Data, facts and instruments on the German health system
What it’s all about
„Alone we can do so little, together we can do so much.“ (Helen Keller)
No term is used more frequently in the external presentation of medical practices, e.g. on websites, than the term „team“. But reality shows that in most practices there is no team-based cooperation at all. This has far-reaching negative effects on efficiency, productivity and quality of outcomes.
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)…
Data, facts and instruments on the German health system
What it’s all about
Unresolved conflicts among medical assistants do considerable damage to a practice. From a business perspective, their most serious consequence is the creation of opportunity costs. These, of course, are not incurred in the form of a bill that has to be paid, but are indirect costs that result from the following effects:…
Data, facts and instruments on the German health system
What it’s all about
The functionality of the practice organisation decisively determines the possibilities of individual patient care, the economic success of the practice and the working conditions of the entire practice team. However, the results of patient surveys and the assessments in doctor rating portals show time and again that there are organisational deficits in medical practices on a broad level.
Data, facts and instruments on the German health system
What it’s all about
„We need a consultant!“: more and more GPs and specialists in private practice feel the need for support in their practice management and are thinking about seeking external help. With the help of a simple procedure, practice owners can define their problem so precisely that a consultant who fits the task exactly can be found and the costs of the support can be minimised.
Data, facts and instruments on the German health system
What it’s all about
The better practice teams are able to assess the needs and satisfaction of their patients, the better they can align their care and support services. Reality shows that a central starting point for optimisation lies in the match between self-perception and the image of others.
Data, facts and instruments on the German health system
What it’s all about
The benchmarking function of a practice management comparison makes it possible to quantify the qualitative descriptions of the work of a medical practice and to compare them with objective-representative measured variables. In this way, it is possible not only to record the type and intensity of the regulations used to manage the practice, but also their effects, so that a 360-degree view of the practice’s work emerges. Key performance indicators (KPIs) can be derived from the comparison. An application example for the field of action „organisation“ illustrates their potential.
Data, facts and instruments on the German health system
What it’s all about
In their external presentation, practice owners like to talk about their „team“. But practice management comparisons show that most practices do not really have teams.
In engineering, streamlining means constructing shapes with low air or water resistance in order to improve the speed and ease of movement. Applied to organisations, the term means an analysis and, if necessary, a redesign of practice management so that
effectiveness, efficiency and productivity, but also the working conditions of the staff are improved and
a business remains agile and active even under changing requirements and changing conditions of action.
Medical practices can also benefit from such an approach.
The benefits of streamlining
A smoothly functioning, i.e. formed, practice management is the central starting point for achieving all conceivable practice goals: reducing work pressure, increasing efficiency and productivity, further improving patient satisfaction, increasing success or securing the future. But how do practice owners manage to streamline their management adequately, even in the context of dynamically changing working conditions?
Practice management: one term for many interdependencies
The problem for GPs and specialists is predominantly that „practice management“ is a conglomerate of many different areas of action that are closely interlinked and, to a large extent, condition and influence each other. Only when these areas – from planning to patient management, leadership, organisation, marketing, market research and controlling – mesh with each other like finely tuned cogwheels does management excellence emerge that is malleable.
Classical solutions only help to a limited extent
In this context, the application of tips, tricks and advice provided to practice owners by various sources does not lead to a noticeable change in their work, because this is – as described – only possible in a holistic way.
Seminars sometimes impart knowledge on individual or several of these interdependencies, but the contents inevitably follow the principle of „one-size-fits-all“, so that the participating doctors – returning to their practices – have increased knowledge, but still no plan for concrete action.
The last resort is to use consultants, but a complete analysis of the practice management is too expensive for many doctors.
Streamlining is easy
A general practitioner or specialist who wants to streamline his practice management in the context of his goals, i.e. improve, develop or realign it, first needs a status description of his work. This is the starting point of the concept of Key Performance Indicators (KPI), which
solves the aforementioned problem of the complexity of practice management by generating orientation parameters,
makes it possible to determine the actual state of practice management without great effort and
simultaneously identifies strengths, but also deficits as well as unused opportunities and risk factors.
With the results of this initial analysis, concrete target parameters for the practice work can be defined and monitored and controlled in a simple but comprehensive way by means of follow-up examinations.
How the indicators are created
KPIs are parameters that are created by comparing the practice management data of a medical practice with objective and representative measured variables. For this purpose, with the help of structured analysis forms (doctor, MFA, patients, referrers, if applicable), the design of the practice management is first described and made measurable via scaling in the later evaluation. In this way, not only the type and intensity of the regulations used for practice management are recorded, but also their effects, so that a kind of MRI image of the practice work is created.
Insights via benchmarking
This information is then subjected to a best practice and a specialist group benchmarking. The best practice comparison shows whether all the regulations, instruments and behaviours that ensure smooth practice operation are actually implemented. The specialist group ratio provides additional information on the extent to which the practice management under investigation meets the minimum market standard. From the KPIs determined
results in a detailed status overview of the strengths, weaknesses, threats and opportunities of the examined practice with a detailed action plan for improvements, changes and developments, furthermore
individual practice management development goals can be formed on the basis of the practice strategy and monitored with regard to progress in implementation.
Thus, a KPI status report corresponds to a balanced scorecard, a „streamlining plan“ for practice management.
„Easy-to-use“ and „Ready-to-go“
The special feature of the KPI concept is that the collection of the necessary information can be done solely by means of questionnaires that are easy to fill in, without the need for an on-site consultant:
the doctor’s questionnaire takes about 30 minutes to complete,
the MFA document is completed in about 20 minutes,
in addition, a patient survey is carried out in which up to 100 practice visitors can be interviewed.
No specialist knowledge or supplementary materials are needed to complete the documents.
KPIs open up design possibilities
Based on the KPI status report created from the questionnaire data and the associated action plan, practice owners are able to decide whether they want to implement the listed suggestions themselves with their teams or resort to external help. In the second case, the prior preparation of the Balanced Scorecard leads to a significant cost saving, as the consulting objective for external help can be precisely delimited and defined.
UP: Unlocking Potentials 