Table 2 System of categories: determinants for success or failure of inter-physician collaboration
| Â | Main category | Sub-category | Anchor quotation |
|---|---|---|---|
Modifiable | Communication | Professional level | P22: Even if there are no issues I would advise everyone to set up structured meetings that ensure feedback and consultation. It doesn’t have to be every week, but once a month or quarter. And it should be in a casual pub atmosphere. So that people can really speak up about anything. |
Personal level | P4: […] everyone should clearly state their interests […] and negotiating always means that both have to compromise […] from today’s point of view, I would say spending 2000–3000 Euro for a facilitated negotiation with a professional would have been a good investment. | ||
Collaboration partner | Mode of acquaintance | NP10: […] and I notice that the best and most secure collaborations are the ones where junior doctors, who have worked in the practice join in. [...]if somebody had worked in the practice for some time already, for their specialisation or as a locum, if they know the practice [..]. | |
Moral concept and values | P4: Strong differences in moral concepts and values lead to failure, that is quite simple. […] | ||
Degree of specialisation | NP8: […] On the other hand, as soon as you are more specialized in a group practice or an association, it reduces comparability; and the less comparability the less trouble develops […] | ||
Practice management | Organisation in general | NP1: But this is always subjective and the more professional the level, meaning the more people work together, the more intense the organisational structure, maybe with a manager or as alimited company, the less relevant these elements become, and fewer will fail. So I think if you want to build a long- lasting arrangement, you have to try to raise the professional level.[…] | |
Staff | P4: […] We treat staff very differently, which makes them insecure. This was one condition that led to the failure of our practice.[…] | ||
Distribution of duties | P4: […] in my personal opinion it’s not the money, or financial imbalance, in fact it’s the uneven distribution of administrative duties, like computer systems etc. | ||
Consulting services/ Delegation | NP12: […] and to organise the things you’re not familiar with, that’s the key solution. To have a good tax consultant, so someone is in control, to have a bank that you trust involved, these are the things that I don’t want to deal with when I’m in my practice treating patients. And I have to find somebody else to do it […] | ||
Preparation for the group practice | Contractional protection | P4: […] define target agreements and – and this is absolutely necessary – to make contracts […] | |
Lack of work experience | P19: […]what I would advise someone above all else is: first of all, to work in a private practice, even if only for some hours or | ||
|  | weeks, just to see the work routine. […] Because private practice is very different from working in a hospital […] | ||
Time management | NP9: […] it’s always successful if they start planning in time, sensible planning, this is a common issue, even overnight, because there is a lot of time pressure. | ||
Use of consulting services | P21: […] many see our professional body, the Association of Statutory Health Insurance Physicians almost as an enemy if you want to put it that way. This is very foolish, because it’s a very competent, powerful and supportive organisation […] | ||
Financial aspects | Allocation of profits | NP15: […] and I would say, a common core issue is the allocation of profits and losses, if someone thinks they have worked more than the other and perceives the allocation of profits, if it is 50:50, as unfair. | |
Accounting | NP2: [...] They have an early warning system that realizes very quickly if something is going on. [...] the smaller [practices] send their billing to the KV every quarter and wait to see what will happen instead of having done in an organised fashion [...] | ||
Disappointed by lack of synergies | NP3: […] physicians expect that if they enter a collaboration, that they can basically cut their expenses in half. But it doesn’t work like that, and sometimes if expectations are too high, that can be a reason for failure, too. […] | ||
Entrepreneurial skills | Lacking preparation to self- employment | P21: […] A lot of naivety. Physicians start a private practice without any preparation. In terms of human, economic or any other form of organisational preparation. They just do it. […] | |
Underestimated complexity | NP13: What is very important for me is entrepreneurial awareness. Many doctors stumble into a collaboration without realizing that they have equal partners, that they share an entrepreneurial position. They underestimate the decisions they have to make in important business matters, in contractual matters. […] | ||
Hospital vs. private practice | NP2: […] they don’t talk about where they are going with their practice, how to handle self-payers, how much money do I require for my personal needs, how should we handle staff issues […] They don’t know this, if they have only worked in a hospital. | ||
Practice Concept | NP11: […] I think one of the main reasons is a deficit that almost every practice has, that there is no coordinated cooperative concept among the partners. […] I believe that numbers are easy, and every economist can illustrate numbers and build a finance plan. The more difficult part is to | ||
|  | agree on ideas for a concept like: Where do I want to go with my practice? How does it fit? What does my partner want? What do we want to offer in medical terms? And all these things […] | ||
Not modifiable | Gender specific aspects | Wish for collaboration Competitiveness | Â |
Willingness to cooperate | Motivation for collaboration Financial commitment Medical specialty | ||
Personality | Favourable qualities Unfavourable qualities Constellation of personalities | ||
Personal consideration | Aims Self-esteem and content | ||
Mode of operation | Division of work Working pace Commitments outside the practice | ||
Interpersonal aspects | Between doctors Working climate | ||
Medical expertise | Professional consensus Degree of specialisation Liability | ||
Private aspects | Interference from spouses Changed consumer behaviour Altered environment | ||
External factors | Economic crisis Urban/rural differences |