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In our study of an interactive marketing organization, we examine how members of different communities perform boundary-spanning coordination work in conditions of high speed, uncertainty, and rapid change. We find that members engage in a number of cross-boundary coordination practices that make their work visible and legible to each other, and that enable ongoing revision and alignment. Drawing on the notion of a “trading zone,” we suggest that by engaging in these practices, members enact a coordination structure that affords cross-boundary coordination while facilitating adaptability, speed, and learning. We also find that these coordination practices do not eliminate jurisdictional conflicts, and often generate problematic consequences such as the privileging of speed over quality, suppression of difference, loss of comprehension, misinterpretation and ambiguity, rework, and temporal pressure. After discussing our empirical findings, we explore their implications for organizations attempting to operate in the uncertain and rapidly changing contexts of postbureaucratic work.

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Although the mandated restriction of resident duty hours has had no measurable impact on the quality of patient care and has led to improvements for the current quality of life of residents, there are many concerns with regards to the training of professional, responsible surgeons for the future.

In this comparative ethnographic case study of the implementation of a reform related to the Affordable Care Act in two community health centers, I find that professionals may not compete to claim new tasks (and thereby not implement reform) if these tasks require them to acquire information unrelated to their professional expertise, use work practices that conflict with their professional identity, or do impure or low-value tasks that threaten their professional interests. In such cases, reform may be implemented if lower-status workers fill in the gaps in the division of labor between the professions targeted by the reform, playing a brokerage role by protecting each profession's information, meanings, and tasks in everyday work. When the new tasks represent professionally ill-defined problems, brokers can be more effective if they use buffering practices rather than connecting practices-managing information rather than transferring it, matching meanings rather than translating them, and maintaining interests rather than transforming them-to accomplish reform. By playing a buffering role in the interstices between existing professional jurisdictions, lower-status workers can carve out their own jurisdiction, becoming a brokerage profession between existing professions that need to collaborate with one another for reform to occur. Public health activists argue that because low-income people's health problems often occur long before they get to their doctor, for the Affordable Care Act to be successful, patients need access to primary care physicians and to enabling programs that address the social determinants of health. Activists across the country have received funding for these programs (American Public Health Association [APHA] 2010). KeywordsMLP reform is an enabling program designed to improve the health outcomes of traditionally disadvantaged groups by changing the everyday practices of health center doctors and legal aid lawyers.Health center doctors typically treat low-income patients' medical problems; with the implementation of 3 MLP reform, they also address the social and legal problems that affect patients' health (e.g., if a patient's apartment lacks heat, it will be difficult for the patient to recover from an ear infection). Lawyers, in working with low-income clients, often use individual cases to bring legal reform for large numbers of the poor; with the implementation of MLP reform, they gain new access and treatment points for vulnerable clients by expanding legal screening, and they increase their ability to solve legal problems related to health for large numbers of the poor by getting doctors to assist with reform efforts.To implement MLP reform, both doctors and lawyers need to change how they screen clients, determine their eligibility for treatment, and treat them. Doctors must learn from lawyers to screen patients for unmet social and economic needs in areas such as income, housing and utilities, education, immigration, and personal and family stability; they must also refer ...