Inter-occupational cooperation and boundary work in the hospital setting

Abstract

Purpose The purpose of this paper is to add a little piece to the research on boundary work and inter-occupational cooperation by addressing two questions: how do actors perform boundary work in an inter-occupational cooperation project that seeks to improve the personnel health work in a hospital setting? What impact does the boundary work have on such cooperation in the personnel health project? Design/methodology/approach The study is based on individual, in-depth interviews and participative observations of focus group discussions conducted at a regional municipal organization in Sweden. Respondents are hospital line managers, experts and strategists in the HR departments, and experts from the internal occupational health service. Findings The concepts on boundary work, which include closing/opening boundary strategies, provide the framework for the empirical illustrations. The cooperation runs smoothly in the rehabilitation work because of an agreed upon process in which the professionals' jurisdictions are preserved through closing strategies. Illness prevention and health promotion are not areas of inter-occupational cooperation because the stronger actors use closing strategies. While the weaker actors, who try to cooperate, use opening boundary strategies in these areas, they are excluded or marginalized. Research limitations/implications The empirical investigation concerns one cooperation project and was completed at one data collection point. Originality/value No similar study of boundary work and inter-occupational cooperation in a hospital setting is available despite the frequency of this professional group configuration in practice. A more inclusive concept of professionalism may facilitate the study of boundary work and inter-occupational cooperation among actors with different professional authority.

An ethnographic study comparing approaches to inter-professional knowledge sharing and learning in discharge planning and care transitions

“…Within the hospital, this is exemplified by the persistence of hospital departments and wards aligned with (usually) medical jurisdictions. Cregård (2018) shows how the relationship between inter-professional coordination and boundaries can be complex. For example, "closed" boundaries do not always result in an absence of coordination, rather more inefficient interactions, whilst "open" boundaries do not necessarily promote coordination, especially if power inequalities exist across boundaries.…”

Lower-status experts' influence on health-care managers' decision-making

“…We used the three main service activities of rehabilitation, prevention and promotion to describe and analyze experts' attempts to gain Lower-status experts' influence influence, focusing on process alignment, strategy alignment, and the distinctions of technical skills and professional attributes. It may be assumed that experts who together perform a service become integrated into a team and have their primary loyalty to the team and the clients for whom they work (Creg ard, 2018). Thus, we assume that an organizational position as cooperating experts is more compelling for the lower-status experts with low professional status than their professional background.…”

Professional boundaries in action: Using reflective spaces for boundary work to incorporate a new healthcare role

“…Hence, they are generally aware of their professional boundaries and the differences among professional groups (Powell and Davies, 2012). However, governments and healthcare organisations increasingly strive to regulate health care professionals and their boundaries to enhance patient care quality and health services' effectiveness (Martin et al 2009; (Cregård, 2018).…”

“…Thus, they increasingly promote new practices that emphasise patient orientation and interprofessional co-operation. Clearly, these expectations increase needs to foster boundary-modifying transformations that enhance the development of desirable new work practices (Cregård, 2018).…”