The consequences of the ?metricnorance“ of German GPs and specialists

What it's all about

GPs and specialists in Germany traditionally have a distanced or even hostile attitude towards business management methods and instruments. In this context, there is also talk of "metricnorance", formed from the words "metric" and "ignorance". The term refers to the ignorance or deliberate disregard of important metrics that provide insights into what is happening in practice. In doing so, they overlook the immense potential for analysis and organisation that they are foregoing and which could help them to drastically improve not only the quality of their patient care, but also their own working conditions. The following example describes what practice owners are foregoing with a metricnorance mindset.

The best practice dashboard

The best practice dashboard shown above is one such optimisation tool. The easy-to-use tool shows all aspects of the practice management performance of a medical practice at a glance. All that is needed to determine the data is half an hour's work on a catalogue of questions, supplemented by a staff and patient survey. Its benefits lie not only in the systemic-holistic analysis concept, but also in the possibility of using the key performance indicators (KPIs) determined for the further management of the practice's work.

An example of the dashboard insights

The dashboard illustrated shows the result of best practice benchmarking in a GP practice with one doctor and four employees. The data collection revealed that only 47% of the best practice standard is utilised. This validated guideline describes all the regulations, instruments and behaviours that are essential in the areas of practice management described to ensure that the work functions smoothly even under changing requirements. When reviewing the values, the areas of low performance immediately catch the eye:

?? A high implementation rate in medical patient care is offset by a low quality of care as perceived by patients (Patient Care Quality Score, PCQS, measured as satisfaction in relation to requirements). The recommendation rate, determined using the Net Promoter Score, is also low. This is primarily due to the poor process quality, which leads to long waiting times at the practice, even though appointments are allocated. The waiting times for new and follow-up appointments are just as long. In addition, practice owners and staff significantly overestimate patient satisfaction (estimated PCQS). As a result, many opportunities for improvement and the need for change in practice management are overlooked.

?? The Teamwork Quality Score (TQS), which reflects the realisation of the working conditions necessary for "real" teamwork from the staff's point of view, makes it clear that the staff in this practice only act as a functional team. Here, work performance is characterised by "service by the book" and "lone wolf behaviour", caused by a low level of management intensity. For example, there are no target agreements, nor are feedback discussions held or appreciation expressed.

?? The fact that the practice as a whole functions inadequately is also due to the fact that there are hardly any planning activities in the form of a strategy, objectives, USP and target group concept. There is also no value system to guide the employees.

?? A lack of attention to and implementation of time and self-management principles puts the practice owner and, as a result, his staff under constant stress, which in turn leads to a large number of careless mistakes.

Conclusion

Looking back at the details of the documentation and questionnaires, over seventy optimisation approaches were identified for the company studied, which could not only increase the quality of patient care, but also efficiency, productivity, working conditions and ultimately the success of the practice. The dashboard is an example of how business management tools can positively change the day-to-day running of a practice; the only obstacle to benefiting from this comprehensive use is changing the mindset that rejects business management.

Futher reading

• Bauer JC. Physician practice management: essential operational and financial knowledge. Jones & Bartlett Learning; 2022.
• Butcher L. The high-performing medical practice: workflow, metrics, and best practices. Productivity Press; 2020.
• Deckard GJ, Borkowski N, Diaz D, et al. Physician practice management and performance measurement. Health Care Management Review. 2021;46(4):340-350.
• Ginter PM, Duncan WJ, Swayne LE. Strategic management of health care organizations. John Wiley & Sons; 2023.
• Henson JW. Optimizing practice management: billing and collection strategies. Neurology. 2020;94(6):265-269.
• Kuhlmann E, Groenewegen PP, Bond C, et al. Primary care workforce development in Europe: an overview of health system responses and stakeholder views. Health Policy. 2022;126(1):1-8.
• Lussier RN, Corman J. Management fundamentals: concepts, applications, and skill development. SAGE Publications; 2022.
• Mitra S, Sinha PK, Mukhopadhyay A. Artificial intelligence in healthcare operations and management. Springer; 2022.
• Raus K, Mortier E, Eeckloo K. The patient perspective in health care networks. BMC Health Services Research. 2020;20(1):1-9.
• Zuckerman AM. Healthcare strategic planning. Health Administration Press; 2021.

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