Building big health care service businesses is not easy. These are complex, regulated organisations that encompass professions which have their own credos and approaches.

Operators are rising to the challenge in many ways.  Siemens Healthineers, which now sees itself as a solutions provider, has moved from a top down approach in which employees follow hundreds of regulations to one where employees are empowered and abide by a list of nine principles which they are expected to internalise and adhere to.

Unilabs, a big European lab group, gives senior staff their own business coaches. And it uses a 360 approach which gives staff clear feedback from bosses, peers and direct reports. Individuals are then invited to explain their behaviour, to explain the underside of the iceberg – the life history which explains our behaviour.  It is an approach close to group psychoanalysis which is designed to build teams and trust.

Rewards are also being examined. Wellspring and Clove, the largest primary care and dentistry groups in India, pay a flat salary to medical staff with a 10% bonus which is entirely dependent on quality. That is completely contrary to the norm in India where commissions and payment by activity are central to most practitioners income.

But they are radical steps for many Europeans. In the UK for instance, the NHS still pays dentists by activity.

We’d argue that all of these steps and more are necessary if health care operators are to build the sort of quality that they need to achieve to really prosper.  Imagine the word of mouth when a client realises that their dentist really is more concerned about the life expectancy of your teeth than doing drill and fill.

It is fascinating to track the M&A that shows how the sector is consolidating. But it is what is happening inside organisations that is the real story.  Inside just about all large groups we think such radical experiments are being conducted and monitored. And it is this which makes the private health care services sector so revolutionary.