Efficiency barriers in German medical practices: Personal initiative? No thanks!

What it’s all about

The results of practice management comparisons and the associated employee surveys in German general practitioner and specialist practices show: In many medical practices, the personal initiative of medical assistants is not welcomed and is even consistently discouraged. There are various reasons for this behaviour on the part of practice owners, including both practical and psychological aspects. This article highlights the most important reasons and outlines the consequences.

Need for control

A widespread reason for suppressing personal initiative is a strong need for control. Many doctors are used to supervising all aspects of the practice themselves in their daily working environment. This need can lead to them unconsciously or consciously restricting the autonomy of their employees to ensure that everything goes their way. This is particularly strong when the practice owner feels a high level of responsibility and risk that they do not want to share.

Fear of making mistakes

Fear of making mistakes plays a crucial role in the decision to suppress initiative. Doctors have a huge responsibility for the welfare of their patients and mistakes can have serious consequences. This fear can make them reluctant to give their employees the freedom to make decisions out of concern that these decisions could lead to mistakes. This creates a situation in which the doctor believes that only he is able to make correct and safe decisions.

Perfectionism

Doctors often tend to be perfectionists, which means that they set very high standards for themselves and their staff. This basic attitude leads them to feel that only they can do the job to the desired quality and then leave their employees little room for their own ideas and initiatives. Perfectionism thus becomes a significant barrier to initiative.

Lack of trust

Another key factor is a lack of trust in employees’ abilities. Doctors who do not allow their employees to use their own initiative often do so because they are convinced that they are not competent enough to act on their own responsibility. This lack of trust can be based on both actual experience and prejudice and results in doctors heavily supervising and directing their staff.

Negative experiences in the past

If a doctor has already had bad experiences where employees’ own initiative has caused problems, this can lead to a general aversion to employees working independently. Such experiences have a lasting effect on the behaviour and management style of doctors, as they increasingly rely on control and restriction in the future.

Communication deficits

A frequently underestimated reason is a lack of communication. When there is a lack of clear and effective communication between doctors and staff, some doctors believe that staff do not understand their instructions or implement them incorrectly. To avoid such misunderstandings and mistakes, the doctor restricts individual initiative and favours clear, direct instructions.

Wish for uniformity

The desire for uniformity and standardisation in the practice is also a motive. Doctors who value consistent procedures and standards tend to avoid any deviations. They leave little room for initiative to ensure that all staff follow the given processes exactly.

Hierarchical thinking

Hierarchical thinking is another psychological factor that favours the suppression of personal initiative. Doctors who are so orientated often see themselves at the top of a strict hierarchy and believe that decision-making and innovation are exclusively theirs. This results in a culture in which employees are assigned a purely executive role and do not dare to make their own suggestions.

Insecurity in the leadership role

Uncertainty in their own leadership role is another reason why doctors restrict their employees’ initiative. If they are unsure how to fulfil their leadership tasks effectively, they resort to excessive control as a substitute to compensate for their insecurity.

Personal values and beliefs

Practice owners who believe strongly in traditional values and tried and tested methods are often sceptical of change and new ideas. This is why they encourage their employees to follow established processes instead of showing initiative and trying out new approaches.

The consequences of suppressing personal initiative

Lack of motivation and commitment

When medical assistants are denied the opportunity to take initiative, this results in a significant decrease in their motivation and commitment. Employees who feel that their ideas and suggestions are not wanted or valued often develop a passive attitude. They limit themselves to the fulfilment of their basic tasks (work to rule) and refrain from proactively contributing to improving the work. Not only does this lead to a stagnation in working methods, but the general working atmosphere also deteriorates.

Loss of creativity and innovative strength

Personal initiative fosters creativity and innovation as employees are encouraged to develop new ideas and approaches. If this initiative is suppressed, practices lose a valuable source of innovation. Medical assistants are often close to patients and are the first to recognise potential areas for improvement in patient care and practice organisation. By ignoring their suggestions, the innovation potential remains unutilised, which can lead to a competitive disadvantage in the long term.

Lower employee satisfaction and higher staff turnover

Employee satisfaction depends heavily on the extent to which they experience personal responsibility and creative freedom in their work. If this freedom is restricted, it leads to frustration and dissatisfaction. Dissatisfied employees are more likely to leave the practice, which leads to higher staff turnover. Recruiting and training new staff is not only time-consuming but also costly and can affect the continuity and quality of patient care.

Inefficient practice processes

Employees who are not allowed to show initiative usually work strictly according to specifications and standard processes without critically questioning or optimising them. Inefficient processes persist, as there are no incentives to suggest improvements. However, inefficient processes increase workload and affect the quality of patient care as valuable resources are wasted.

Failure to develop problem-solving skills

Personal initiative and the ability to make decisions independently are essential components for developing problem-solving skills. If medical assistants are denied this opportunity, they are unable to react flexibly and effectively to unexpected challenges. This results in problems, especially in stressful or critical situations.

Increased stress levels and risk of burnout

A work environment that suppresses initiative causes stress and increases the risk of burnout among medical assistants. If they constantly have the feeling that they are being monitored and have no control over their work, they experience a high level of psychological pressure. This has a negative impact on their health, increases sickness rates and reduces work performance.

Poorer team dynamics and collaboration

Team dynamics and collaboration also suffer when personal initiative is restricted. In an environment where employees are not allowed to contribute their own ideas, a culture of mistrust and uncertainty is created. Staff are less inclined to communicate openly and work together constructively, which has a strong negative impact on teamwork and the effectiveness of the entire practice team.

Conclusion

The findings from practice management comparisons and employee surveys in German medical practices reveal a significant issue: the discouragement of personal initiative among medical assistants. This behavior stems from various practical and psychological reasons on the part of practice owners, including a need for control, fear of mistakes, perfectionism, lack of trust, negative past experiences, communication deficits, a desire for uniformity, hierarchical thinking, leadership insecurity, and traditional values. These factors collectively create an environment where personal initiative is stifled.

The consequences of suppressing personal initiative are profound. It leads to decreased motivation and commitment, a loss of creativity and innovative strength, lower employee satisfaction, higher staff turnover, inefficient practice processes, underdeveloped problem-solving skills, increased stress levels, risk of burnout, and poorer team dynamics and collaboration. This not only affects the well-being of medical assistants but also the overall efficiency and quality of patient care. Encouraging personal initiative is essential for fostering a motivated, innovative, and cohesive practice team, ultimately benefiting both staff and patients.