An investigation into the malfunctioning of specialists in Dutch hospitals

Abstract

Objective: To determine how much malfunctioning there is among medical specialists attached to hospitals.

Design: Retrospective and descriptive.

Setting: 21 hospitals in the province of North Holland in the Netherlands.

Method: After preliminary discussions with key figures in the field, the Health Inspectorate for North Holland visited 21 hospitals in North Holland between March 1992 and November 1993. Hospital managers were required to complete and return a printed questionnaire prior to the visit.

Results: According to hospital managers and medical staff, 93 out of a total of approximately 2000 specialists had malfunctioned in some degree over a period of 5 years. The main symptoms of malfunctioning mentioned were: lack of social skills, medical and technical errors of judgement, and inability to work in a team. Authorities complained about the lack of a system of sanctions.

Conclusion: Hospitals are inclined to conceal the malfunctioning of specialists and readily engage in a conspiracy of silence. Since new legislation has given the health insurer contractual freedom and has conferred greater powers on the inspectorate, it might be possible to impose more effective sanctions in the future. Prevention of malfunctioning is of course to be preferred. Unfortunately, very few proposals put forward by the umbrella organisations concerning improved job application procedures and job performance discussions have actually been implemented. More research is required into malfunctioning in other health professions such as general practice and dentistry.