Data, facts and instruments on the German health system

What it is all about

As practice management comparisons show time and again, general practitioners and specialists have a huge potential for unused improvement that could make their daily work easier, more efficient, more productive and even more patient-oriented. However, due to a wrong perspective, they are not recognised.

An example

The owner of an ophthalmology practice has been conducting regular patient surveys for a long time. The satisfaction results determined with the help of a school grade scaling were acceptable from his point of view and, except for a few aspects, gave no reason for interventions or changes.

Within the framework of a recently conducted practice management comparison, the key performance indicator (KPI) „Patient Care Quality Score (PCQS)“ was then determined during the patient survey. The validated KPI measures the quality of care by relating the patient satisfaction score, both overall and for each service feature surveyed, to the best practice standard, the practice visitors‘ requirements. This relational information is important because not all performance characteristics have the same meaning and importance. Only a combined view makes it possible to form priorities for action by distinguishing between core and marginal strengths and weaknesses.

Wrong methods also obscure the view

The superiority of the two-dimensional survey in terms of objectivity and realism compared to the school grading system is shown by the result of a comparison: if school grades and requirement/satisfaction values are collected in parallel, the grade „3“, for example, is associated with PCQS values between 31.4% and 54.7%. The range makes it clear how little precise the school grade value is.

The distribution of the sub-KPIs surprised and alarmed the practice owner very much, because it made clear that there was a considerable need for action. The overall value even fell into the range of „borderline quality of care“ PCQS > 40% to <= 60%). In this constellation, the patients‘ dissatisfaction relates to a large number of different aspects. If no changes are made, a negative spiral develops that can lead to a further decline in PCQS.

Insights through categorisation

Furthermore, the PCQS system has three additional outcome corridors:

PCQS > 80%: Best Practice Quality of Care

This is the ideal state to strive for, but only a few practices achieve it.

PCQS > 60% to <= 80%: Quality of care largely in line with requirements

Patient criticism is kept within narrow limits. In most cases, it can be countered by a few corrective measures.

PCQS > 40% to <= 60%: Borderline quality of care,

In this constellation, patient dissatisfaction relates to a large number of different aspects. If no changes are made, a negative spiral develops that can lead to a further decline in the PCQS.

PCQS 0% to <= 40%: Inadequate quality of care

From the patient’s point of view, the care provided by these medical practices is out of the question and would have to be developed from scratch.

Potential activation through change of perspective

Due to their high level of involvement, practice owners and medical assistants are often blind to their work and tend to regard negative feedback as an isolated case. Therefore, they are only able to comprehensively identify the need for change with the help of a structured change of perspective. Such a change of perspective consists of three areas of action:

adopting a higher level of observation („bird’s eye view“)
use objective and validated metrics
examine the system holistically, i.e. do not only analyse sub-areas, but all areas of practice management and their interactions.

The instrument from practice for practice

The instrument developed for the practice to achieve a change of perspective with regard to business management is to use the Practice Management Comparison©. The validated survey, which can be carried out without the need for an on-site consultant, requires only thirty minutes of a doctor’s working time and identifies an average of forty suggestions for improving practice work.