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Journal cover: Journal of Health Organization and Management

Journal of Health Organization and Management

ISSN: 1477-7266
Previously published as: Journal of Management in Medicine

Online from: 2003

Subject Area: Health Care Management/Healthcare

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Redrawing medical professional domains: New doctors, shifting boundaries, and traditional force fields


Document Information:
Title:Redrawing medical professional domains: New doctors, shifting boundaries, and traditional force fields
Author(s):Constanze Kathan-Selck, (Faculty of Economics and Business, Department of International Business & Management, University of Groningen, Groningen, The Netherlands), Marjolein van Offenbeek, (Faculty of Economics and Business, Department of International Business & Management, University of Groningen, Groningen, The Netherlands)
Citation:Constanze Kathan-Selck, Marjolein van Offenbeek, (2011) "Redrawing medical professional domains: New doctors, shifting boundaries, and traditional force fields", Journal of Health Organization and Management, Vol. 25 Iss: 1, pp.73 - 93
Keywords:Emergency services, Hospitals, Medical management, The Netherlands
Article type:Case study
DOI:10.1108/14777261111116833 (Permanent URL)
Publisher:Emerald Group Publishing Limited
Acknowledgements:This article is based on a project supervised by Arndt Sorge and Rijk Gans at the University of Groningen. The authors are very grateful for their input. The project was financially supported by The Netherlands Organization for Scientific Research (NWO).
Abstract:

Purpose – 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.

Findings – 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.

Practical implications – 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.



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