PhD Candidate Rachel Gifford investigates the perceived effects of different organisational models, including payment systems, of medical specialists on intergroup relations and collaborative behavior. Supervised by Eric Molleman (Organisational Behavior and Human Resource Management) and Taco van de Vaart (Operations), she specifically focuses on medical specialists in Dutch hospitals, and compares across both self-employed and salaried employees. ‘Healthcare is a really important field. Everyone needs healthcare. I hope to understand how the organisation of specialists can help us move towards a more value-based system and stimulate collaborative behavior.’

Q. What are your main findings so far?

A. I am just now finishing my first study, which is an exploratory multiple case study investigating the recent changes in the organisation of medical specialists in Dutch hospitals. In this study so far we find that the way in which specialists are organised, including how they are incentivised and paid, is perceived to have a strong effect on intergroup relations and group behavior, including willingness to collaborate on initiatives to improve healthcare delivery. We also find that this effect is not only on intergroup relations between specialists, but also between specialists and the organisation. Additionally, when new payment systems are introduced, or specialists are pressured to move to new systems, this may constitute a threat to group identities, triggering a response of resistance and reorganisation, which may be counter to the aims of the organisation.

We also see how money comes to be valued as a symbolic good, and that the response of specialists to changes in payment and incentive systems is influenced by the symbolic, rather than the monetary value of payment. For example, money was seen to provide group identity validation, status and power, and organisational influence.

Q. What will be the societal impact?

A. With the aging population, the increasing prevalence of chronic diseases and complex care, healthcare systems worldwide are searching for ways to simultaneously cut costs while also maintaining and increasing the quality of care. This requires a substantial reorganisation of care, for example moving towards a more multidisciplinary approach and away from the more traditional specialty siloes. This reorganization of care often requires incentivising healthcare providers in a different way, for example moving away from traditional fee for service productions and towards more value based approaches. However, it remains difficult to implement changes and it is unclear what the effects of different systems are on intergroup relations and the willingness of specialists to engage in collaborative behaviors. We investigate how such systems may create barriers to, or facilitate collaboration which research has shown is an important aspect of quality care for complex patients.

Additionally, our research looks at the specific changes within Dutch healthcare. Following the policy changes surrounding physician employment and entrepreneurship in 2015 resulting from increasing pressures to cut healthcare costs and improve quality, several new and innovative models of healthcare delivery were recently introduced into the Dutch system. However, research remains limited on the effects of these models, and more broadly on the effects of different organisational systems on collaborative outcomes. Our research attempts to offer a more in depth understanding of the challenges to implementing, and the potential outcomes, of these new systems.

Q. What is the importance of your research?

A. First, I believe it is important to gain the perspective of the healthcare providers themselves in understanding the potential negative or positive impact of policy changes which try to redesign or implement new payment systems. Also, by taking an identity approach, we show how the move towards more multidisciplinary and value based healthcare may actually trigger identity threats and resistance to change, and can offer insights into how changes in healthcare payment and organisation can best be implemented to avoid such effects.