This paper proposes that boundary work is inherent to leadership practices in healthcare settings, and explores this phenomenon in interprofessional healthcare teams. Specifically, the study focuses on leading through and across boundaries in four interprofessional healthcare teams operating in the area of mental health services. We give special consideration to the specific contexts of these teams, and address the boundaries that are constructed and managed in interactions. Our qualitative study revealed that leadership can be exercised by different members and at different levels within the teams, and that it involves managing the boundaries between (a) roles of different members of the leadership constellation, (b) leadership and clinical roles, (c) formal leaders and other members of the team, (d) different professions, (e) personal life experiences and professional work, and (f) the team and what members consider to be the environment. We identify different types of boundary work tactics that involve opening, closing, and contesting/ negotiating boundaries. In addition, we address the potential consequences of each of these tactics. We consider the implications of our findings to leadership research and practice in healthcare contexts and beyond.

The challenges of managing interprofessional boundaries within multidisciplinary teams are well known. However, the role of intraprofessional relations in influencing the dynamics of interprofessional collaboration remain underexplored. Our qualitative study offers a fine-grained analysis of the interplay between inter- and intraprofessional boundary work among three professional groups in a multidisciplinary team over a period of two years. Our contribution to the literature is threefold. First, we identify various forms of “competitive” and “collaborative” boundary work that may occur simultaneously at both inter- and intraprofessional levels. Second, we reveal the dynamic interplay between inter- and intraprofessional boundary negotiations over time. Third, we theorize relationships between the social position of professional groups, and the uses and consequences of competitive and collaborative boundary work tactics at intra- and interprofessional levels. Specifically, we show how intraprofessional conflict within high-status groups may affect interprofessional dynamics, we reveal how intraprofessional and interprofessional boundaries may be mobilized positively to support collaborative relations, and we show how mobilization within lower-status groups around interprofessional boundary grievances can paradoxically lead to further marginalization.

This article analyses an alliance between a public utility company and a consortium of Associations upholding consumer rights. The project consists of developing means in order to help customers with very low income in a collection situation by suggesting payment arrangements that would take account of their financial situation. Inter-organizational collaboration is a way to increase the capacities of organizations and to apply leverage to existing resources so as to solve social problems more effectively by pooling together resources, skills and knowledge. We examine the making of this social innovation through the arrangements taking in three institutional dimensions: cognitive, normative and regulative. The case study shows that the legitimacy of the agreement was based on recombining the values of fairness and solidarity. The innovation process was rooted in the exchange of knowledge and access to resources based on the expertise of actors. The agreement moved beyond the experimental framework when it was diffused as a newly learned procedure which became an organizational routine.Alianza intersectorial e innovación social: ¿ Cuándo la empresa comercial se cruza con la sociedad civil ?El artículo examina la alianza entre una empresa de servicios públicos y un consorcio formado por asociaciones de defensa de los derechos de los consumidores. El proyecto consiste en desarrollar medios para ayudar a los clientes con menores rentas y dificultades de pago. Se trata de proponer modalidades de pago que tengan en cuenta su situación financiera. La colaboración interorganizativa es una forma de incrementar las capacidades de las organizaciones para una puesta en común de las competencias, * The authors thank the editor of the journal and anonymous reviewers for their helpful comments throughout the review process. We also appreciate the comments on an earlier draft from our colleagues and students of Centre de recherche sur les innovations sociales (CRISES).

While there is growing recognition of leadership as a collective phenomenon, the question of how leadership is shared in the context of hierarchical asymmetry has been neglected in the collective leadership literature. Our article addresses this gap by examining how sharing leadership is negotiated in team interactions that are steeped in asymmetry deriving from the professional hierarchy. Adopting a leadership-in-interaction approach, we draw on fine-grained analysis of observed interactions on interprofessional teams from two health care organizations to compare the discursive strategies used by professionals in a superior hierarchical position to the ones used by those in inferior positions to share leadership. These strategies are organized into a matrix of interactional moves that resist or enact the professional hierarchy. Empirical vignettes are provided to demonstrate how sharing leadership and hierarchical leadership can be co-present and even intertwined in an interaction. We show that leadership is shared (or not) as a result of how the professional hierarchy gets negotiated in interactions. More specifically, we conclude that the sharing of leadership in this context tends to occur prior to decision making, especially around problem formulation, if the interactional climate allows. Furthermore, it requires concrete effort: Those in superior positions of influence mindfully relax the hierarchy whereas those in inferior positions create moments of sharing leadership through resistance and struggle.

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