Table 2 The match of information processing and the situation on weekends
| Uncertainty sources | Capacities | Situation on weekends | |
|---|---|---|---|
| Task complexity | Admission of patients with diverse symptoms, treatment needs, and treatment stages |
• Matrix structure supported by contracts and matrix managers • Triage system • Self-contained subunits managed by emergency physicians • Morning conference • Different roles |
• Less effective morning conference, because the conference is managed by a physician from another department • One single emergency physician covers both A1 and A2 |
| Different numbers of patients |
• Flexible self-contained subunits • Matrix structure • External agreements about calling physicians from other departments when their skills are needed | • Less flexibility of resources between self-contained subunits, because only two units are in operation and one is “outsourced” | |
| Patients with a mix of conditions |
• Emergency physicians and nurses with emergency care skills • Flow master to coordinate | • The temporary physicians have limited skills, e.g., skills in surgery and coordination | |
| Lack of information about the influx of patients | • Hospital visitation | • Less time to use the information provided by the hospital visitation | |
| Lack of knowledge about the patients' conditions and which competences are needed |
• Triage system • Formalized rules and SOP guide less experienced physicians • Supervision |
• Less supervision of the less experienced physicians because of the emergency physician’s limited time (and skills if a temporary physician is on duty) | |
| Task inter-dependence | High degree of co-solving of tasks, employees rely on one another to perform their individual tasks |
• Flow master and coordinating nurses coordinate overall tasks • Staff employed in the same department treat most of the patients • Cetrea and EPR facilitate communication • Triage system and formalized rules to coordinate the subtasks |
• The emergency physician has too much to do, leaving a lot of coordination to the coordinating nurse • Less use of Cetrea due to the “outsourcing” of tasks |
| Inter-unit task inter-dependence | Dependence on extensive collaboration with other departments at the hospital | • Matrix structure supported by contracts and matrix managers |
• More tasks are solved by physicians from other departments on weekends → increased uncertainty, requiring more coordination • Focus is changing from the emergency care process to a focus on specialty |
