Data, facts and instruments on the German health system
What it’s all about
Excessive waiting times, uncoordinated procedures, poor telephone accessibility, hectic consultations with doctors – deficits in practice organisation are the number one point of criticism when patients are asked about their satisfaction with medical practices. are asked. Doctors and staff are also negatively affected. About 2/3 of the problems identified in practice analyses come from the area of organisational design. Doctors and their staff also suffer from this stress, anger and demotivation are the consequences of unresolved organisational deficits.
Poor practice organisation and the economic consequences
Poor practice organisation also has serious economic consequences. On average, for example, labour productivity in general practices is 28% lower than it could be with optimised organisation. This means that with an assumed monthly salary of the staff of € 5,000, an amount of € 1,400 is used for unproductive work. Added up over the year, this results in a „bad investment“ of € 16,800. Added to this are the lost profits for the patients who could not be treated due to the poorly adjusted practice organisation as well as for patients who – deterred by the inadequate organisation – change the practice. The costs for guaranteeing the operation of the practice (electricity, water, rent) during the unproductive phases must also be added.
Operation optimisation through organisational improvements
An optimisation of the practice organisation thus supports essential areas of action of the practice management: it
- enables full utilisation of the labour productivity that can be realised on the basis of practice size, number of staff, consultation hours and services offered,
- helps to increase the number of patients who can be treated, to reduce costs and to increase the economic result,
- creates scope for offers that require explanation, such as IGeL,
- supports the best possible use of rooms and equipment,
- reduces stress for practice owners and staff and creates a noticeably more positive emotional atmosphere in the practice for patients,
- promotes staff motivation through more calculable working hours,
- is the best marketing instrument to distinguish the practice from other practices, to retain regular patients and to attract new patients.
Thus, an optimally functioning organisation offers the prerequisite for the best possible medical care, in which every patient can receive the treatment he or she needs on an economically solid foundation.
Hindrances to organisational improvements: The main problem lies in management
But with such a multitude of advantages, why do so few doctors bother to improve the organisational conditions in their practices? Three reasons are responsible for this, two of which lie in the area of management responsibility of the practice owners:
(1) Different perceptions
In most medical practices, there is a „two-worlds phenomenon“: doctor/physicians and staff operate in completely different areas that are connected to each other by interfaces. In their „inner world“ of the consultation and treatment rooms, most doctors do not notice the problems of the „outer world of the practice“ at the reception, in the waiting room or in the corridors. As long as no problems are brought to their attention (for which there are often no communication routines), they assume that the practice world as a whole is fine.
(2) Low level of staff involvement
The practice staff experience organisational problems directly. They could therefore contribute significantly to improving the organisational conditions of their practice. But: their opinion is not asked. Only in very few medical practices – according to the complaint of many medical assistants – are organisational improvements regularly discussed in the team. Otherwise, the bosses play it cool and leave the practice unchanged.
(3) Refraining from too expensive help
If practice owners recognise the need for and opportunities of organisational change, they face the problem that organisational analyses – if they are bought in externally – are expensive and time-consuming. The prices for professional implementation start at about € 1,500, and the price scale is open upwards. However, most people shy away from this.
In three steps to sustainable organisational optimisation
The first step is to talk to the practice team. Experience has shown that every member of staff knows areas, situations and work where procedures are not working properly and perhaps already knows a solution. About 70% of all organisational problems could be solved by implementing the knowledge of the medical assistants. It is best to dedicate a complete team meeting to organisational improvement, in which all approaches are collected and summarised in a realignment plan. Thereafter, the discussion of the organisation should be an integral part of every practice meeting in order to ensure continuous development.
If, contrary to expectations, the practice is still not running smoothly after the measures described above, it is a good idea to carry out a simple work analysis. With its help, the organisational structure and workflow, the ordering system and the doctors‘ time management can be checked and synchronised with the patient structure. The implementation is done with the help of a patient run sheet on which all work is documented for the duration of a week according to type, duration and person responsible/performer. By combining all the data, a multi-dimensional image of the practice’s work processes is created. This shows, among other things, what happens in the practice during patient consultations, to what extent and with what consequences unannounced patients influence the processes, which tasks the staff carry out with what workload (basis for personnel planning), whether the work processes are optimally coordinated or how the patients‘ length of stay is composed. It is advisable to carry out such an examination once a year in order to increase the efficiency of the work flow in this way, because experience shows that behaviour and regulations creep in again and again that inhibit the work flow without it being registered by those involved.
With regard to the ordering system, practices with a strict appointment system have clear advantages compared to practices with other organisational principles (e.g. semi-open consultation hours):
- patients are significantly more satisfied,
- the stress load for the doctor and staff is less,
- administrative work can be done promptly
- the number of overtime hours can be significantly reduced,
- staff productivity is higher,
- the number of patients treated per day is higher due to precise planning.
Total optimisation of practice management
General practitioners and specialists who would like to examine their organisation as well as their personnel management, but also all other areas of practice work, can use the Practice Management Comparison© for this purpose. The validated examination, which can be carried out without the need for an on-site consultant, requires only thirty minutes of medical working time and identifies an average of forty suggestions for improving practice work. All the information is available in a free briefing paper.