Leadership as boundary work in healthcare teams

Abstract

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.

Organizational Construction and Interdisciplinary Identity in a New Health Care Organization

“…Leadership of such groups involves "the practices of influencing how boundaries are drawn and managed" (Chreim et al 2013:204). In health care, these boundaries may include one's intrapersonal boundaries as well as boundaries between leadership and clinical roles, between leadership positions and team members, among different professions, between client and professional, and between team and environment (Chreim et al 2013). The "boundary work" that leaders do may work to build, destroy, or blur boundaries (Gieryn 1983) or to negotiate, confirm, or contest boundaries (Chreim et al 2013).…”

Patients' perceptions of their medical records from different subject positions

“…They also anticipated both negative and positive outcomes of breaking established boundaries of professions and expertise. Even if there is a clear tendency to polarize these issues, in general, the breaking or maintenance of any boundaries tends to have both a positive and negative impact that goes beyond individual groups of stakeholders (e.g., Chreim, Langley, Comeau-Vallée, Huq, & Reay, 2013;Fennell & Alexander, 1987;Denis, Lamothe, Langley, & Valette, 1999;Desombre, Kelliher, Macfarlane, & Ozbilgin, 2006;Finn, Currie, & Martin, 2010). The eradication of the professional authority of clinicians can have a very real negative impact on health care.…”

Une famille recomposée : l’intégration d’un centre de réadaptation dans un centre hospitalier

“…Ils ont montré que la présence d'une identité de transition facilitait la réalisation effective de ce type de changement. Enfin, d'autres travaux ont porté sur le travail frontalier requis quant aux frontières disciplinaires pour un fonctionnement optimal des équipes multidisciplinaires (Brown, Crawford et Darongkamas, 2000;Chreim et autres, 2013). Finalement, la gestion des frontières serait un défi demandant une attention particulière afin de maintenir l'identité et l'expertise organisationnelles.…”