Digitization of outpatient medicine: Progress trap „practice management insufficiency“

Data, facts and instruments on the German health system

What it’s all about

The central goal of the digital transformation of healthcare is to increase the quality of care. But the fulfillment of this objective will fail in the outpatient sector if the practice management insufficiency that prevails here is not eliminated at the same time.

Practice management, more than just organization

The term „practice management“ refers to the totality of all regulations. Instruments, measures and behaviors,

  • which are used in the action areas of planning, organization, market research, leadership and cooperation, time and self-management, patient management, marketing and financial management of medical practices of all specialties and
  • whose interaction ensures the operation of the practice.

Practice management acts as a transmitter of the medical competence of physicians and the activities of medical assistants into the concrete care of patients.

The quality of its design determines how comprehensively the skills of the physicians and the abilities of the staff are made available to the patients in the form of comprehensive assistance.

Furthermore, it determines how quickly practice teams can react to changes of any kind, implement them and benefit from them (example: digitization).

If work structures and processes do not function or function only inadequately, this is referred to as „practice management insufficiency“ and digital solutions and tools are difficult to implement and do not provide sustainable benefits for practices.

Determination of the digital predisposition

Against this background, the Best Practice Standard of Practice Management, which describes the regulations, instruments and behaviors necessary for practice management to function smoothly even under changing requirements, is the appropriate instrument for determining the degree of predisposition of practice operations to digital applications (Digital Predisposition Status DPS).

The DPS provides information on how pronounced the current readiness and ability of medical practices to introduce digital offerings is.

A determination of the predisposition situation of German medical practices using the results of the IFABS Business Comparison Tracker© for GP, specialist and dental practice management resulted in the following orientation values


If the DPS, i.e., compliance with the best practice standard, is above 80%, these are practices with a comprehensive digital predisposition. They have all the prerequisites for systematic and planned implementation of digital concepts. 12% of German medical practices belong to this category.


In the DPS range between 60% and 80% are those practices with a predisposition capable of development (18%). They implement most of the necessary basics, but individual prerequisites are still lacking. If this deficiency is eliminated, they will immediately be able to work with digital support.


In the DPS interval of 40% to 60% of best practice implementation are the physician practices with a borderline predisposition. Some of the necessary practice management building blocks are in place, but an equally large number are not. Affected practice teams (39%) must first engage in a systematic practice management setup in order to use digital technologies at all.


A DPS of less than 40% characterizes practices with minimal predisposition (31%). In the constellation measured, their management is fundamentally not suitable for implementing digital health solutions. Deployment is thus not hopeless, but extremely unlikely without a fundamental change in practice management.

Three lines of development

Against this background, there will be three lines of development:

  • Practice teams that are already best practice-oriented will have few implementation problems and will benefit from the efficiency and productivity advantages right from the start, which will simultaneously lead to an increase in the quality of care,
  • Practices with practice management problems will have the choice of eliminating them immediately, or
  • leave their working framework unchanged and thus not be able to tap the digitization benefits for themselves and their practice visitors.

What are the causes of practice management insufficiency (PMI)?

If, as described earlier, the practice management regulations selected by practice teams are not suitable for organizing practice operations in such a way that they meet the requirements of everyday work and function smoothly in principle, this is referred to as practice management insufficiency (PMI). The reason for its occurrence is that

  • the selection of precautions taken and measures implemented is incomplete and / or incorrect, or
  • their implementation is insufficient and / or incorrect.

Approximately 2/3 of German medical practices are affected by PMI to varying degrees and degrees of severity. This large number results from the fact that general practitioners and specialists on average do not even use 50% of the precautions necessary for a smoothly functioning practice.

The results of the IFABS Betriebsvergleich-Tracker© for general practitioner, specialist and dental practice management also show how this situation arises:

The importance of practice management is only a secondary priority for physicians.

When a new practice is founded, taken over or cooperated with, processes are defined that correspond to the acute scope of action, but are never subsequently reviewed for their viability. In the event of problems, selective help routines are developed which, over time, are incorporated into the original process design and become an integral part, but the efficiency and productivity of these solutions and their interaction with the basic organization are also never checked.

Doctors see the problem causes for work pressure, stress, etc. in the external area of their companies.

This fact has been communicated to them in this way for years in the media with constant references to increasing patient demands and bureaucracy, but the screening of practice management shows that in most cases the problems come from within the practices themselves. Moreover, all practices are equally affected by these problems, but those operating according to the best practice standard do not complain about them because they adequately address them in their processes.

Doctors do not take advantage of their employees‘ tips

In more than half of all practice operations, ideas and suggestions from MFAs exist on how work could be done better, but at the same time, staff complain that practice owners do not act on them.

Monocausal thinking

A fundamental problem related to PMI is that physicians predominantly think monocausally and try to identify „the“ practice management dysfunction. Practice management, however, is a multifactorial event that must be examined in its entirety because experience shows that there is never „the one“ cause.