Change Aversity: Why German GPs and specialists ignore their employees’ suggestions for change

What it’s all about

In the healthcare sector, the interaction between doctors and their staff plays a central role in the success of a practice. Nevertheless, the results of practice management comparisons show that the majority of German doctors in private practice ignore their employees’ suggestions for change or give them little commitment. This behaviour, known as “change aversion”, is deeply rooted in the psychological structures and dynamics that operate in the professional environment.

Status and hierarchy

A key factor influencing how doctors react to suggestions from their staff is the status and hierarchy within the practice. Doctors have undergone long and intensive training which elevates them to a position of expertise and authority. This hierarchy creates a natural barrier to suggestions from staff who are perceived as less experienced or less competent. The difference in status leads doctors to regard their own judgements and decisions as superior and to underestimate the ideas of their colleagues, even if the organisational rather than the medical area is affected.

Need for control and autonomy

Doctors are characterised by a strong need for control. They are responsible for the well-being of their patients and the overall functionality of their organisations. This responsibility leads to a need for autonomy and control over all aspects of their work. Suggestions for change from employees are therefore perceived as a threat to this autonomy, as they jeopardise the doctor’s freedom to make decisions. The doctors’ need for control is so strong that they reject even suggestions that could eliminate fundamental mismanagement just to preserve their own authority and independence.

Psychological defence mechanisms

Some practice owners perceive suggestions for change as an attack on their competence. In order to ward off this unpleasant feeling, they ignore the suggestions, devalue them or delay the decision to implement them. This defensive attitude protects the doctor’s self-esteem, but undermines the potential for improvements in the practice.

Confirmation bias

People tend to favour information and suggestions that confirm their existing beliefs and decisions. Doctors who have established a certain way of working therefore unconsciously seek out information that supports this way of working and reject suggestions that challenge it. The result is stagnation and the prevention of the implementation of potentially valuable ideas.

Communication barriers

Effective communication is critical to the exchange of ideas and suggestions. In many practices, however, according to employees, there are communication barriers that hinder the exchange between doctors and them. Hierarchical structures, lack of time and different communication styles contribute to suggestions not being heard or being misunderstood. The lack of open communication reinforces the tendency to ignore suggestions.

Resistance to change

Resistance to change is a widespread psychological phenomenon. Change brings uncertainty and requires adaptation, which is often perceived as stressful. Doctors working in an established system therefore often show neophobic resistance to suggestions that imply change. They favour the status quo and avoid the risks and efforts associated with change. This resistance is deeply rooted in human nature and can only be overcome by targeted measures.

Personality factors

GPs and specialists who tend to be highly confident and assertive find suggestions unnecessary or disruptive. On the other hand, introverted or less self-confident doctors perceive suggestions as criticism, which automatically results in defensive reactions. Personality traits such as openness to experience or adaptability significantly influence the willingness to accept and implement suggestions.

Empathy and trust

Empathy and trust are key factors for the acceptance of suggestions. Doctors with a high degree of empathy and a trusting relationship with their employees are more willing to take their suggestions seriously and implement them. Trust creates a positive working atmosphere in which employees feel encouraged to share their ideas and doctors are more open to new approaches. However, building trust takes time and conscious effort.

Why a change of perspective is urgently needed

The low level of commitment that doctors in private practice show towards suggestions from their employees is the result of complex psychological and organisational factors. Status differences, control needs, defence mechanisms, confirmation bias, communication barriers, resistance to change, personality factors, empathy, trust and organisational culture all play a role. However, self-reflection and a resulting understanding of these factors can help to develop strategies that promote the acceptance and implementation of proposals and thus improve the efficiency and quality of practical work.
One figure shows how urgently a change of perspective is needed for German GPs and specialists: on average, practice owners do not implement almost half of the best practice standards for practice management. This validated guideline describes all those regulations, behaviours and instruments of practice management that are essential for smooth functionality even under changing requirements. This deficit not only has far-reaching negative consequences for individual practices and their future viability, but also for the efficiency of outpatient medicine as a whole in Germany.