Data, facts and instruments on the German health system

What it’s all about

On their websites, medical staff in GP and specialist practices always present themselves as teams, but the reality in the businesses is far removed from this. This is also a problem for the digitalisation of practice management.

Professional practice activity is not realisable without teamwork

The complex work processes in medical practices can only be carried out with a high quality of care, in a patient-oriented, efficient and productive manner if the activities of all MFAs mesh like cogwheels in every situation. The implementation principle for this is collaboration in team form. Teams are characterised by

common goals,
a strong sense of „we“,
largely autonomous task completion,
mutual complementation and support, as well as
self-direction to solve problems and self-initiated measures to improve work results.

characterised. Teamwork is thus the transmitter that enables the medical competence of the doctor to be used in the best possible way for the diagnosis and therapy of the individual patient.

Even the path to digitally supported practice management requires teamwork

When developing scenarios for digitally supported practice management, it is commonly assumed that medical assistants are relieved by automation effects. However, they are also confronted with completely new tasks that increase the volume of work, make activities more complex and differentiated and also require digital medical assistants to be ready to act and react more quickly. The realisation of these requirements is only possible with functioning teamwork. But what is the starting situation for this?

Representative study of forms of cooperation in medical practices

An exploration pursued this question and determined how pronounced the team principle is currently implemented in GP and specialist practices. To answer this question, the medical assistants‘ statements on the degree of realisation of the best practice standard in their practices, i.e. the basic requirements for optimally functioning cooperation, were used. This resulted in the key performance indicator „Teamwork Quality Score“ (TQS), which classifies the cooperation as follows:

TQS > 80%: Team

This constellation indicates optimal working conditions through cooperation as a team.

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 complete 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. Moreover, 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 „duty according to the rules“ and „lone wolf behaviour“.

A sobering result: groups instead of teams

In the medical practices examined, the average Teamwork Quality Score (TQS) was only 43.7%, i.e. as a rule, groups work in GP and specialist practices instead of teams. This means that most practice staff work well below the 60% productivity threshold. Only from this indicator value upwards do practice owners benefit from the synergy and motivational effects of staff cooperation in the form that

the organisation functions better and there are fewer clerical errors and duplication of work,
doctors are hardly burdened by non-medical day-to-day business due to the operational self-control skills of their medical assistants,
there is almost no overtime,
stress levels are lower and
the patients are clearly more satisfied, mainly with regard to the doctors‘ information and communication performance, so that the recommendation rate is also higher.

Doctors rely on self-direction of the staff

The implementation intensity of the best practice standard also describes one of the central aspects of doctors‘ leadership behaviour. Practice owners are often of the opinion that when it comes to the topic of „cooperation“, it is up to the staff themselves and rely – without any activities of their own – on the self-controlling powers of the staff, which will somehow create the necessary intensity and quality of cooperation. But this mechanism only works in a few cases, because many „teams“ are very heterogeneous in terms of age, experience, length of service or personality of the members. In order to form functioning and harmonising teams out of them, leadership needs to be geared towards this.

Conclusion

At present, the team-related foundations for implementing digitally supported practice management are extremely poor. It is primarily the practice owners who are called upon to take the initiative to develop the framework for action in their businesses in a team-oriented manner. This benefits not only the transformation process, but already the doctors themselves and their staff.

Further assistance

GPs and specialists who would like to examine and develop the quality and functionality of their staff’s cooperation can use the Valetudo Check-up© „Teamwork Medical Practice“ for this purpose. The concept, which can be carried out without the need for an on-site consultant, makes it possible to carry out a professional analysis of the key factors of teamwork. Furthermore, the instrument uses open questions to determine the practice’s strengths and weaknesses as well as suggestions for improvement from the staff’s point of view.