gms | German Medical Science

The German healthcare system is facing an ongoing radical change and development [1], [21]. Rapid advances in medicine, medical technology and pharmaceuticals, the ageing of the population, the increasing tendency to urge hospitals and medical staff to work in a profit-oriented way constitute among other factors clear present and future challenges [1], [21]. The health sector has become an enormously dynamic and complex market that also implies continued escalation in health spending [1], [17]. Physicians and surgeons in particular increasingly complain of increasing stress attributed to measures aiming at cost reduction in hospitals [1], [13], [21].

In the German healthcare system, priorities were always put on free choice, ready access, high number of providers and high-tech equipment than on cost effectiveness or cost containment and, indeed, this was always supported by the public [24]. In the last 20 years, substantial changes have been implemented to allocate resources more efficiently aiming at meeting the health needs of the increasingly demanding population [8]. Whether the high level of spending on health improves quality care is becoming doubtful [8]. Therefore, cost-efficient use of resources is essential [5], [6], [8], [12], [22]. This issue was mentioned by the World Health Report 2000, which ranked Germany at number 25 in health system performance [8], [23]. Despite the fact that this report was criticized for its methodological weaknesses, Figueras considered the general conclusion regarding Germany as valid [8].

According to the German Federal Ministry of Health, nearly 2,200 hospitals and over 300,000 doctors care for about 72 million members of the statutory and 8.5 million privately insured [2], [3], [18]. Furthermore, an increasing number of people (currently about 4.3 million) find jobs in the health care system in spite of the difficult economic situation [2], [3], [18]. Annual health care expenditure totaled to approx. 293.8 billion Euros in 2011, which amounts to 11.3% of the gross domestic product [4], [19].

Germany is well known as the largest market in Europe. Therefore, it highly attracts the industry of medical technology, pharmaceuticals, and biotechnology. According to the German Federal Ministry of Health, in 2005 over 3,000 new patents in the medical field were noticed, Germany being second to the United States among world market leaders in the sector of medical technology [2]. However, a health care system is not a “normal” market. The highest priority must always be patient satisfaction and the delivery of good medical and human service. Patient satisfaction is relatively high in Germany compared to other European countries [10].

The health care market in Germany has became an increasingly complex, dynamic and volatile business in which future events become largely uncertain and unpredictable. Strategic planning has to keep up with these challenges. It must enable hospitals to quickly and flexibly adapt strategy to changes in the environment that become essential to their success [9], [26].

To achieve this task, a modern strategic planning tool is needed with strategic planning processes offering the alignment and integration of external and internal perspectives enabling hospitals and managers to plan for multiple outcomes and options and therefore provides a sound basis for facing increasing challenges [9], [25], [26].

There are several strategic planning tools [14], [15], [16], [20], [26]. According to these tools, future scenarios are developed with corresponding strategies for each scenario. Yet, the most important task is to develop a strategy that can be applied with success in all possible scenarios. This is known as the core strategy [26].

Increasing hospital performances by getting healthcare professionals to speak the same language: complementary education as a core strategy!

Sound management is the pillar of good performance in hospitals. This is common sense. This fact has been supported by findings of recent research from McKinsey & Company and the Centre for Economic Performance at the London School of Economics [7]. In this study, the management practices were assessed in nearly 1,200 hospitals in seven countries (Canada, France, Germany, Italy, Sweden, UK, and USA). A further report pointed out that priority must be given to increasing the number of managers that possess both the clinical and the managerial skills [11].

The core strategy for hospitals in Germany is complementary education of the medical staff as well as top management. The medical field is a vast and fascinating one, but it is limited within the boundaries of hospitals. Medical practice is a huge responsibility. Further, doctors always try to keep up with scientific and medico-technological development. This necessitates continuous self-education in the medical field, attending workshops, seminars and engaging in scientific research, especially in university hospitals. This hardly leaves any time or mental capacity for perception of non-medically oriented fields of life. Their sight outside the health care field is very short. Economic and business principles and guidelines are particularly foreign to medical professionals. It is, indeed, a different line and a different kind of thinking. Therefore, doctors must be educated in business and economics.

Non-medical hospital executives, on the other hand, are already diving in a totally different medium. They possess the know-how of business and economics. But they definitely lack the insight in the facts of the medical profession ranging from the art of dealing with human nature and human body up to the enormous responsibility carried by the medical staff and the tremendous workload they are exposed to.

The only way to deal with challenges facing the health care system, at least on the hospital level, is to get all parties to speak a common language paving the way for understanding and accepting each others’ opinion. This is the only way to get them together in the same boat. Otherwise, the medical staff and non-medical hospital executives will continue speaking different languages and setting totally different priorities. It is not a matter of who is right or wrong; it is not an issue of who thinks better or worse. It is simply a matter of getting both parties to set common priorities and search for the strategy line that yields mutual benefit.

Proper and complementary education is, indeed, the core strategy. Accordingly, courses, workshops or even part-time graduate or postgraduate education in business and economics is recommended for the medical staff. The question raised here is: who should pay for this? Well, either doctors are willing to invest in themselves seeking a broader insight in life or complementary qualifications that make them more competitive, or hospitals introduce conditioned sponsoring programs, e.g. financing workshops or seminars or education requiring a minimum duration of further employment of the candidate. If the candidate decides to quit, she or he has to pay back to the hospital.

As far as non-medical hospital executives are concerned, there is no better way than to host them in a hospital department for a period of 6–12 months, introducing them to the daily medical activities, of course without self-performing sophisticated medical care. This should be certified by the supervising medical staff. And this certificate and training program should be considered as a prerequisite for occupying management and top management positions in hospitals.

Further, it is time to reconsider the long tradition of appointing the head of medical departments based solely on the medical academic career. I believe that choosing the head of a hospital department or a clinic must be based on the personal ability or potential to lead and to manage in addition to the experience on the pure medical field. The ability to lead and manage is a gift. It can be stimulated, strengthened and developed by complementary education in business, economics and leadership.

The health care sector has become enormously dynamic, complex and volatile market in which future events are uncertain. Strategic planning has to allow hospitals to quickly and flexibly adapt strategy to changes in the environment. This is essential to ensure a sustainable success. Proper and complementary education of the medical staff as well as of non-medical top executives and managers of hospitals is recommended as the core strategy. This harmonizes both professional medical and managerial efforts with a synergy effect that allows soundly facing the increasingly challenging environment of the health care sector in general and in hospitals in particular.

The author declares that he has no competing interests.

This work is adapted from the Master Thesis “Scenarios for the German health care system using the example of a University hospital” submitted for the partial fulfillment of the MBA-Degree in General Management at the HHL in 2010 and was supervised by Prof. Dr. Torsten Wulf and Philip Meißner, MBA, Leipzig Graduate School of Management, HHL.