Boundary organising in healthcare: theoretical perspectives, empirical insights and future prospects

Abstract

PurposeThe purpose of this paper is to introduce a special issue on boundary organising in healthcare bringing together a selection of six leading papers accepted for presentation at the 12th Organisational Behaviour in Health Care (OBHC 2020) Conference. Design/methodology/approachIn this introductory paper, the guest editors position the special issue papers in relation to the theoretical literature on boundaries and boundary organising and highlight how these contributions advance our understanding of boundary phenomena in healthcare.FindingsThree strands of thinking – practice-based, systems theory and place-based approaches – are briefly described, followed by an analytical summary of the six papers included in the special issue. The papers illustrate how the dynamic processes of boundary organising, stemming from the dual nature of boundaries and boundary objects, can be constrained and enabled by the complexity of broader multi-layered boundary landscapes, in which local clinical and managerial practices are embedded.Originality/valueThe authors set the scene for the papers included in the special issue, summarise their contributions and implications, and suggest directions for future research.Research implications/limitationsThe authors call for interdisciplinary and multi-theoretical investigations of boundary phenomena in health organisation and management, with a particular attention to (1) the interplay between multiple types of boundaries, actors and objects operating in complex multi-layered boundary systems; (2) diversity of the backgrounds, experiences and preferences of patients and services users and (3) the role of artificial intelligence and other non-human actors in boundary organising.Practical implicationsDeveloping strategies of reflection, mitigation, justification and relational work is crucial for the success of boundary organising initiatives.

Rethinking organizational culture in intersectoral coordination: the perspective of boundary work

“…Such friction is often labeled as a culture of “resistance to change” that can prevent the implementation of new initiatives (Cheraghi et al ., 2023; Johansson et al ., 2014). The boundary work approach, however, helps understand how friction can build bridges between different organizational values and practices and enhance coordination (Kislov et al ., 2021). In other words, what often starts as an instance of “othering” in response to the confrontation of two perspectives, and as a way of safeguarding professional boundaries, can develop into the recognition of a shared problem space (Akkerman and Bakker, 2011).…”

“…Most of the literature on boundary work is concerned with the processes that take place in the encounter between the different social worlds of organizations (Pedersen et al ., 2017; Meir, 2015). Less attention has been given to the intraorganizational workings of boundary work (Kislov, 2021; Comeau-Vallée and Langley, 2020). While the interorganizational effects might be more transient as collaboration and coordination come and go, the intraorganizational implications might be more sustained and have a deeper impact on organizational culture.…”

“…Meier (2015) illustrates how professionals from different departments at a hospital ward identified a shared problem in the patients, around whom relations between the professionals were negotiated temporarily, dissolving existing hierarchical and organizational boundaries. In this way, boundary objects can strengthen the capacity of an idea or practice to be transferred across boundaries, fertilizing the ground for a common repertoire of ideas, which can be described as “boundary bridges” facilitating coordination or collaboration across boundaries (Kislov et al ., 2021).…”

The Psychoneuroimmunological Model of Moral Distress and Health in Healthcare Workers: Toward Individual and System-Level Solutions

“…Compared to other occupations, the medical professions include work stressors that are linked to sometimes grueling, often stressful environments that include repeated exposure to suffering, pain and death; significant responsibility for patient outcomes; unpredictable workflow, long and irregular working hours; exposure to personal health risks; a fast work pace; and the need for rapid adaptations to changing standards of care, and administrative and teaching duties [ 19 ]. Further complexities of healthcare work include navigating the permeable boundaries between work and non-work and family responsibilities, frequently resulting in work-life conflicts [ 20 ]. Finally, HCWs are vulnerable because they typically prioritize patients’ needs above their own [ 21 , 22 ].…”

Boundary work: a conceptual frame for workplace ethnographies in collaborative settings

“…Most prominently, this includes multi-sited studies of transnational and multi-sited companies and organizations (e.g. Prasad and Shadnam, 2023; Fishberg, 2022; Duijn, 2020; Trouillot, 2003; Garsten, 1994); netnographies of novel virtual technologies that allow remote working and working together (Lemmetty et al ., 2022; Purli, 2007) and network-ethnographies of hybrid and network-based organization of work (Kislov et al. , 2021; Berthod et al ., 2017).…”