Organisational Development

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

Antegrade optimizes the
hospital performance

We sup­port your health­ca­re com­pa­ny on all levels to achie­ve a bet­ter stra­te­gy and orga­niz­a­ti­on.
We cover the fol­lowing key aspects:

Organizational development

We help you deve­lop a sui­ta­ble struc­tu­re and orga­ni­sa­ti­on for your health company


We exami­ne your depart­ments in detail and deve­lop the ide­al port­fo­lio for your indi­vi­du­al tar­get market.

Development & control of the entire tertiary area

We impro­ve per­for­mance and effi­ci­en­cy across all parts of your busi­ness — from cate­ring ser­vices to cen­tral sterilization.

Corporate management systems

With a cus­to­mi­zed cor­po­ra­te manage­ment sys­tem, your hos­pi­tal will be more trans­pa­rent, and visi­ons will be more easi­ly implemented.


As an inte­rim mana­ger, we help you to impro­ve your manage­ment, imple­ment chan­ges and sup­port you on all levels.

Cooperation Development & Merger

We help you to coope­ra­te with other com­pa­nies, deve­lop the allo­ca­ti­on of tasks and crea­te a win-win situation.

Digitalization & IT development

We accom­pa­ny you com­pet­ent­ly on the path of digi­ta­liz­a­ti­on — from the pro­cess con­cept to digi­tal stra­te­gy deve­lo­p­ment and implementation.

Business Management & Training

Antegrad deve­lo­ps effi­ci­ent manage­ment sys­tems, hel­ps with its imple­men­ta­ti­on and trains the managers.

Distressed Health Care

We sup­port you with all necessa­ry mea­su­res for your hos­pi­tal and help you to opti­mi­ze
your stra­te­gic positioning.