We assist you in developing a proper set-up and organisational structure for your healthcare business.
Small, medium and large sized companies and clinic-groups require individual solutions in terms of leadership and organisation.
Given our hands-on approach, we are well aware of existing limitations and hence are able to propose the most suitable and advanced organisational structure for your operations.
55 to 70 percent of a hospital’s total costs are personnel costs. Recent rules published by the Federal Ministry of Health regarding reimbursement schemes depending on stipulated staffing structure in nursing cause severe staffing and performance challenges to hospital operators and owners.
Over the last years, a constant over-proportional rise of personnel cost vs. revenues can be observed in the primary sector., forced hospitals have been forced to compensate this worsened ratio by increased work efficiency including working pressure to the staff where ever rules and regulations allow to do so.
Antegrad supports in:
1. Setting up staff and staff qualification concepts for the primary sector at present and, in line with the corporate and medical strategy, for the future. Antegrad lays the foundation of concepts shaping the future of the client by establishing business plans (containing content and figures) to identify and benefit from business opportunities, including definition of time lines and assessing risks associated. This includes a catalogue of counteractive measures to be applied in case deviations and delays – plan vs. actual — occur over time.
2. Developing efficient business organisation concepts and assessing the adequate staff level and to cover all given tasks of secondary and tertiary functions.
3. Performing benchmarking analyses as a basis for make-or-buy decisions.
4. Drafting of performance based organisational structures, developing of the underlying transformation and development plan as well as setting up a performance management system for these areas (substantiation of each make-or-buy decision with its particular calculation and performance measurement scheme and).
5. Operational implementation of staff development and recommended changes.
While key success factors in the primary functions are identification and utilization of market niches, marketable medical portfolio, service coverage coordinated within the region, cooperations and deliberate competition, key criteria in secondary and tertiary service areas are efficiency and highest possible facilitation of primary services in terms of processes, scope of services and cost.
Business organisation concepts for Primary functions:
Market analyses, competition analyses as well as epidemiological and demographic developments determine the basic conditions for each medical discipline. Detailed and conscious development of a specific service portfolio for each medical department and specialty is absolutely crucial for the hospital’s future and hence an essential task for the management.
Antegrad facilitates this by:
- Achieving transparency of the market and chances/risks of the current service portfolio
- Reconciliation of a target concept for each medical department/specialty and the joint establishing of a development plan comprising scope of services, training and staff structure
- Management of implementation process and analysis of progress and deviations
- Identification of opportunities for cooperations and supply concept across sectors
- Implementation and funding
Business organisation concepts for Secondary functions:
Frequently the existing status is as follows:
- All secondary functions charge the costs of their services to the primary departments. Key staff in the primary functions are not satisfied with this procedure since they perceived charged cost as too high, particularly compared to the performance levels of services received.
- Given the fixed charging system, secondary functions are not exposed to usuals market pressure.
- Efficiency (according to applicable KPIs such as number of examinations per time unit etc.) is low compared to the one of external providers and response times are too high.
- There permanent tensions between secondary and primary services departments.
Antegrad contributes to and facilitates re-adjusting and coordinating the entire service process with the primary processes. Only the optimisation of the entire process (from ordering material up to provision of documented examination results) generates significant improvements rather than constant mutual blaming. Antegrad analyses existing obstacles and proposes alternative, harmonized scenarios. We structure the implementation plan and make concepts work in reality
Business organisation concepts for Tertiary functions:
Frequent findings made in tertiary areas are:
- A structural organisation according to service types
- Historically evolved organisation rather than one based on processes/teams
- Very limited transparency
- On higher management level: Little know-how and subject matter experience of these functions
This inevitably leads to:
- Low level of operational efficiency
- Low level of acceptance and respect for tertiary services staff within the hospital (Technical Department, IT etx.)
- Significant gap — in any aspect – between and non-medical staff
- Far too high operational cost for real estate/facility management, technical equipment/services, IT, general administration etc. – while at the same time poor service levels, long duration of project execution and perceived low levels of competence.
Antegrad provides very specific and proven assistance to define the requirements for tertiary service functions as well as standardizing all processes of services requests by the users. We support you developing and implementing state-of-the art service concepts (e. g. decentralized catering or digital supply chain). Antegrad’s approach is always based on close cooperation and reconciliation with the client. We strictly recommend applying a true expert’s view to shape the new organisation. By this, we clearly differentiate ourselves from consultants who use to develop organisations and scope if services in a bottom-up procedure mostly based on opinions and preferences of client’s key staff. Antegrad is able to utilize and refer to its comprehensive operational experience in different business lines to transfer proven concepts to healthcare operations.
If we prefer it or not – as a hospital manager, one is in full competition to private medical practices and other hospitals. Hospital operations have emerged to be a business, and hospital owners expect profits in each fiscal year. In case of constant failure to achieve that the ‘usual’ entrepreneurial basic scrutinising concerns are raised, leading to the existential question: Can the entity continue to exist and offer its services to the market?
Even if this direction is subject to well-based macro-economic and ethical discussions, these frame conditions have to be deemed and observed as given by any hospital management, for now and at least the midterm future.
As a consequence, management has to be fully aware of its cost and services of the hospital – at all times, in a detailed and reliable manner. Leadership should be fully aware which services generate profits (and which don’t), which functional area is has acceptable cost structures (and which haven’t) and should consciously direct development and investment funding streams.
Transparency of accounting and reporting systems is an inevitable precondition for each responsible entrepreneurial decision making. In any case, the adequacy of the existing structure of the accounting/reporting system has to be critically examined if the above purpose is fulfilled in a reliable manner .From our experience, frequently chief doctors / heads of department do not take questions and challenges to their results serious, since the figures presented are invalid and/or non-transparent and cannot be verified undoubtedly.
Together with its clients, Antegrad develops the most appropriate accounting and reporting system. Derived from the organisational structure, we recommend simple accounting and reporting structures and clear rules of revenue and cost allocation – and we implement the same.
Does a hospital need to manage and execute its construction projects with own resources only?
Can we seriously expect staff members of a hospital construction department to handle such projects in a fully professional manner?
Do we have to perform each and every test procedure in the own laboratory?
Does the hospital really need to operate own technical workshops and — if yes — what should be their scope of services, what services are excluded and who is entitled to draw that line?
Is an own kitchen required and do the cleaning services need to be conducted with own staff?
In any hospital, these questions are answered in a very heterogeneous way – however, the ‘border lines’ frequently are not set based on conscious decisions. They just have emerged over time, and it remains unclear if the existing split between make or buy may lead to satisfactory results and can be deemed efficient, swift, adequate and cost worthy.
Antegrad challenges all those topics in depth and provides comprehensive and diligent response to the management – along with an outline of the potential in terms of factual/timewise and financial impact. Antegrad assesses existing competencies and resources as well as options in all functions and recommends the ideal make-or-buy interface. We set up the transformation plan and assume the project management rule in the transformation / development phase as well as for key projects (including construction projects). Antegrad achieves transparency in the tertiary sector, drives services towards market levels and ensures full external comparability. We are prepared to operationally manage these functions during the transformation phase, to execute transformation and to develop the talented staff members who are capable to continue developing the organisation after Antegrad’s exit.
Do you have questions or want to obtain further information?
Please get in touch with us.
Your contact partner: Gerhard Becker