2. Health Care Fundamentals and Oral Health Care Management
2.3. Existing Oral Health Care Management Publications
2.3.3. Clinic Organisation and Controlling
Controlling is a wide field. Mostly controlling refers to the monetary and financial controlling that is being pursued in the managerial process of supervising bookkeeping and
25 S. Kock, 2012, p. 126
26 S. Kock, 2012, p. 115 f.
27 Grzibek, 2013, p. 20
28 e.g.: Esders, 2007: a guidebook with suggestions and guidelines for the creation of standard operating procedures
29 Ewerdwalbesloh, 2018, p. 2f.
30 Kollwitz, 2013
31 Franz & Seidl, 2018, p. 46
32 Däumler & Hotze, 2017, p. 150; Franz & Seidl, 2018, p. 46; Koch, 2018, p. 429
33 Däumler & Hotze, 2017, p. 153
numbers whilst running a company. However – depending on definition – controlling can be seen as a much wider field. At the example of health care businesses, 34 35 has divided controlling into a range of different parts that all play a major role when running an HC business (see Figure 4). Whether all of the shown fields really belong to controlling and if they all apply to a practice of a general practitioner or a dentist is to be exploited in the subsequent paragraphs.
Figure 4: The Fields of Controlling in Health Care
36
34 Frodl, 2012, pp. 77–136
35 2012
36 adapted from Frodl, 2012, pp. 77–136
Controlling
1. Cost-Controlling
Investment-2.
Controlling
3. Solvency-Controlling
Organisation-4.
Controlling
5. Medical-Controlling 6.
Personnel-Controlling 7.
Marketing-Controlling 8. Care-Controlling
9. Logistics-Controlling
One of the major issues doctors face, are their limited accounting procedures 37 which do not allow for proper 1. cost controlling (Figure 4) Bookkeeping / accounting information is usually several months delayed 38, does not use clear accounts, is by definition difficult to be understood and in addition usually not presented in a way for the decision-taker (medical practitioner) to understand and process the relevant information 39. Modern advice literature recommends that practitioners, willing to open and run their own facilities, shall participate in extensive business training, in order to face and stand up to the challenges, they may face when running their own company 40. If costs are not properly understood and controlled, no 2. investment controlling or 3. solvency controlling (Figure 4) for the company can be pursued and thus wrong decisions can be a result. Economical changes of the circumstances often are not realized 41. Consequently the living standard of the owner-managers are not adapted to the changed circumstances and lead to over-withdrawals that put the company at further risk
42. Accounting and controlling procedures, even by doctors in crisis, are not seen as a necessary or useful tool in strategic business planning, but much rather as an outsourceable
“necessary evil” that does not show relevant information 43. However, management advice literature agrees that clear, well-understood and properly implemented controlling procedures are a requirement for successful practice management 44 and thus should be implemented more frequently 45. Significant potential for the improvement of clinic 4.
organisation and respectively adequate controlling (Figure 4) procedures is in the optimisation of daily processes and in fact the practice infrastructure as such 46. Especially when optimizing the invoicing of services to the publicly health insured or the HCI provider respectively, remunerations can be optimized and thus increased. 47. Further profit potential in medical practices – this is not applicable to OHC – can be found in the so called IGeL-Leistungen, a kind of service financially supported by the patient rather than fully paid by the insurance 48.
37 J. Kock, 2015, pp. 50–54
38 S. Kock, 2012, p. 123; Meßmer, 2015
39 J. Kock, 2015, p. 53
40 Grzibek, 2013, p. 21
41 H Börkircher, 2004, p. 149ff.; Lehmeier, 2004, pp. 6, 8
42 Meßmer, 2015
43 S. Kock, 2012, p. 122
44 Ewerdwalbesloh, 2018, p. 24f.; Frodl, 2012, p. 23
45 Ueberschär & Demuth, 2015, p. 138
46 Ewerdwalbesloh, 2018, p. 4f.
47 Ewerdwalbesloh, 2018, pp. 8–14, 91
48 Ewerdwalbesloh, 2018, p. 15f.
Covering and explaining these services in detail would – since not being applicable to OHC – exceed the limitations of this study. In OHC there is something similar being the non-contractual services (NCS). NCS refers to services that are not paid for by the HCI, but the patient. The quality of appointment planning also has a significant impact on patient movement in the clinic, waiting times and thus patient satisfaction overall 49. 5. Medical controlling (Figure 4) refers to the standards of medical care provided by a practitioner and the control of the quality of the service, especially when more practitioners are collaborating and offering their services in one system. The impact of medical quality on the entire company is explained in section 2.3.2. 6. Personnel controlling (Figure 4) is being explained in section 2.3.4 in which general HR and leadership topic in the context of practices are being discussed and elaborated upon. 7. Marketing controlling (Figure 4) basically refers to the measurement of results of any marketing endeavours pursued by the company. Here, however, it is to be stated that it is particularly difficult to measure the tangible results of marketing activities.
Which marketing activities can be pursued and how the market / patient is to be understood before selecting the respective activity / strategy is explained in section 2.3.6. 8. Care controlling (Figure 4) is not applicable to normal practitioners that do not offer outpatient care. Only example in the case of OHCs are surgeons, providing ambulant care services straight after surgery, whose quality is to be maintained and measured. 9. Logistics controlling (Figure 4) is only a field in hospitals, bigger HCCs or large clinics with several owners. As a consequence, it will not be covered in this paper.
Whether all aspects shown in the figure and discussed above really are part of controlling can be discussed. Nevertheless, the model is presented here in order to show that – also in HC – a range of controlling procedures can be completely incorporated in the entire business model. If the model is implemented, controlling oversees all business functions and turns into a properly reported tool, allowing for a fast way to find parts of the company that challenge the ongoing success of the business.
49 Havers, 2016, p. 108; Nowak, 2008, p. 133
2.3.4. Human Resources Management in the Oral Health Practice