TableĀ 2

Determinants for the employment of physician assistants for inpatient care

ThemePerceived facilitatorsPerceived barriers
The innovation
  • Need for continuity of care

  • Need for quality improvement

  • High workload MRs

  • More effective employment of MRs for other tasks

  • Employee of the ward initiated the idea

  • No need for change

  • Time and cost investment for the education of a PA

  • Risk that the PA resigns shortly after finishing education

  • PA does not work at irregular shifts

  • Limit the education possibilities of MRs

  • Lack of scientific evidence on outcomes

  • Diversity of different professionals who can be employed for inpatient care

Professional interactions
  • Positive experiences with PAs in inpatient care elsewhere

  • Negative experiences with PAs in inpatient care elsewhere

  • Resistance from professional associations of medical specialists

Incentives and resources
  • Shortage of MRs for inpatient care

  • Relatively low salary of PA

  • Standardisation of medical care

  • Shortage of appropriate PA for inpatient care

  • Discussion about payment of salary PA

Capacity for organisational change
  • Support of the management

  • Staff physicians are employed by the hospital

  • Uncertainty because of approaching take-over of hospitals

  • Uncertainty because of changes of high impact within the organisation of the staff physicians

Social, political and legal factors
  • Improved legislation to prescribe medication and indicate and perform medical procedures

  • Less authorised to prescribe medication and take decisions in comparison to MRs

  • MR, medical resident; PA, physician assistant.