Mastering the medical mindshift: Why leadership is so important

Data, facts and instruments on the German health system

What it’s all about

Many established practice owners are convinced that, due to their size, they do not need any special leadership measures, since the interaction of the staff results natively from the tasks to be done and the staff already know how to help themselves when problems and questions arise. A serious mistake.

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Mastering the medical mindshift: deficits in practice organisation are primarily a problem of personnel management

Data, facts and instruments on the German health system

What it’s all about

Excessive waiting times, uncoordinated procedures, poor telephone accessibility, hectic consultations with doctors – deficits in practice organisation are the number one point of criticism when patients are asked about their satisfaction with medical practices. are asked. Doctors and staff are also negatively affected. About 2/3 of the problems identified in practice analyses come from the area of organisational design. Doctors and their staff also suffer from this stress, anger and demotivation are the consequences of unresolved organisational deficits.

Poor practice organisation and the economic consequences

Poor practice organisation also has serious economic consequences. On average, for example, labour productivity in general practices is 28% lower than it could be with optimised organisation. This means that with an assumed monthly salary of the staff of € 5,000, an amount of € 1,400 is used for unproductive work. Added up over the year, this results in a „bad investment“ of € 16,800. Added to this are the lost profits for the patients who could not be treated due to the poorly adjusted practice organisation as well as for patients who – deterred by the inadequate organisation – change the practice. The costs for guaranteeing the operation of the practice (electricity, water, rent) during the unproductive phases must also be added.

Operation optimisation through organisational improvements

An optimisation of the practice organisation thus supports essential areas of action of the practice management: it

  • enables full utilisation of the labour productivity that can be realised on the basis of practice size, number of staff, consultation hours and services offered,
  • helps to increase the number of patients who can be treated, to reduce costs and to increase the economic result,
  • creates scope for offers that require explanation, such as IGeL,
  • supports the best possible use of rooms and equipment,
  • reduces stress for practice owners and staff and creates a noticeably more positive emotional atmosphere in the practice for patients,
  • promotes staff motivation through more calculable working hours,
  • is the best marketing instrument to distinguish the practice from other practices, to retain regular patients and to attract new patients.

Thus, an optimally functioning organisation offers the prerequisite for the best possible medical care, in which every patient can receive the treatment he or she needs on an economically solid foundation.

Hindrances to organisational improvements: The main problem lies in management

But with such a multitude of advantages, why do so few doctors bother to improve the organisational conditions in their practices? Three reasons are responsible for this, two of which lie in the area of management responsibility of the practice owners:

(1) Different perceptions

In most medical practices, there is a „two-worlds phenomenon“: doctor/physicians and staff operate in completely different areas that are connected to each other by interfaces. In their „inner world“ of the consultation and treatment rooms, most doctors do not notice the problems of the „outer world of the practice“ at the reception, in the waiting room or in the corridors. As long as no problems are brought to their attention (for which there are often no communication routines), they assume that the practice world as a whole is fine.

(2) Low level of staff involvement

The practice staff experience organisational problems directly. They could therefore contribute significantly to improving the organisational conditions of their practice. But: their opinion is not asked. Only in very few medical practices – according to the complaint of many medical assistants – are organisational improvements regularly discussed in the team. Otherwise, the bosses play it cool and leave the practice unchanged.

(3) Refraining from too expensive help

If practice owners recognise the need for and opportunities of organisational change, they face the problem that organisational analyses – if they are bought in externally – are expensive and time-consuming. The prices for professional implementation start at about € 1,500, and the price scale is open upwards. However, most people shy away from this.

In three steps to sustainable organisational optimisation

Step 1

The first step is to talk to the practice team. Experience has shown that every member of staff knows areas, situations and work where procedures are not working properly and perhaps already knows a solution. About 70% of all organisational problems could be solved by implementing the knowledge of the medical assistants. It is best to dedicate a complete team meeting to organisational improvement, in which all approaches are collected and summarised in a realignment plan. Thereafter, the discussion of the organisation should be an integral part of every practice meeting in order to ensure continuous development.

Step 2

If, contrary to expectations, the practice is still not running smoothly after the measures described above, it is a good idea to carry out a simple work analysis. With its help, the organisational structure and workflow, the ordering system and the doctors‘ time management can be checked and synchronised with the patient structure. The implementation is done with the help of a patient run sheet on which all work is documented for the duration of a week according to type, duration and person responsible/performer. By combining all the data, a multi-dimensional image of the practice’s work processes is created. This shows, among other things, what happens in the practice during patient consultations, to what extent and with what consequences unannounced patients influence the processes, which tasks the staff carry out with what workload (basis for personnel planning), whether the work processes are optimally coordinated or how the patients‘ length of stay is composed. It is advisable to carry out such an examination once a year in order to increase the efficiency of the work flow in this way, because experience shows that behaviour and regulations creep in again and again that inhibit the work flow without it being registered by those involved.

Step 3

With regard to the ordering system, practices with a strict appointment system have clear advantages compared to practices with other organisational principles (e.g. semi-open consultation hours):

  • patients are significantly more satisfied,
  • the stress load for the doctor and staff is less,
  • administrative work can be done promptly
  • the number of overtime hours can be significantly reduced,
  • staff productivity is higher,
  • the number of patients treated per day is higher due to precise planning.

Total optimisation of practice management

General practitioners and specialists who would like to examine their organisation as well as their personnel management, but also all other areas of practice work, can use the Practice Management Comparison© for this purpose. The validated examination, which can be carried out without the need for an on-site consultant, requires only thirty minutes of medical working time and identifies an average of forty suggestions for improving practice work. All the information is available in a free briefing paper.

To download the briefing paper (German)…

Mastering the medical mindshift: Professional practice management is always business-based

Data, facts and instruments on the German health system

What it’s all about

Physicians in private practice have a distant to negative relationship to the term „business management“. Ignorance and prejudice are mainly responsible for this. But this attitude means that important tools that can acutely improve patient care, ensure the flexibility needed for transformation in the medium term and secure the success of the practice in the long term are not used.

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Strategic practice management: Teamwork – The underestimated success factor

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.

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Practice management company comparisons show blind spots in doctors‘ and medical assistants‘ self-assessment of quality of care

Data, facts and instruments on the German health system

What it’s all about

Practice owners and medical assistants in GP and specialist practices overestimate the quality of care they provide by an average of 30%.

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Medical Mindshifting: Corporate culture check for GP and specialist practices

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)…

Medical mindshifting: Practice owners need to address conflicts within staff

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:…

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Mastering the medical mindshift: The problem child of organisational quality

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.

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GP and specialist management: Systematically finding the right practice management consultant

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.

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