Data, facts and instruments on the German health system

What it’s all about

A professionally developed corporate culture that is consistently implemented in everyday work is a key success factor for any business activity. Of course, this also applies to outpatient medical care, but there is a need to catch up here.

The essence of corporate culture

The term “corporate culture” describes a basic attitude, both internal and external, which is made up of the values, standards and views that determine the decisions, working methods and behaviour of a company’s employees. With its relevance to action and signal or image effect, the culture envelops the existing competences, resources, structures and the management of processes.

Every company – regardless of its purpose and size – has its own corporate culture, including medical practices. However, it only represents a success factor and supports the achievement of corporate goals if it is

• is the result of strategic planning
• the staff is involved in the establishment and development of the concept and broad acceptance is ensured,
• has a character that is binding and suitable for everyday use,
• is oriented towards the best practice standard in the sense of a proactive, contemporary, agile and participative-integrating orientation, and if
• there are no differences between the planned and the practised culture.

How pronounced is the corporate culture in German medical practices?

If medical professionals are asked to evaluate the implementation of the parameters of the best practice standard of corporate culture for their practice operations, the average value for the key performance indicator “Corporate Culture Quality Score” (CQS) – considered across all speciality groups and practice sizes – is 34.7%. This current implementation status of the practice culture is the verification of the repeatedly expressed assumptions and individual observations that the topic of “practice culture” has hardly any significance for many practice owners. For comparison: the CQS of dental practices is 65%.

A part of the medical profession is not even aware of the importance of practice culture, as business management issues are hardly represented in medical training. Others regard patient care as the guiding principle of their actions, from which everything else follows by itself. And thirds fundamentally refuse to deal with the concepts and instruments of applied business administration, because for them medicine and economics are incompatible.

Regardless of the cause, however, it should be noted that this behaviour also leads to a culture that is characterised by a passive, backward-looking, rigid, authoritarian-separating (“lone wolf”) orientation and is thus not conducive to success. If one compares “culturally professional” practices with the others, it becomes apparent that the practice culture not only influences the quality of patient care, i.e. the core medical service, but also the economic result, but also work motivation, productivity and efficiency. Practice owners of the next generation of doctors have recognised this and are relying on this concept.

Culture discrepancies lead to unproductive collaboration

At the same time, however, practice owners communicate a cultural impression to the outside world, primarily by presenting their workforces as teams. This form of collaboration is characterised by common goals, largely autonomous task completion, mutual complementarity and support, as well as self-direction to solve problems and self-initiated measures to improve work results.

However, practice analyses show that groups work in medical practices. Cooperation in this category 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, the cooperation is often characterised by unresolved conflicts. Although every medical assistant strives to do her job well, there is no sustained commitment to continuous improvement. The reason for this degree of collaboration is the lack of a professional practice culture.

Missing practice culture leads to practice management insufficiency

However, the CQS of just under 35% not only has an unfavourable effect on motivation and teamwork, but also on practice management. The term refers to the totality of all regulations. instruments, measures and behaviours

• which are used in the fields of planning, organisation, market research, leadership and cooperation, time and self-management, patient management, marketing and financial management of medical practices of all disciplines and
• whose interaction guarantees the operation of the practice.

Practice management functions as a transmitter of the medical competence of physicians and the activities of medical assistants into the concrete care of patients. The quality of its organisation determines how comprehensively the doctors’ skills and the staff’s abilities are made available to the patients in the form of comprehensive assistance. It also determines how quickly practice teams can react to changes of any kind, implement them and benefit from them (example: digitalisation).

Smoothly functioning practice management is based on the systematic use of business methods, instruments and management behaviours that ensure that internal and external demands on practice work are met. Its basis is also the practice culture.

If practice management is not suitable for organising practice operations in such a way that they meet the requirements of everyday work and basically function smoothly, we speak of practice management insufficiency (PMI). The reason for its occurrence is that

• the selection of precautions taken and measures implemented is incomplete and/or incorrect, or
• their implementation is insufficient and / or incorrect.

This creates a vacuum, because internal and external demands on the practice’s work are not adequately met.

What medical assistants lack in practice culture

Drawing on the results of staff surveys makes it possible to identify missing aspects of the practice culture that impair teamwork and cooperation. These include:

• Lack of practice and work goals
• Insufficient competence regulations
• Too little freedom for independent action
• Unclear rules of cooperation
• Lack of support for necessary conflict resolution
• Unequal treatment
• Too little unambiguity in decision-making
• Too little internal communication
• No promotion and development of skills
• Lack of recognition
• Lack of acceptance of suggestions for improvement
• Lack of solidarity of practice owners with their MFAs in the face of actually unfulfillable patient demands
• Reprimands in the presence of patients
• “Moody Doctors”

Lack of corporate culture affects the quality of work in MVZs, centres and large practices.

The importance of a sustainable corporate culture increases with the size of a company. For some time now, a trend towards larger operating units has been evident in outpatient medicine. Many of them also show descriptions of their cultural approaches in their external presentation, but company analyses often show a lack of or incorrect internal implementation, which leads to the fact that the advantages that can actually be achieved through the size effect cannot be activated.

Likewise, of course, the performance of doctor’s networks is also influenced by the practice-cultural equipment and realisation.

With the help of practice culture to future agility

In the course of the developments in the health care system, the practice culture will gain in importance in the future. A still small proportion of the medical profession has recognised this and is developing corresponding approaches that help them not only to optimise teamwork as a management principle, but above all to optimise the agility of their practice management: while the health policy, medical, social and entrepreneurial environment in which general practitioners and specialists operate has so far been characterised by relative constancy and predictability, medical practitioners are now confronted with changes that lead to volatility and disorientation and which cannot be adequately countered with the previous, mostly static practice management concepts. The solution to this problem, which will increase significantly in intensity in the future, is agile practice management. The book “Agiles Praxismanagement für Haus- und Fachärzte” (Agile Practice Management for General Practitioners and Specialists) describes the benefits it brings and how to implement it. To the table of contents (German)…