The existence of boundaries within the supply chain
| First order | Second order | Themes |
|---|---|---|
| Specialists on-call for ED but not available | Dual roles | Structural boundaries |
| Competing interests | ||
| Specialists not always available/reachable | ||
| Limited amount of specialists | Resource constraints | |
| Specialists in the operating theatre (OR) | ||
| Indirect communication | ||
| Specialists hard to reach | Spatial separation | |
| MS not all acute hearted | ||
| ED something on the side | Commitment | Interpersonal boundaries |
| ED tasks de-prioritized | ||
| EPs not specialists | ||
| MS must have final say | Trust | |
| Assumptions | ||
| Poor interpersonal relations | ||
| Thresholds of communication | Familiarity | |
| Unfriendly on the phone | ||
| Lack of awareness for ED protocol and process | ||
| MS not trained in ED | Understanding | |
| Lack of oversight | ||
| ED prioritizes speed | ||
| Diagnostic use on ED by MS | Approach to work | Cultural boundaries |
| MS not proactive | ||
| Discharge/admit decision | ||
| Get patients off ED quickly | Goals | |
| MS will not take patients without full diagnosis | ||
| Patient ownership | ||
| Power dynamics | ||
| EPs not real specialists | Status | |
| EPs in back office | ||
| Resistance to EP expansion | ||
| EP educational track | Education | |
| EP training broad but not deep |
| First order | Second order | Themes |
|---|---|---|
| Specialists on-call for ED but not available | Dual roles | Structural boundaries |
| Competing interests | ||
| Specialists not always available/reachable | ||
| Limited amount of specialists | Resource constraints | |
| Specialists in the operating theatre (OR) | ||
| Indirect communication | ||
| Specialists hard to reach | Spatial separation | |
| MS not all acute hearted | ||
| ED something on the side | Commitment | Interpersonal boundaries |
| ED tasks de-prioritized | ||
| EPs not specialists | ||
| MS must have final say | Trust | |
| Assumptions | ||
| Poor interpersonal relations | ||
| Thresholds of communication | Familiarity | |
| Unfriendly on the phone | ||
| Lack of awareness for ED protocol and process | ||
| MS not trained in ED | Understanding | |
| Lack of oversight | ||
| ED prioritizes speed | ||
| Diagnostic use on ED by MS | Approach to work | Cultural boundaries |
| MS not proactive | ||
| Discharge/admit decision | ||
| Get patients off ED quickly | Goals | |
| MS will not take patients without full diagnosis | ||
| Patient ownership | ||
| Power dynamics | ||
| EPs not real specialists | Status | |
| EPs in back office | ||
| Resistance to EP expansion | ||
| EP educational track | Education | |
| EP training broad but not deep |
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