Although collaboration between healthcare professionals is essential for the delivery of effective, efficient, and high-quality care, it remains an ongoing and critical challenge across health systems. As a result, many countries are experimenting with innovative payment and employment models. The literature tends to focus on improving collaboration across organizational and sectoral boundaries, and largely ignores potential barriers to collaborative work between members of the same profession within a single organization. Despite intergroup dynamics and professional boundaries having been shown to restrict patient flow and collaboration between specialties, studies have so far tended to overlook the potential effects of differentiated organizational and payment models on physicians’ behaviors and intergroup dynamics. In the present study, we seek to unpack the influence of physicians’ payment and employment models on their collaborative behaviors and on intergroup dynamics between specialties, adding to the current scholarship on physician payment and employment by considering how physicians’ view and act in response to different structural arrangements. The findings suggest that adopting hybrid models, in which physicians are employed or paid differently within the same organization or practice, creates a bifurcation of the profession whereby physicians across different models are perceived to behave differently and have conflicting professional values. These models are perceived to inhibit collaboration between physicians and complicate hospital governance, restricting the ability to move towards new models of care delivery. These findings can be used as a basis for future work that aims to unpack the reality of physician payment and offer important insights for policies surrounding physician employment.

There is a growing trend of physicians becoming employees of hospital systems and employment is viewed as a mechanism to help achieve health system goals. Yet, the research is mixed on the effects of moving physicians to employment models. While the literature has traditionally placed such forms of employment relationships in opposition to professional autonomy, it has often overlooked the effects on other professional values and there is little empirical work that actually assesses how such a shift affects and is perceived by clinicians themselves. To address these gaps, we conducted a mixed method study at one hospital that recently moved all formerly self-employed physicians to employment contracts. We interviewed physicians to understand how the shift into employment was perceived to influence their work in three domains: the patient domain, the individual domain and the organizational domain. We then conducted a follow-up survey across both formerly employed and self-employed physicians to test our initial findings. We find both positive and negative effects in different domains, offering insights into the mixed results found in the current literature.

Purpose Emergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance. Design/methodology/approach To provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period. Findings The authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes. Originality/value This study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.

The implementation of digital technologies in the context of Industry 4.0 radically changes methods of production and thereby the jobs of blue-collar workers. Although the work design effects of digitalization on the operator 4.0 have been explored in the existing literature, less is known about the simultaneous effects on white-collar work and the underlying (re)design process of human work including the factors that shape this process. To address this gap, we performed an in-depth industrial case study of an organization in the process of digitalization. Our findings confirm the concurrent impact of digitalization on blue- and white-collar work and suggest that its human implications highly depend on the extent to which, and at what moment, human factors are considered during the design and implementation process. Where work design knowledge lacked, the motivation of system designers turned out to be an important individual factor to realize favorable work design outcomes. At the organizational level, results show the importance of early involvement of system users and incorporating social performance indicators in addition to operational performance indicators in the statement of project goals. Our findings provide important empirical input for the further development of human-centric models and theories that integrate the challenges and opportunities for blue- and white-collar workers that are emerging when adopting digital technologies.

BACKGROUND:Technological innovation in healthcare is often assumed to contribute to the quality of care. However, the question how technology implementation impacts healthcare workers has received little empirical attention. This study investigates the consequences of Electronic Health Record (EHR) implementation for healthcare workers' autonomous work motivation. These effects are further hypothesized to be mediated by changes in perceived work characteristics (job autonomy and interdependence). Additionally, a moderating effect of profession on the relationship between EHR implementation and work characteristics is explored.METHODS:A quantitative uncontrolled before-and-after study was performed among employees from a large university medical centre in the Netherlands. Data were analysed following the component approach for testing a first stage moderated mediation model, using Generalized Estimating Equations (GEE).RESULTS:A total of 456 healthcare workers (75 physicians, 154 nurses, 145 allied healthcare professionals, and 82 administrative workers) finished both the baseline and the follow-up survey. After EHR implementation, perceived job autonomy decreased, whereas interdependence increased. In line with our hypothesis, job autonomy was positively associated with autonomous motivation. In contrast to our expectations, interdependence also showed a positive association with autonomous motivation. Autonomous motivation was stable over the course of EHR implementation. This study did not provide support for a moderating effect of profession: no differences were observed between the various professions regarding the changes in their experienced job autonomy and interdependence after EHR implementation.CONCLUSIONS:Our study showed that healthcare professionals' perceptions of their work characteristics, but not their autonomous motivation, were changed after EHR implementation, and that these experiences were relatively similar for physicians, nurses, and allied healthcare professionals. The stability of healthcare workers' autonomous motivation may be explained by the opposite effects of decreased job autonomy and increased interdependence, and by the EHR being in line with healthcare workers' values. The changes in job autonomy and interdependence may have consequences beyond motivation, for example by affecting clinical decision-making, proactive behaviour, and the quality of teamwork. These potential consequences of EHR implementation warrant further research.

BACKGROUND:Health care professionals' work motivation is assumed to be crucial for the quality of hospital care, but it is unclear which type of motivation ought to be stimulated to improve quality. Motivation and similar concepts are aligned along a motivational continuum that ranges from (intrinsic) autonomous motivation to (extrinsic) controlled motivation to provide a framework for this mixed-methods systematic review. PURPOSE:This mixed-methods systematic review aims to link various types of health care professionals' motivation directly and through their work-related behaviors to quality of care. METHODS:Six databases were searched from January 1990 to August 2016. Qualitative and quantitative studies were included if they reported on work motivation in relationship to work behavior and/or quality, and study participants were health care professionals working in hospitals in high-income countries. Study bias was evaluated using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. The review protocol was registered in the PROSPERO database (CRD42016043284). RESULTS:A total of 84 out of 6,525 unique records met the inclusion criteria. Results show that health care professionals' autonomous motivation improves their quality perceptions and work-related behaviors. Controlled motivation inhibits voicing behavior, but when balanced with autonomous motivation, it stimulates core task and proactive behavior. Proactivity is associated with increased quality of care perceptions. PRACTICE IMPLICATIONS:To improve quality of care, policy makers and managers need to support health care professionals' autonomous motivation and recognize and facilitate proactivity as an essential part of health care professionals' jobs. Incentive-based quality improvements need to be complemented with aspects that stimulate autonomous motivation.

Emergency care is an emergent process requiring input from various healthcare professionals within the hospital. To avoid crowding and efficiently flow patients through the ED, collaboration between professionals across multiple sub-units is crucial. Yet, the multidisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. To deliver efficient and effective emergency care, professionals must integrate rapidly, working across functional, spatial, and professional boundaries. To provide a more holistic understanding of the inherent challenges to professional integration in this setting, we carried out an in-depth case study at a busy, level one trauma center in the Netherlands that recently implemented a reorganization of acute care delivery to improve emergency department flow. Speaking directly with medical professionals at the interfaces of emergency care across two models of care delivery we provide insights into key relational and cultural factors that come to effect supply chain functioning. We find the existence of structural, relational and cultural barriers across both models of care, and demonstrate how each boundary uniquely influences collaboration, and ultimately, patient flow.

To support the process of integration of Netherlands (NLD) and German (DEU) units in the DEU1. Panzerdivision (“Project Taurus”), the Commando Landstrijdkrachten of the Netherlands and the Kommando Heer of Germany asked the University of Groningen to study the development of identity and culture in these units. A large-scale survey with three waves was executed by the university in 2017, 2018 and 2019 among soldiers in the staffs of the 1. Panzerdivision, Panzerlehrbrigade9 and 43Mechanised Brigade, as well as the entire Panzerbataillon414 and 45Armoured Infantry Battalion. In addition, the present findings draw on interviews conducted prior to and after the survey waves. The level of integration is a prominent factor in how soldiers perceive the integration. This relates to how many soldiers of the other nation operate in a unit, and consequently to the frequency of contact between soldiers of the two nations. Units with 10% or more soldiers of the other nation we call ‘Deeply Integrated’. Units with less soldiers of the other nation but still a binational command relationship, are called ‘Structurally Integrated’.

Rapid advancements in an array of digital technologies and applications promote the transformation of industrial production into cyber-physical systems (CPS). This process is projected to lead to a completely new level of process automation, thereby redefining the role of humans and altering current work designs in yet unknown ways. However, existing literature is rather ambiguous and not explicit on how the transformation towards CPS affects work design. In this study, we therefore consider this transformation at a much more detailed level. Our main contribution is the development of a framework to assess work design changes in the transformation towards CPS, and the consideration of the role of management choice therein. The framework relates (future) capabilities of CPS on the machine, production line, factory and supply chain scope to functions of human information processing. We then evaluate how the potential automation or augmentation of those functions by CPS affects job characteristics. Automation in this context is defined as the transfer of control and decision-making from humans to CPS, while augmentation means that technology is used to enhance human productivity or capability. We expect that the transformation towards CPS and the resulting automation and augmentation of tasks will shift the majority of human work to jobs characterized by high levels of job complexity, job autonomy and skill variety. This effect will become more severe when tasks are increasingly automated in the transformation towards CPS. During this development, human skills and knowledge will presumably remain critical in near future industrial production. Nevertheless, the ultimate implications for work design are strongly dependent on management choice. Strategic decisions are required on (1) which functions to automate across different scopes of operations and (2) how to group the resulting pool of tasks into jobs. This may result in various work designs. However, this choice is to a certain degree limited, and the role of technology is to restrict, rather than determine management choice.

Purpose Technology uncertainty poses significant challenges to manufacturers, as rapid changes in product and/or process standards and specifications can disrupt the smooth flow of materials in extended supply chains. Practitioners and researchers alike who take a relational perspective widely regard supplier involvement as a potentially effective strategy to cope with technology uncertainty, as focal manufacturers can tap into their upstream supply networks for complementary resources and capabilities. However, the literature lacks a nuanced understanding of the supplier involvement processes. Specifically, the role of resource dependence for supplier involvement has yet to be systematically understood. To fill this gap, this study aims to combine the relational perspective with the resource-dependence perspective to explore how buyer dependence, supplier dependence and buyer–supplier interdependence influence buyers’ decision-making on tapping into upstream supply networks for coping with technology uncertainty. Design/methodology/approach To test the hypotheses, a survey is conducted among Dutch firms with more than 50 employees in the discrete manufacturing industries (ISIC 28-35), resulting in a sample of 125 manufacturers. Findings First, there is a significantly positive relationship between technology uncertainty and supplier involvement, giving support to the expectation that buyers are indeed involving their key suppliers in the product/process design and improvement, as a response to technology uncertainty. Second, buyer dependence and interdependence are found to be positively moderating the relationship between technology uncertainty and supplier involvement. In contrast, supplier dependence has a negative moderating effect on the baseline relationship. Research limitations/implications The authors contribute to a relational view on buyer–supplier relationships by showing that the validity of this view, in the context of technology uncertainty, is contingent on the resource dependence between buyers and suppliers, and the authors contribute to the supply chain management literature more generally by combining a relational perspective with a resource-dependence perspective. Practical implications The findings provide several nuanced insights into the effect of resource dependence (buyer dependence, supplier dependence and interdependence) on supplier involvement for coping with technology uncertainty. Originality/value This study contributes to the supply chain management research by going beyond the benefits of supplier involvement and highlights the circumstances under which supplier involvement is likely to occur.

We investigated how actors navigate an organizational field marked by prolonged institutional complexity following changes initiated by a government reform. In fields marked by prolonged complexity, individuals can meaningfully engage with multiple logics available to them to respond to change. When changes in the external environment disrupt previously forged pragmatic collaborations, actors may be forced to renegotiate their field positions. Through the analysis of a multiple case study, we show how actors navigated the field and renegotiated their position by engaging with institutional logics as tools. We uncover the use of three key strategies: defending, co-opting, and reframing. Depending upon which strategies are used following a disruption, the formation of new collaborations, particularly when power dynamics have shifted, may prove to be difficult. We contribute to the literature on institutional complexity and logics, showing how actors strategically engage with logics to navigate fields marked by prolonged complexity, and the effect of these strategies on the formation of pragmatic collaborations.

Relationships with leaders do not happen in isolation from the relationships one has with one’s peers. Therefore, we examine the influence of leader‒member exchange on follower job performance in light of the larger social networks in which followers are embedded. Testing multilevel models with data that were gathered using questionnaires from a sample of 240 nurses and 20 supervisors working at four Dutch hospitals revealed that a positive relationship exists between leader‒member exchange and follower job performance when follower workflow network centrality and/or follower friendship network centrality are high but not when they are both low. The results of this study show how the different follower relationships with the supervisor and colleagues intertwine in explaining follower job performance and suggest that the larger network in which followers are embedded within their work teams is important for explaining variations in the results regarding the relationship between leader‒member exchange and follower job performance. Our study indicates that leaders should have an eye for the network position of their followers when developing high quality leader‒member exchange relationships. For followers, a good relationship with their leader is important, but its value depends on their relationships with colleagues.

Expertise is an important, positive determinant of employees’ work identities. Previous research has shown that reciprocal expertise affirmation - i.e. the mutual recognition by team members that they respect, value, and affirm each other’s expertise - is positively related to team performance. However, in order to leverage positive identity processes for the effective functioning of work teams, it is important to examine all relevant levels of analysis. In this study we replicate earlier team level findings in a field setting, and extend them to the individual level of analysis using multi-source data from 86 organizational work teams. Moreover, we validate a measure in a separate sample of 155 employees from 27 teams. Our findings suggest that it is conceptually and empirically meaningful to distinguish between individual-level and team-level perceptions of expertise affirmation and that each has differential, additional implications for the performance of work teams and their individual members.

The drive for employees to perform well may tempt them to practice exaggerated self-promotion tactics. The supposition is that those with a strong performance-approach orientation are especially inclined to do this, but that contextual variables are relevant. In this study, I examined the influence of the combination of two contextual variables (perceived audience power and feedback) on the relationship between performance-approach orientation and exaggerated self-promotion. A sample of 277 employees from two companies participated in the study. I found that the presence of a powerful audience weakened the positive relationship between performance-approach orientation and exaggerated self-promotion if the feedback from that audience was highly salient, and that a powerful audience strengthened this relationship if the salience of this feedback was low.

In this paper we address how director expertise impacts a director's social status and conformity within the board. Our results, derived from two unique multi‐source datasets of peer ratings on director status and conformity of non‐executive directors from Dutch organizations, indicate that industry‐specific expertise and financial expertise differently impact directors’ social status and influence within the board. We find that directors’ individual performance orientation – the motivation to demonstrate expertise – acts as an important contingency for expertise to increase directors’ status within the board. Additional analyses using archival data and interviews with non‐executive directors substantiate our findings and provide additional insight into the dynamics operating within boards. This study extends existing research on boards of directors and provides unique micro‐level insights into the boardroom dynamics that connect director expertise to director status and conformity within boards.

Advantageous structural positions in a social network provide opportunities for employees. In this study, we examined whether the interaction between the personality traits neuroticism and extraversion affects the extent to which employees benefit from network centrality. Data from a sample of 299 nurses from four Dutch hospitals revealed that affect‐based network centrality was associated with higher job satisfaction and that in‐degree advice network centrality was associated with higher ratings by supervisors with respect to job performance, but only for extraverts low in neuroticism and introverts high in neuroticism. The results show that the existence and magnitude of the positive relationship between affect‐based network centrality and job satisfaction, and the positive relationship between advice network centrality and supervisor ratings of job performance, may crucially depend on the specific interactional combination of personality traits. These findings provide an explanation for the variation in results regarding the network centrality–job satisfaction link and extend empirical evidence for the network centrality–job performance link. The current findings offer team managers insight into how a combination of personality traits influences the effect of network centrality on individual work outcomes. Implications for social networks and selection of employees are discussed.Practitioner points The positive relationship between affect‐based network centrality and job satisfaction and the positive relationship between advice network centrality and job performance depend on the specific interactional combination of neuroticism and extraversion. Employees benefit most from network centrality when they are high on extraversion and low on neuroticism, or when they are low on extraversion and high on neuroticism. For jobs that require much social interaction, extraverts low in neuroticism are preferred.

Drawing from corporate governance research and social identity theory, the authors argue that the relationship between outside directors’ time in office and outside director task involvement is more complex than generally anticipated. By using a unique multisource data set composed of peer ratings provided by fellow outside directors rating a focal director’s task involvement, this study analyzes director task involvement at the individual director level of analysis. The authors propose and empirically demonstrate that outside director tenure has an inverted U-shaped relationship with outside director task involvement that is moderated by a director’s social identification with the organization. As such, the authors demonstrate that social identification with the organization provides a critical contingency for the curvilinear relationship between outside director tenure and outside director task involvement. Findings suggest that outside directors who socially identify with the organization are more likely to grow “stale in the saddle” at lower levels of tenure. These findings provide support for the merit of analyzing outside directors at the individual level of analysis and suggest that a “one-size-fits-all” approach may not be most appropriate in assessing the effects of tenure on outside director functioning.

This article introduces a conceptual framework for understanding the antecedents of a strong professional identity among medical specialists and its consequences for the quality of healthcare. Three work conditions are proposed under which a professional identity improves the overall work productivity within a specialty, but impedes the efforts of medical specialists to work effectively with others outside their domain because of the experience of identity threat. These conditions are: complex multidisciplinary collaborations, the emergence of new specialties and medical technological developments. The framework has important theoretical and practical implications and calls for future studies on individual characteristics of specialists and on organizational factors that may ensure the benefits and circumvent the threats of a strong professional identity.