Faculty of Economics and Business, Department of International Business & Management, University of Groningen, Groningen, The Netherlands.
J Health Organ Manag. 2011;25(1):73-93. doi: 10.1108/14777261111116833.
This paper aims to investigate the forces that influence the shifting of professional boundaries on the entry of a new medical occupation in Dutch hospitals - non-specialist emergency physicians.
DESIGN/METHODOLOGY/APPROACH: Five case studies of Dutch hospitals were conducted and the emergency physicians' implementation process was analyzed by means of force field analysis.
Emergency physicians were conceptualized as being the answer to unequivocal contextual changes. However, their contribution to better performance varies due to problems in the implementation process. Strong socio-political forces between traditional specialties and these new doctors mediate the intended improvement. The emergency physicians aim to establish their own organizational-, patient- and knowledge-domain by redrawing professional boundaries but they are not on a par with the specialists who set these boundaries. Consequently, emergency physicians only gradually redraw the existing boundaries, resulting in limited added value. Their reaction is to obtain power by striving to develop into a recognized specialty; ironically, by becoming an additional layer in the traditional medical hierarchy they might lose their envisaged added value.
RESEARCH LIMITATIONS/IMPLICATIONS: This paper is based on the first Dutch hospitals that implemented emergency physicians. The number of cases is therefore limited. Moreover, the study took place at an early stage of emergency physician implementation.
The extent of successful redrawing depends on the implementation's transition logic, the existing degree of differentiation and boundary permeability and on the ideological power developed by the leaders.
ORIGINALITY/VALUE: The introduction of emergency physicians is currently being discussed in many countries worldwide, and some countries consider following the Dutch example of non-specialist doctors. This paper supports health professionals and hospital managers in not falling prey to the same pitfalls as some Dutch hospitals.
本文旨在探讨影响新医疗职业（荷兰医院的非专科急诊医生）进入时专业边界转移的力量。
设计/方法/途径：对荷兰的 5 家医院进行了案例研究，并通过力场分析对急诊医生的实施过程进行了分析。
急诊医生被认为是应对明确的背景变化的答案。然而，由于实施过程中的问题，他们对绩效提升的贡献有所不同。传统专业和这些新医生之间的强烈社会政治力量调解了预期的改善。急诊医生试图通过重新划定专业边界来确立自己的组织、患者和知识领域，但他们与设定这些边界的专家并不平等。因此，急诊医生只是逐渐重新划定现有边界，从而产生有限的附加值。他们的反应是通过努力发展成为一个公认的专业来获得权力；具有讽刺意味的是，通过成为传统医疗等级制度的另一个层次，他们可能会失去预期的附加值。
研究局限性/影响：本文基于荷兰第一批实施急诊医生的医院。因此，案例数量有限。此外，该研究是在急诊医生实施的早期阶段进行的。
成功重新划定的程度取决于实施的过渡逻辑、现有分化程度和边界渗透性，以及领导者所发展的思想权力。
原创性/价值：在世界范围内，许多国家正在讨论引入急诊医生，一些国家正在考虑效仿荷兰的非专科医生模式。本文为卫生专业人员和医院管理人员提供了支持，使其不会重蹈荷兰一些医院的覆辙。
