Table 4 Overview of results of the thematic analysis with explanatory quotes (n = 19)

The Implementation Strategy Had Gaps, But Was Supported by Ongoing Adjustments

Lack of timely information about the implementation process caused frustration. However, there was great willingness from the management to implement ongoing changes as issues were raised.

- Paramedic 2: “Things get introduced without us being fully informed. Just all of a sudden. But they also said in the interview: ‘We’ll be paving the road as we drive.’ And that’s fine enough. But I would perhaps like it if those of us who are actually on the ground were involved in the process from the beginning, because after all, it’s us who have to do the work.”

- Paramedic 1: “This project group has really listened to the things I mentioned during the interview. And they had the right people involved, so in that sense, I think the leadership has been good. I like that part”.

Facilitating a Patient-Centered Approach for the Benefit of the Patient and the System

The PVU was justified by the professionals by: (1) optimal use of scarce resources within the healthcare system, and (2) patient-centered and high-quality patient care delivered by the PVU.

- Paramedic 1: “So, I think, from a socio-economic perspective, it’s the best thing I’ve ever been a part of”. Interviewer: It’s the PVU?”. Paramedic 1: “Yes, because 37%, who don’t undergo hospitalization at costs of 25,000 DKK each, well. It speaks for itself. I need just one patient, one patient to justify my own salary. Then I need one patient to stay home every 5 days. Then I’ve earned my own salary.”

- Technical dispatcher 7: “I think it’s a good idea, and it makes sense from a holistic perspective. But, I could easily use an extra ambulance.”

Community Partnership and Internal Collaboration Enables Paramedics as Healthcare Facilitators

Internal collaboration within the EMS as well as partnerships across the broader healthcare system were perceived as important for effective and high-quality operation of the PVU.

- EMS dispatcher 5: “We have a really good collaboration with the PVU. They often come up and talk to us about tasks, so we discuss a lot. We receive a lot of professional consultation, and I learn a great deal from them. Almost every time they are on duty, they come up for a cup of coffee and talk about the tasks they’ve been on, and… so, I think, in terms of both professional consultation and the collegial aspect, we have a really good collaboration.”

- Technical dispatcher 3: “I think it’s both that we trust each other, but also because if I say to him, ‘I’m super under pressure,’ he does it a bit faster than if it’s someone I don’t have a relationship with because then he knows that I only say: ‘I’m under pressure’, when I really am.”

Flexible Workflows Were Needed to Maintain Professional Agency

A common challenge was lack of agency and professional recognition, which restricted their work, due to guidelines restricting the PVU’s operation.

- Paramedic 2: “We should also move away from the fact that I have to confer with the EMCC physician. I would like it to be the case that we COULD call, as it is right now, we MUST call the EMCC physician. And if it were the case that you could call if you were in doubt and consult with the EMCC physician, because it’s a good idea to have an EMCC physician as a backup. But it’s intimidating that you HAVE to with every patient. That you can’t assess it yourself. Not that I can’t go out and assess this professionally, but that I have to ask my ‘dad’ or ‘mom’ for permission first…”

- EMS dispatcher 5: “But in situations where we can say with 100% certainty, ‘I know she needs to go in.’ Then, I think it would be nice to be able to choose not to send it [the PVU] ourselves. Because then we’re in a situation where some resources could be better used elsewhere.”