Interviews Hungary

Figure 20: Interview Results Hungary (own development out of primary research)

The structured qualitative research in Hungary – due to limitations in funding – was mainly pursued in Sopron, where the researcher was present for meetings at the research institution. Additionally, some personal contacts allowed for telephone interviews with professionals in other parts of Hungary. Overall in this research about Hungary, 14 Hungarian OH professionals were interviewed. Due to some of the practices in Hungary to be organized not as doctor-owner-run practices but more as business optimized companies with employed practitioners, some of the interviews were also pursued with management professionals – in such case primarily women in charge of running the business side of the practice. For purposes of giving some structure to the respondents the interviewees were grouped as shown in Table 3. It is to be mentioned here, however, that such grouping may lead to misinterpretation since

Interview Results Hungary

Strict Separation of

• Medical and Management Duties

• Ownership and Medical Profession

Different legal forms are common

More Business thinking

• Monthly business meetings

• Change analysis

• Market monitoring important

Dental Tourism 50% or more of Revenue

• International customer more lucrative

• Limited treatment time

Very little marketing

• WOM!

• Patient orientation

Most found after 1990 Medical staff training

very important

respondents in some groups are very different in the understanding of their tasks and duties.

Even though no significant focus has been placed on the gender of the respondent, it shall be mentioned, that eight of the nine medical professionals were male and that four of the five business professionals were female, no matter their age. Only one of the interviewees was below forty years old, a female business professional (HPB2). Figure 20 shows which aspects seemed important to Hungarian subjects according to the interviews. Interestingly it was significantly harder to find public listings of practitioners in Hungary than it was in Germany.

It might be linked again to the language, however, the subjects placed significantly more importance in the interviews to offline personal recommendations than the German practitioners eventually did.

Out of the small number of respondents in Hungary, it comes out, that ownership and medical profession are to be treated separately. Whereas four of the six interviewees of practices with less than ten employees were working in practices that were owner-run, only one of the employees that was working in a practice with more than ten employees would work in a business that was owned by medical professionals only. This implies that ownership – as soon as the business turns significantly profitable – tends to be treated separately from medical management. At larger size of the entire company (not only dentistry but also other non-medical business offers) different legal forms including the AG were implemented.

Due to language barriers and the geographical focus on primarily Sopron and a bit Budapest, all subjects that participated in the interviews were addressing at least part of their services to tourists. The international customer would be much more lucrative, however came with the challenge that across border financial claims are not enforceable, a challenge especially addressed by HPB4 and HPB5 working in Budapest but also by HPB3 who had experience in both cities. It seems that this is a challenge that is more present in the capital, since none of the practitioners nor management professionals based in Sopron or not experienced in Budapest mentioned that as a challenge or specific duty to be taken care of.

Eleven of the fourteen professionals worked in practices which were founded either 1990 or later (HMS1, HPB1, HMB3 were found earlier). About 40 % of all participants worked in companies since their foundation or were somehow actively involved in the foundation of the clinic. The foundation of a practice seemed to be less of a challenge to the research subjects than the continuous monitoring of the market. No matter the size of a practice, duties were always split in a way for practitioners to only secondarily be involved in non-medical

decision taking and challenges. Even in the smallest practice with only two team members (including the owning doctor), the practitioner would do nothing but treat patients (HPS3) – his assistant had to care for all other duties from appointment planning, over material ordering to marketing and also treatment assistance. To all participants of the study (but HPS3) it was totally clear, that goal planning was crucial, business processes are a requirement for success and that reporting needs to be monitored closely. Apart from HPS3 and HMS1 all clinics were totally clear on the need of monthly report meetings to meet business goals. If business goals were not met, none of the clinics – according to the research subjects – would decrease staffing size, however understanding of the reasons for change would be paramount in order to adapt behaviour and succeed in the near future. HPB4 explained that it was crucial to understand the reasoning of changes directly in order to be able to react to the market.

HMB2 explained that business would always go down between July and September which would be a normal yearly cycle. In July because of holidays (but their business would keep open since working with 9 practitioners overall), in September because of wine harvest. Their customers in these months would have another focus. Since the employees in HMB2 prefer to take holidays in other seasons of the year, taking holiday in July would even be rewarded with an additional day of holiday. The majority of practitioners (86%, all but HPB1, HMB3) saw a continuous increase in demand and constant growth since the millennium. HPB1 and HMB3, however, were tackled by the increase of cheap flights to Budapest and saw many of their potential clients disappear there. HPB3 explained, that in his experience, working in Budapest came with the challenge of significant timing limits from the side of the customer who usually had booked return flights and no (planned) financial means for changes. HPS1 and HPS2 explained that marketing would not be a typical tool to use. In accordance with HMB2, the strongest tool for getting patients would be quality care and thus WOM. HMB1 explained that the network of their satisfied patients would be large enough for their practice to grow every year for decades. The use of beyond-border marketing measures - in fact - got HMB3 according to own information into a severe law suit in Austria since his marketing would not adhere to Austrian laws. No investigation about Austrian HC marketing laws nor their cross-border-breach-potential was pursued in this study. The comment of the subject is depicted but the case not screened.

All medical subjects agreed that no part of their studies prepared them at all for the challenges they face in business. The business requirements were mostly learned on the go

and in many cases professionalized with management / business employees. All practices but HPS3 were run as a business with operational standards and clear business goals.

Phenomenology allowed for the understanding that the majority of subjects stressed payment terms prior to treatment.

Figure 21: Importance of Business Success Factors according to Interviews in Hungary (own development out of primary research)

In order to allow for an understanding of the importance of the business success factors described in existing publications, the subject’s answers were translated in a scale from one to five for the eight factors found in the literature. Given that nearly all practitioners focused on the importance of patient orientation and saw marketing rather as a less important tool, the point was split in marketing as one point and patient orientation as another. The average was calculated for medical professionals, business professionals, for smaller and bigger practices and for all respondents as visualized in Figure 21. The visualization, however, does not grant statistical validity. According to the organization for economic co-operation

1 2 3 4 5

Planning, Strategies and Goals

Good Health Care

Clinic Organisation &

Controlling

HR skills, management and leadership

Continuous Staff Training Patient Orientation

Marketing Cooperation Models

Entrepreneurial Skils

Management Success Factors Interview Hungary

Practitioner Managment Small Big Average

and development in Hungary there are currently 6589 practicing dentists in 2017 ³¹⁵. Assuming that every subject’s opinion (no matter if practitioner or management professional) would represent the opinion of one practice, then the confidence interval would still be at 26%. Thus, even the strongest outcomes in this qualitative investigation can only be seen as trend and not as a reliable result. Nevertheless, it can be said, that the quality of care, continuous staff training and patient orientation seem to be important in Hungary.