Data, facts and instruments on the German health system
What it’s about
Conflicts between medical professionals have fundamentally destructive effects on the quality of care and work of GP and specialist practices and are detrimental to the overall success of the practice, especially if they remain unresolved for a longer period of time. The entrepreneurial owners of high-performance practices (HPPs) therefore see conflict prevention and curation as their personal task and take care of the issue professionally, both preventively and curatively. With them, Eris, the goddess of conflict in Greek mythology, has little chance of success.
Productivity and profit „killer“ No. 1 in medical practices: Unresolved conflicts
Hidden or openly acted out: conflicts in practice teams – if they are not avoided or resolved – have serious consequences for the work of the practice if they persist, because
- work productivity decreases
- the quality of work decreases,
- motivation, staff satisfaction and team spirit dwindle,
- the working atmosphere deteriorates and
- patient satisfaction is jeopardised.
The result: with the same structure, medical practices with unresolved conflicts have a significantly worse economic result than other practice operations.
Two anti-conflict strategies
Conflicts are situations in which at least two different views, ideas or interests confront each other that cannot be harmonised through their own efforts. Entrepreneurially oriented doctors are aware in this context that the practice owners themselves are responsible for most conflicts, as the staff lack a binding framework for action, transparency and orientation. To counteract this, corresponding conflict management concepts can be found in HPPs. Regardless of their respective design, they consist of two areas of action:
- conflict prevention in the sense of anticipatory avoidance of conflicts, and
- conflict resolution.
Basically, the analysis of conflicts in medical practices shows: about two thirds can be avoided through prevention and one third requires resolution.
From the results obtained in practice analyses and practice management company comparisons, six causes of conflict can be identified, which HPP owners counteract preventively as follows:
This type of conflict is avoidable through staff selection that focuses on social competence. Likewise, a staff appraisal system helps to create a largely conflict-free atmosphere of cooperation. Regular management discussions and team meetings round off the prevention tools in this area.
The practice owners counteract them by setting comprehensive and detailed overall practice goals and derived partial work goals for the staff. With the help of written agreements and their target/actual comparison, target orientation is established as a working principle and possible target conflicts are avoided.
Missing task definitions
The third reason for conflicts is the lack of task definitions, which leads to overlapping areas of responsibility, ambiguous competencies and over- or under-demanding of staff. Detailed job descriptions and clear task allocation and coordination counteract these negative consequences.
Inadequately organised processes
Strict allocation of and adherence to deadlines, planning of consultation times, possibly differentiated according to different types of deadlines, and the formation of time blocks for similar types of work optimise the flow of work and thus eliminate a major source of conflict.
With the help of leadership, it can be ensured that the staff members achieve the goals for their work areas and thus the overall goal of the practice. However, it is precisely in the area of leadership that there is a very high potential for conflict if the instruments are used inadequately, i.e. too intensively, incorrectly or not at all. HPP doctors therefore rely on principles of leadership and cooperation and on a leadership style characterised by intensive staff communication, far-reaching delegation and well-dosed motivational measures, so that they are on the „safe side“ in terms of conflict prevention.
Inadequate staff qualification
Last but not least, the lack of staff skills is often the cause of conflicts; the „antidote“ is comprehensive staff development. The objective is to professionalise the staff through appropriate measures in accordance with the strategic objectives of the practice so that they can optimally fulfil their current and future tasks. If this is guaranteed, there can be no over- or under-challenging with its conflict-promoting consequences. Some of the measures consist of participation in external seminars, but more frequent are internal practice trainings.
If conflicts cannot be avoided and the conflict partners are not able to resolve the situation themselves, HPP doctors know that they must act by ensuring that the situation is resolved as quickly as possible. Three questions help them to prepare the solutions:
- Who is involved in the conflict?
- What is the conflict about?
- What is the conflict status (duration and intensity of the conflict)?
The clarification of these questions leads to a conflict resolution discussion with the parties involved. If it is not possible to resolve the dispute even with the help of several talks, the practice owners are left with three options:
- firstly, the conflicting parties can be separated in such a way that their points of contact are minimised, e.g. by transferring different areas of responsibility,
- Secondly, a third person can be called in, e.g. a colleague who has no connection to the practice and the conflicting parties, and who then takes on the role of moderator or mediator,
- thirdly, depending on the intensity of the conflict and the reason for it, one can separate from the person causing the conflict.
The difference between conflict management in high-performance practices and others is first and foremost the awareness that conflicts within the staff do concern the practice owner(s) and that they can be reduced to a minimum through a series of easily established measures.
A test gives doctors information: How far are their operations on the way to becoming a high-performance medical practice?
Developing a practice into a high-performance practice is easier than many GPs and specialists think. A test shows practice owners where they stand and what they may still need to do: the Valetudo Check-up© „Practice Management“ is a benchmarking analysis that can be implemented without the need for an on-site consultant to examine and optimise the functionality of practice management. It enables practice owners – irrespective of the size of the practice and the speciality – to determine the status of the development of their practices into HPPs and identifies any steps and measures that may still be necessary.