Inside outsourcing


It has become more common in Dutch hospitals to outsource the department of allied healthcare to the private sector. This development has affected the department of physiotherapy, being part of allied healthcare, in hospitals significantly and as a result the need for guidance in this new situation has increased. In response to this, the Dutch Association of Physical Therapy in Hospitals (NVZF) conducted a comprehensive study into the process of outsourcing with the objective to inform and advise departments of physiotherapy in hospitals about outsourcing developments. The reason to share this work is that we would like to compare our results from this national study internationally, to exchange experience and knowledge from a broader perspective.


Eight hospitals where outsourcing was occurring or considered were interviewed. The EFQM-Model (European Foundation for Quality Management - Excellence Model) was used to evaluate the evolution the departments of physiotherapy made on the edge of public sector and private practice.


The study provided the following insights into the outsourcing process of physiotherapy in Dutch hospitals: (a) three main motives of the board of a hospital to outsource the department of physiotherapy and three factors influencing whether outsourcing will occur, (b) four different organizational structures of departments of physiotherapy, two of which reflect outsourced departments and (c) nine critical factors to be considered by the department of physiotherapy when outsourcing is considered or will take place.

Cost and savings

Motives for outsourcing are the financial situation of the hospital, a focus on primary care, and a lack of space. Factors influencing the probability that hospitals will outsource are the financial situation of the hospital, the presence or absence of a vision or strategy and the ratio of production between clinical- and outpatients.

From the four structures in which the department of physiotherapy can be organized, two new structures have developed besides two old structures, due to the impact of outsourcing.

Nine critical factors to consider for a successful implementation of outsourcing the physiotherapy department are vision, lean management, quality, labor conditions, focus, business model, communication, self-empowerment and long-term policy.


Implications for Practice - The gathered information has been summarised in a guideline. The NVZF board and members have indicated that this publication provides important guidance when outsourcing of hospital-based physiotherapy is considered.

Implications for Research - Even though not being the purpose of this study, the data has demonstrated that no conclusions can be drawn on the question whether an outsourcing process has been successful. This issue is complex and difficult to measure. The research has demonstrated that the success of a department of physiotherapy depends on adopting a clear vision and leading one's own transformation rather than opting to outsource or not. Our recommendation is to study the success of outsourcing in a follow-up research, leaning on a fully scientific design.

Top three learning points

  1. Not the fact that you are outsourced or not is of the utmost importance, but that you have a clear vision linked to good strategic starting points
  2. New developments in the field can best be investigated with a qualitative research design
  3. Success can only be measured if we define it properly

Fund acknowledgements

This study was funded by the Dutch Association of Physical Therapy in Hospitals.

Additional notes

Presented at Physiotherapy UK 2018. 

For further information about this work contact Rudi Steenburger at: