Boundary preservation or modification

The challenge of collaboration in health care

Abstract

Collaboration has been alleged to increase quality and reduce costs in health care, however previous research shows that well-functioning integration might be difficult. This paper looks upon multi-professional teamwork from the professionals’ perspective. The purpose is to study how organising processes are upheld or reshaped in a collaborative human services setting, and to explain the underlying mechanisms behind emerging organising processes. Two cases of multi-professional teamwork were studied and data collected through interviews with team members and their managers. The results suggest that it is possible to distinguish between organising processes of boundary modification and boundary preservation, respectively, where preserved legal and economic boundaries, maintenance of organisational cultures and separate service provision processes work to uphold existing organising processes , whereas disconnection of team activities from the parent organisations and the establishment of boundary platforms instead contribute to develop new modes of human services delivery. In particular, boundary platforms create meeting places for professionals to develop new ways of acting and producing services and therefore have the potential to exceed and modify physical, social and mental boundaries. Between the forces of boundary preservation and boundary modification, a tension will be induced and continuously upheld through political processes among actors.