Twee en een samen is geen anderhalf: Een kwalitatieve, landelijke inventarisatie samenwerkingsverbanden HAP-SEH

Abstract

Abstract in English Methods: Interviews, survey and observation of managers of both Accident & Emergency Departments and General Practioners Cooperatives. Goal was to gain a better understanding of the human aspect of the cooperation of both organizations. Conclusions & Discussion This study shows that it is impossible to fully integrate accident and emergency departments with out-of-hours general practioners cooperatives, because both organization have different functions with coherent organizational cultures. The most profitable way to work together is to specialize on their original functions and optimalize these core competencies and at the same time cooperate on issues where overlap exist. This overlap concerns (among others) self-referrals, but also overhead and the daily functional relationship between the organizations. Management of change is defined as a human activity with all the features of human decision-making, such as uncertainty, contextuality and subjectivity. Managers use three perspectives as starting point for organization. The first is the patient, second the professional repertoire and third the formal regulations as starting point for the design of services. Final outcomes of the process of management are complex, ambiguous theories of action for the performance of the service. Main challenges for managers are improvement of both cost and quality and to limit workload. Limits on organization are imposed by the limited capability of patients to make informed decisions, the restrictions of formal regulations and third due to availability obligations the impossibility to unite demands for the highest quality at less cost. Due to the complexity of the matters a significant learning process is needed to create optimal performance of services for all stakeholders. Implications for further research are the examination of effects of implementation of particular organizational structures, the examination of the consequences of not working together and finally a closer examination of the motives and characteristics of hospitals.