The increased pressure for improved organisational performance has led to increased competition among Dutch hospitals, reflected in for example yearly rank- ings published in popular newspapers.
The general Rembrandt van Rijn hospital employs around 1,600 people including 300 medical specialists and 1,300 nurses and medical support staff. Almost half of the medical specialists within the hospitals are self-employed, which is a typical characteristic of the Dutch healthcare sector. These self-employed special- ists have a powerful position within the organisation and are represented at the highest level, without being formally employed by the organisation.