Enacting Fit in Work Organization and Occupational Structure Design: The Case of Intermediary Occupations in a Dutch Hospital

We report and interpret findings from an investigation of work redesign and the introduction of a new occupational position, nurse practitioner (NP), in four different subunits in a large Dutch university hospital. Full development of the new position and its contribution to performance crucially depend on the delegation of medical tasks to NPs. The motive for introducing the new occupation and redesigning the work processes was to improve treatment quality and patient-centredness, to reduce throughput times and to assure operating efficiency. However, the degree and modality of reaching such objectives depends on the local politics of management and medical practitioners, resting on interpretations of appropriate roles and task divisions. Thus, task environmental influences affect work structure redesign as the former were perceived and enacted by local practitioners. The overall process of redesign and the way it differed between departments is best explained by combining a modified contingency theory with an interactionist and organizational politics approach.