of its functionality for patients has become an important parameter for assessing the performance quality of medical practices.

The guidebook „100 Best Practice Tips for an Even Better Practice Organisation“ (German) supports general practitioners and specialists as well as their teams with practical, tried and tested tips for a smoothly functioning organisation. For the most part, they come from practising doctors who have developed their businesses in a best-practice-oriented manner and are supplemented by basic, organisation-promoting findings from practice management business comparisons. All tips give you clues as to how you can save time and costs with good organisation, increase productivity, achieve a better quality of work (keyword: work-life balance) and be more successful overall.

To the guide „100 Best Practice Tips for an even better practice organisation“ (German)…