Emergency physicians in the Netherlands:the development and organizational impact of new multidisciplinary professionals in hospitals

This thesis investigates the organizational impact of a new medical occupation in Dutch hospitals, i.e. so-called emergency physicians (EPs). These doctors receive a 3-year non-specialist training, aiming to enable them to diagnose and treat patients in emergency care units in hospitals. The study follows two objectives: First, we provide an insight in factors that contribute to similarities and differences of the EPs’ occupational development and the development of their professional role. To this end, two comparisons are conducted: 1) EPs’ professional development in Netherlands to the UK, where EPs have been existing as a medical specialty for decades; 2) the development of the EPs’ occupational role within different Dutch hospitals. These parts of the study are based on literature reviews, document analysis and expert interviews. Second, we investigate under which conditions and to what extent EPs can contribute to a better fit between contextual characteristics and the organizational structure of emergency care units, leading to a better organizational performance. This second part of the study is based on the comparison of seven in-depth case studies. Data were collected by means of both quantitative and qualitative methods. The UK is often referred to as a role model for the use of EPs in the Netherlands. Still, both countries differ with regard to the occupational development of EPs and their utilization in hospitals. The same applies within the Netherlands: the implementation of EPs and the subsequent development of their occupational role differ between Dutch hospitals. These differences can be explained by the local force fields and by the influence of certain actors, mainly medical specialists. EPs can only contribute to better organizational performance if the work structure enables them to work rather autonomously. However, the local integration into existing medical hierarchies and the delegation of decision making power and responsibility in patient care are often difficult. If existing work structures are not modified, EPs can become an additional layer in the patient care process and limiting rather than advancing organizational performance