Introduction: The German healthcare system is facing ongoing radical change and development. The increasing tendency to urge hospitals and medical staff to work in a profit-oriented way constitute among other factors clear present and future challenges. Physicians and surgeons in particular increasingly complain of increasing stress attributed to measures aiming at cost reduction in hospitals. The highest priority must always be patient satisfaction and the delivery of good medical and human service.

Problem description: The health care market in Germany has become an increasingly complex business with uncertain and unpredictable future events. Strategic planning has to enable hospitals to quickly and flexibly adapt strategies to changes in the environment that become essential to their success. The most important task is to develop a strategy that can be applied with success in all possible future scenarios. This is known as the core strategy.

Discussion: The core strategy for hospitals in Germany is complementary education of the medical staff as well as top management. Accordingly, courses, workshops or even part-time graduate or postgraduate education in business and economics are recommended for the medical staff. As far as non-medical hospital executives are concerned, there is no better way than to host them in a hospital department for a period of 6–12 months. This paves the way for understanding and accepting each others’ opinion which increases hospital performance.

Conclusion: Proper and complementary education of the medical staff as well as of non-medical top executives and managers of hospitals is recommended as the core strategy. This harmonizes both professional medical and managerial efforts with a synergy effect that allows soundly facing the increasingly challenging environment of the health care sector in general and in hospitals in particular.