Mastering the medical mindshift: the problem child of organizational quality

Data, facts and instruments on the German health system

What it’s all about

The functionality of the practice organization significantly determines the possibilities of individual patient care, the economic success of the practice and the working conditions of the entire practice team. The results of the IFABS Business Comparison Tracker© for general practice, specialist and dental practice management show that organizational deficits exist in medical practices on a broad level.

The Best Practice Standard as Key Performance Indicator

The organizational framework necessary for the smooth operation of a medical practice can be described with the help of the Best Practice Standard. It contains all the design features in the areas of planning, patient contact, ordering system, organizational structure, process organization, working environment, leadership, collaboration and self-management that are absolutely necessary for the smooth functionality of practice operations in both general and specialist practices.

These include parameters

  • from the entrepreneurial sphere of action, such as work target planning and control
  • to details of the ordering system (e.g. planning and adherence to buffer times) and leadership (e.g. holding regular practice meetings, target agreements)
  • to the working style of the practice owner (e.g. delegation behavior, way of performing tasks, etc.).

The Organizational Quality Score (OQS) quantitatively condenses the relationship between reality and best practice standard.

The organizational quality of the medical specialty groups in comparison

The results of the IFABS Operational Comparison Tracker© for general practitioner, specialist and dental practice management show clear differences in the medical specialist groups with regard to the OQS: for example, the score for surgically working ophthalmologists is 70.2%, while their conservatively working colleagues only achieve 42.9%. ENT practices achieve a level of 49.8%, dermatologists 44.9%, practices in physician networks 52.6% and MVZs 41.9%.

Overall, it is clear that a good half of the organizational arrangements that are actually necessary have not been implemented, which means that outpatient care is clearly below its potential.

Organization primarily pursues the passive goal of coping, not the active one of controlling.

The reason for these low scores is mainly that professional organizational analyses have been conducted in only one-third of German medical practices to date. In many of the remaining practices, the processes that were established when the practice was founded or taken over still exist, modified over time by a large number of routines that are used to try to meet changing requirements.

The whole thing also works more or less, but it is an approach that pursues the passive goal of coping, not the active one of controlling.

Moreover, this initiates a negative spiral: Time pressure leads to a multitude of smaller and larger errors, the correction of which in turn takes additional and non-existent time.

Organization analyses are an investment in work and supply quality

Work analyses, which in many cases can even be carried out on one’s own, bring the practice conditions into a stable balance with the requirements. The resulting time freed up is the result of the synergistic effect of many mostly small changes. The effort required for this is an investment in calmer practice processes, more time for patients and, of course, for administration.

The connection also makes it clear that quality of care is primarily a question of organizational quality.

Scarcely considered: the connection between organization and competence assessment.

From the patients‘ point of view, responsibility for inadequate processes clearly lies with the teams. This attitude also affects the assessment of physician competence,

because for practice visitors, organizational functionality in the form of fast appointments, punctual doctor consultations and a smooth practice flow is now a decisive competence characteristic.

If one compares medical practices whose quality of care, measured as the Patient Care Quality Score (PCQS, the ratio of requirements and satisfaction), is above 80% for the organizational components of practice work with structurally similar (size, service profile, location) practices that have significantly lower values, the competence rating in the first-mentioned practices is 20% higher on average.

Operations comparison shows the quality status

General practitioners and specialists who would like to examine their practice organization with regard to unused improvement reserves and in the context of the entire management are provided with the Practice Management Comparison© for this purpose.