Mastering the medical mindshift: The problem child of organisational quality

Data, facts and instruments on the German health system

What it’s all about

The functionality of the practice organisation decisively determines the possibilities of individual patient care, the economic success of the practice and the working conditions of the entire practice team. However, the results of patient surveys and the assessments in doctor rating portals show time and again that there are organisational deficits in medical practices on a broad level.

The Best Practice Standard as a Key Performance Indicator

The organisational framework of a medical practice that is necessary for smooth operation can be described with the help of the Best Practice Standard. It consists of the design features necessary for both general practitioners and specialists in the areas of planning, patient contact, ordering system, organisational structure, procedural organisation, working environment, leadership, collaboration and self-management.

The characteristics range from parameters

  • from the entrepreneurial sphere of action, e.g. work target planning and control, to details of the ordering system (e.g. patient contact).
  • to details of the ordering system (e.g. planning and adherence to buffer times) and leadership (e.g. holding regular practice meetings, agreeing on objectives)
  • to the working style of the practice owner (e.g. delegation behaviour, way of performing tasks, etc.).

The organisational quality of the medical specialty groups in comparison

If one compares the degree of their best practice implementation (method: Practice Management Business Comparison© ) in the medical specialist groups, clear differences in organisational quality can be identified (sorting in descending best practice implementation rate):

  • Ophthalmologists / Surgical: 70.2%
  • Surgeons: 68.6%
  • Gynaecologists: 61.3%
  • Orthopaedic surgeons: 53.7%
  • Internists: 50.4%
  • ENT: 49.8%
  • Urologists: 48.1%
  • General practitioners, general internists: 47.3%
  • Dermatologists: 44.9%
  • Paediatricians: 44.1%
  • Ophthalmologists / Conservative: 42.9%
  • Neurologists / specialists in neurology: 41.2%.

In addition, the following ratios could be determined:

  • Practices in networks of physicians: 52.6%
  • Medical centers: 47.8%
  • Private doctors 63.2%.

Organisation primarily pursues the passive goal of coping, not the active one of steering

The reason for these low scores is mainly that professional organisational analyses have been carried out in only one third of German medical practices so far. In many of the remaining practices, the processes that were established when the practice was founded or taken over still exist, modified over time by a multitude of routines with which one tries to meet the changing requirements. The whole thing more or less works, but it is an approach that pursues the passive goal of coping, not the active one of controlling. Moreover, this initiates a negative spiral: Time pressure leads to a multitude of smaller and larger errors, the correction of which in turn takes additional and non-existent time.

Organisation analyses are an investment in quality of work and supply

Work analyses, which in many cases can even be carried out on one’s own, bring the practice conditions into a stable balance with the requirements. The resulting time freed up is the result of the synergistic effect of many mostly small changes. The effort required for this is an investment in calmer practice processes, more time for patients and, of course, also for administration. The connection also makes it clear that quality of care is primarily a question of organisational quality.

Scarcely noticed: the connection between organisation and competence assessment

From the patients‘ point of view, the responsibility for inadequate processes clearly lies with the teams. This attitude also has an impact on the assessment of medical competence, because for practice visitors, organisational functionality in the form of quick appointments, punctual doctor consultations and a smooth practice flow is now a decisive competence characteristic.

If one compares medical practices whose quality of care, measured as Patient Care Quality Score (PCQS, the ratio of requirements and satisfaction), is above 80% for the organisational components of practice work, with structurally similar (size, service profile, location) practices that have significantly lower values, the competence rating in the first-mentioned practices is on average 20% higher.

Comparison of businesses shows quality status

General practitioners and specialists who would like to examine their practice organisation with regard to unused reserves for improvement and in the context of the entire business management can use the Practice Management Business Comparison© for this purpose. More information (German) is available via this Link.