Data, facts and instruments on the German health system
What it’s all about
„Alone we can do so little, together we can do so much.“ (Helen Keller)
They are widespread, catchy, readily accepted without scrutiny because they spare them action and self-reflection, but are false and influence physician action: toxic mindsets in outpatient medicine. One example is the statement, „We are a team.“ No term is used more frequently in the external presentation of medical practices, e.g., on websites, than the term „team.“ Yet the reality is that in most practices, there is no team-based collaboration at all. This has far-reaching negative effects on efficiency, productivity and quality of results.
Professional practice activity cannot be realised without teamwork
„Teamwork: the fuel that allows common people to attain uncommon results.“ (Andrew Carnegie)
The complex work processes in medical practices can only be carried out with a high quality of care, in a patient-oriented, efficient, productive and economically successful manner if the activities of all medical assistants mesh like cogwheels in every situation. One of the basic principles of business management that guarantees this state of affairs and also leads to the reliable achievement of goals and to above-average work results – not only in medical practices – is excellently functioning teamwork. It ensures the activation of the maximum possible synergy of all those involved in the work process.
What makes teams stand out
Unity is strength… when there is teamwork and collaboration, wonderful things can be achieved.“ (Mattie Stepanek)
This teamwork excellence does not happen automatically, but is the result of professional leadership and a number of determining factors that together form the best practice standard of teamwork. These include
- common goals,
- a strong sense of „we
- largely autonomous task completion,
- mutual synergistic-symbiotic complementarity and support
- self-direction to solve problems and
- self-initiated measures to improve work results.
What teamwork achieves
„With an enthusiastic team you can achieve almost anything.“ (Tahir Shah)
Teamwork is a 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.
Or to put it another way: the care concept of a practice and its organisation can be as good as they want to be, without functioning teamwork they are only partially effective.
Furthermore, this form of collaboration has the effect that
- in structurally comparable practices, those with professionally working teams generate a significantly higher profit than those without this feature,
- the personnel costs correspond to a significantly higher output, but not in the form of additional work, but through synergies,
Comparisons show that after switching to a true team structure, work performance increases by 30% to 50%, depending on the previous collaboration situation.
- overtime is significantly reduced,
- the sickness rate is very low,
- practice owners benefit from a significantly higher workload,
- patient satisfaction and willingness to recommend are significantly better, a fact that is also reflected in internet ratings, and that
- the image effect is more pronounced.
The path to digitally supported practice management also requires teamwork
Great things in business are never done by one person. They’re done by a team of people.“ (Steve Jobs)
When developing scenarios for digitally supported practice management, it is commonly assumed that medical assistants are relieved by automation effects. However, they will also be confronted with completely new tasks that increase the volume of work, make the activities more complex and differentiated and also demand a faster readiness to act and react from the future digital medical assistants. However, the realisation of these requirements is only possible with smoothly functioning teamwork.
Measurement of teamwork quality
„Coming together is a beginning. Keeping together is progress. Working together is success.“ (Henry Ford)
If one analyses the information of medical assistants collected in practice management company comparisons on the degree of realisation of the best practice team standard in their practices, i.e. on the basic requirements for optimally functioning cooperation, the key performance indicator „Teamwork Quality Score“ (TQS) can be determined. It classifies the cooperation as follows:
- TQS > 80%: Team
This constellation characterises optimal working conditions by working together 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 their job well, there is no sustained commitment to continuous improvement.
- TQS 0 to <= 40% Special-purpose association
Here, work performance is characterised by „service by the book“ and „lone wolf“ behaviour.
Low level of teamwork in German medical practices
No one can whistle a symphony. It takes a whole orchestra to play it.“(H.E. Luccock)
If one follows today’s presentations on practice websites or in practice brochures, teamwork is now an integral part of practice performance. A look at reality, across all speciality groups and practice types, proves the opposite: the average Teamwork Quality Score (TQS) is only 43.7% (optimum: 100%), i.e. this important practice success factor is only insufficiently developed.
The consequences are errors, annoyance, work pressure, wasted time, patient dissatisfaction and lower economic returns.
Group instead of team
„If you want to go fast, go alone. If you want to go far, go together.“ ( African Proverb)
Collaboration, which falls into the score range between 40% and 60%, characterises – as already described above – group collaborations with
- low synergy of individual activities,
- little initiative
- hardly any mutual support in case of problems,
- unresolved conflicts
- no sustained commitment to continuous improvement.
The degree of co-working in this form is better than in a special-purpose association (TQS between 0% and 40%), but worse than in a community (TQS between 60% and 80%) and of course far from teamwork (TSS > 80%).
Practices in which groups work are thus operating far below their realisable performance potential.
„It takes two flints to make a fire.“ ( Louisa May Alcott)
Subjective assessment instead of objective determination
The determination of teamwork quality, arguably one of the most important tools for ensuring efficiency, productivity and motivation, but also high-quality patient care and financial practice success, is usually based only on simple observations and thus leads to false conclusions. Practice owners usually use subjective criteria to assess the functionality, efficiency as well as productivity status of their staff and think they know „their“ teams exactly. Comparisons of the assessment with the actual conditions determined in company comparisons, however, prove the opposite, because in many cases the team members develop routines to cover up internal discrepancies and problems.
The autopilot effect
Another cause for the current state of affairs is the basic attitude of many practice owners to forego active team-building and instead rely on the self-controlling powers of the staff. But this mechanism only works in very few cases, because most practice staffs are very heterogeneous in terms of age, experience, seniority or personality of the members. In order to form functioning and harmonising teams out of them, management needs to be geared towards this. However, the Key Performance Score on physician leadership intensity is currently below the 40% limit on average – viewed across all speciality groups – and thus contributes as a deficient component to the widespread practice management insufficiency (PMI) in the outpatient sector.
What practice owners can do
„Talent wins games, but teamwork and intelligence win championships.“ (Michael Jordan)
An essential step in developing the strategic practice management of a GP or specialist practice is thus to develop a management system with three objectives:
There is „real“ teamwork,
i.e. the work to be done is divided between the team members in the best possible way. The task of the leadership of the practice owner(s) here is to
- coordinating the individual work frameworks
- enabling the staff to carry out the tasks in the practice as independently as possible, and
- the synergistic bundling of skills, commitment, behaviour and performance.
The simplest form of synergy is that one staff member stands in for every other staff member, even if it is not about her area of responsibility, a state which at present slightly more than half of all MFAs would like to see. In a „real“ team, the work goals of the staff members are no longer focused solely or to a large extent on themselves, but on the team, i.e. practice performance. The basis is always a definition of the tasks to be done and the allocation of the tasks to the staff.
There is a team spirit,
i.e. the team members follow the same goals, ideals and ideas, e.g. with regard to the quality of the work, the keeping of promises or with regard to the friendliness in dealing with patients. Creating team spirit is thus nothing other than generating shared values. Leadership, from this point of view, aims at aligning the individual working frameworks of the staff members so that they follow the same guidelines within the team working framework. Three benefits result from the creation of team spirit:
- Orientation: with the help of shared values, it becomes transparent to staff what is important in their work performance,
- Drive: shared values are aspirational and encourage continuous commitment,
- Coordination: values act as standards that guide cooperation and work flow.
There is team harmony,
i.e. team members accept and respect each other. In this context, leadership must prioritise and work towards the compatibility of the different types of employees and functioning conflict resolution mechanisms.
With ten questions to determine teamwork quality
„In union there is strength.“ ( Aesop)
General practitioners and specialists who want to use the success principle of „teamwork“ comprehensively and professionally for their businesses must first know the status of the cooperation quality of their staff for a pinpoint change.
A validated and easy-to-implement option is the use of the Valetudo Check-up© „Teamwork Medical Practice „, a procedure which
- comprehensively and objectively determines the quality of cooperation with only ten simple questions,
- identifies necessary measures for improvement as well as unused potentials and
- can be easily implemented at any time, as no staff member has to „come out“.
A staff member only needs about twenty minutes to complete the analysis questionnaire. After the evaluation, the system’s expertise describes in detail how best to proceed in individual cases – if the team status has not yet been reached. It also includes a benchmarking comparison of the quality of cooperation in medical practices of the same specialist group. The analysis determines the following insights:
- Team Experience Portfolio (TEP)
What is the current self-image of the team members, broken down into a description of strengths, weaknesses, threats and opportunities as a result of previous cooperation experiences?
- Overall Team Satisfaction (OTS)
How do the team members generally rate their framework of action in comparison with their requirements?
- Team Harmony Balance (THB)
How pronounced is the degree of agreement among team members in evaluating their working framework? The information can also be used as an
This information can also be used as an indicator of the potential for conflict within the team.
- Teamwork Quality Score (TQS)
How far has the quality of cooperation been developed in the sense of implementing „real“ teamwork? Often the members interact only as a community, group or alliance of purpose.
- Return on Management (ROM)
What impact do team building measures have on teamwork quality?
- Team Development Options (TDO)
What ideas and suggestions exist from the employee’s point of view that contribute to further improving teamwork?