Why do medical specialists at university hospitals keep leaving and how could they be encouraged to stay at hospitals for longer? These were just two issues looked at by zeb/business.school, a Steinbeis Transfer Institute belong to Steinbeis University Berlin, in collaboration with the management consultants zeb and the University Hospital Muenster (UKM), in work conducted in its clinic for anesthesiology, operative intensive care and pain management. It was all part of a joint research project called FacharztPlus. The aim was to establish why people left the hospital and define measures to keep specialists on board by improving working conditions and career prospects.
The aim of the project, which was sponsored by the Federal Ministry of Education and Research (BMBF), was to identify suitable measures to encourage medical specialists who have just completed their five- or six-year training to stay on for another five years, if not longer. The project covered three main research topics:
One important part of the project was an assessment of the current situation at the UKM. Measures previously introduced at the clinic to address issues of a specialist, methodical and technical nature had not been enough to address the shortage of doctors, so as the project progressed, attempts were made to identify possible solutions from outside the industry. Any solutions identified to solve the problems at the clinic will be checked from a statutory, organizational and technical standpoint and translated into an action plan. The initial work carried out at the clinic and subsequent evaluations serve as the foundation for implementing the measures for further testing in other pilot projects. This additional work will be carried out at selected departments of the UKM, as well as on-site at project partners: RWTH Aachen University Clinic and the University Medical Center in Rostock.
The situation analysis in the first stage of the project involved over 50 interviews – nearly the entire sample of senior doctors and specialists at the hospital. The senior doctors were invited to imagine they were in the situation faced by the specialists. The interview latest around 90 minutes, with questions covering perceptions of strengths, weaknesses and suggested improvements, especially in terms of work organization, leadership, work ethics and staff development. The interviews were based on a technique called “generative dialogue” – conversation in a safe, private setting aimed at thinking up ideas. The results of such interviews give pointers in terms of strengths, weaknesses, hurdles and challenges at the hospital. For the majority of the interview, open questions were used and around 2,000 qualitative statements had to be assessed before being sorted by topic and evaluated as positive or negative. This resulted in a strengths and weaknesses profile of the hospital as described by the specialist doctors, with indications on areas where action was needed and the priorities for further research.
With the help of net promoter scores (NPS), a technique used in market research, the project team was also able to use the interviews to quantify the satisfaction levels of senior doctors and specialist when it came to staff training and the work of senior doctors. The aggregated NPS of the respondents showed how many were actively supportive (“promoters”) and how many were more critical (“detractors”). The respondents were asked to rate on a scale of 0 to 10 whether they would recommend certain areas to others. The ultimate NPS is the relative difference between the number of promoters and detractors. The results showed that medical specialist training was generally recommended by the specialists, but that they were not likely to recommend subsequently working as a specialist.
Another market research technique that was used in the interviews to gain quantitative feedback was the semantic differential. This involves scoring the item being investigated using attributes on opposite ends of a scale. The Likert scale was also used. Both questioning techniques were applied to the company culture.
To identify potential improvements that could already be made during training and understand the prospects in other areas affected by specialist shortages, a random sample was also included in the situation analysis, consisting of assistant doctors and nursing staff. To do this, another interviewing technique was used based on repertory grids, in order to evaluate items based on an individual rating system with opposite poles and scales from the respondents. The underlying idea behind this kind of personal construct was strongly influenced by the American psychologist George A. Kelly. According to his theory, people distinguish and organize their surroundings into individual constructs, some of which are similar or dissimilar. So in the interviews, respondents were asked to what extent groups such as their own or different professions were more like each other or different, and to define opposite poles for different terms. This was also carried out for the clinic, versus the whole UKM. The method made it possible to derive differences between care workers and doctors, or the changing attitudes of doctors as their job progresses.
The problem with the lack of doctors is not just on a superficial level. It is actually threatening the performance of the hospital in the long term. By exchanging notes with industry associations, chambers of industry and commerce, and hospital operators, the project team members ascertained that the problem is by no means limited to the UKM. Many German hospitals share the same structural problems, especially university hospitals. There is clearly no simple solution: the problem must be solved on a holistic level and not just through individual measures. The market research confirmed the suspicions of the project partners, namely that within the hospital sector there are only a few feasible solutions. Also it would be of little use to transfer solutions directly from other industries. The FacharztPlus project will thus concentrate on developing solutions that can be adapted individually to the problems faced and optimized in order to do justice to future challenges.
An important part of the FacharztPlus project will therefore be to keep the lines of communication open between industry representatives, scientists and external institutions and companies. Many conferences and conventions were attended in 2014. The project team also organized a scientific conference in November 2014 on the topic of demographics and skills management, which also looked at the project findings and issues related to gender and age differences. The speeches and articles submitted at the conference will be published in due course in a volume of proceedings.
Prof. Dr. Joachim P. Hasebrook
Steinbeis Transfer Institute zeb/business.school (Baden-Baden)
Univ.-Prof. Dr. Klaus Hahnenkamp
Anesthesiology, intensive care, emergency medicine and pain medicine at University Medicine Greifswald (UMG)