Clinical picture of “Goal Deficiency Disorder (GDD)”: German GPs and specialists hardly ever use target agreements

What it’s all about

Benchmarking analyses of practice management show that only 10% of German doctors have a professional goal agreement system. This alarmingly low level illustrates the considerable discrepancy between the requirements of effective practice management and the reality in many medical practices. But what are the concrete disadvantages for doctors in private practice who do not agree targets with their employees?

Reduced employee motivation and commitment

A major problem in medical practices without target agreements is the reduced motivation and commitment of employees. Without clear goals and expectations, employees lack orientation in terms of their performance and behaviour. This results in a general indifference and a lack of initiative. Employees feel less valued and are less willing to go above and beyond the minimum, which has a negative impact on the overall performance of the practice.

Unclear performance expectations and uncertainty

Without target agreements, performance expectations remain vague and unclear. Employees do not know exactly what is expected of them and how their performance will be assessed. The effects are uncertainty and stress, as employees are constantly unsure whether they are actually fulfilling their employer’s expectations. This uncertainty has a significant impact on job satisfaction and well-being, which in turn negatively affects the efficiency and quality of work.

Lack of performance evaluation and development support

Target agreements are an important tool for assessing performance and promoting development. Without them, there is no structured system to measure and specifically promote the performance of employees. Without clear feedback on their work, employees are unable to pursue specific development goals for themselves. As a result, their professional progress stagnates and doctors have no opportunity to optimise the training and development of their employees.

Lack of team coordination and collaboration

Target agreements support team coordination and collaboration by defining common goals and responsibilities. Without these structures, there is a lack of clear coordination within the team. This leads to misunderstandings, duplication of work and inefficient work processes. Staff may work in isolation and without a shared understanding of their roles and responsibilities, which affects the effectiveness and harmony of the team.

Lower patient satisfaction

The quality of patient care depends largely on the motivation and commitment of the practice team. Without target agreements, the quality of patient care suffers as staff are less motivated to give their full commitment to the well-being of patients. This can lead to longer waiting times, less friendly service and an overall less positive patient experience. Dissatisfied patients switch practices and spread negative word of mouth, jeopardising the reputation and economic stability of the practice.

Higher staff turnover and recruitment costs

A lack of clear goals and development opportunities has a strong negative impact on employee satisfaction and retention. Dissatisfied employees are more likely to leave the practice, resulting in higher staff turnover. Recruiting and training new employees is time-consuming and costly, which places an additional burden on the practice. High staff turnover also affects the continuity of patient care and the knowledge within the team.

Inefficient use of resources

Without target agreements, there is a lack of systematic planning and utilisation of available resources. This results in inefficient utilisation of time, personnel and financial resources. Employees do not work on the most important tasks or projects and there is a lack of prioritisation of work processes. Inefficient processes and unclear responsibilities increase the operating costs and profitability of a practice.

Lack of innovation and improvement

Target agreements support the creation of a culture of continuous improvement and innovation. Without these structures, there is a lack of incentives and systems to develop and implement new ideas and improvements. People remain stuck in outdated ways of working and are unable to adapt to changes in the healthcare sector or integrate new technologies and methods. Such stagnation jeopardises competitiveness in the long term.

Lack of transparency and accountability

A system without target agreements inevitably suffers from a lack of transparency and accountability. Clear objectives and regular reviews create accountability and clarity regarding the performance and contributions of each team member. Without these structures, there are no clear benchmarks to assess performance and define responsibilities. This leads to the development of a culture of abdication of responsibility and lack of accountability, weakening the efficiency and cohesion of the team.

The reasons why doctors do not conclude target agreements with their employees

Lack of knowledge and understanding

A key reason for not agreeing targets is a lack of knowledge and understanding of their importance and benefits. Doctors do not realise how this tool can help improve practice management and staff performance.

Lack of time and workload

Practice owners are often under enormous time pressure and are faced with a heavy workload. The day-to-day running of a practice, combined with the treatment of patients and administrative tasks, supposedly leaves little room for additional management tasks. Target agreements require careful planning, regular discussions and continuous monitoring, which is wrongly perceived as additional work that many doctors cannot or do not want to do.

Lack of management and leadership skills

Another reason lies in the lack of management and leadership skills of many doctors. Medical training focuses primarily on clinical skills and less on business or management-related competences. As a result, doctors feel insecure or underprepared when it comes to making effective target agreements and conducting staff appraisals, so they avoid such activities.

Fear of conflict and confrontation

Target agreements require open and honest discussions about performance, expectations and opportunities for improvement. Quite a few doctors shy away from these discussions for fear of conflict and confrontation with their staff. They want to preserve the harmony in the practice, which is often only superficial, and fear that target agreements will provoke disagreements or negative reactions. This fear of potential conflict prevents them from introducing structural management practices.

Traditional work culture and resistance to change

Many medical practices have a traditional working culture characterised by established routines and habits. Change is often perceived as threatening and is met with resistance. Target agreements represent a significant change in the way of working and require an adaptation of existing practices. This resistance to change is another reason why many doctors are reluctant to implement the tool.

Distrust of the effectiveness

Other doctors doubt the effectiveness of target agreements and do not see any significant benefit for their practice. This scepticism may be based on negative experiences, a lack of success stories or a general aversion to formalised management practices. This mistrust prevents them from investing time and energy in the introduction of target agreements.

Prioritising medical activity over management tasks

For many physicians, direct patient care takes centre stage. Management tasks, including target agreements, are often seen as secondary. Physicians are primarily focused on providing the best possible medical care to their patients and view management practices as distracting or less important.

Personal beliefs and values

Some physicians have personal beliefs and values that prevent them from implementing goal setting. They may believe that professional performance and commitment should be taken for granted and not require formal agreements. This belief can be deeply ingrained and can be a hurdle that is difficult to overcome.

Lack of trust in the team

Another psychological aspect is a lack of trust in the staff. Doctors with this attitude may have doubts about the ability or willingness of their staff to adhere to target agreements or take them seriously. This lack of trust can be based on past experiences or prejudices and leads to doctors not wanting to make formal agreements.

Conclusion

The disadvantages of not agreeing targets are manifold and considerable. They affect the motivation and commitment of employees, the clarity of performance expectations, the opportunities for performance evaluation and development promotion, team coordination and cooperation, patient satisfaction, employee retention and the efficient use of resources. Medical practices that do without target agreements risk significantly compromising their efficiency and quality and, in the long term, being sidelined in the highly competitive healthcare market.

The reasons why many doctors do not conclude target agreements with their employees are varied and deeply rooted. They range from a lack of knowledge and understanding to a lack of time and skills to fears of conflict and change. Traditional work cultures, a lack of resources and personal beliefs also play a role. These complex and interrelated reasons explain why only a small percentage of German doctors have implemented a professional target agreement system in their practice.