Multidisciplinary collaboration as a loosely coupled system: Integrating and blocking professional boundaries with objects

Abstract

In this paper, the concept of loosely coupled systems is applied to describe multidisciplinary collaboration in healthcare. It is further argued that tools employed in collaborative activities may be regarded as object components of such a system. Drawing on observational studies and interviews of a group of health professionals from different disciplines collaborating on breast cancer, it is argued that differences in use of such objects may either inhibit or encourage cross-boundary collaboration. This effect is influenced by how the meanings of these objects vary between participants in the collaborative interaction. Meaning variation allows for more integration across boundaries, while meaning immutability may block the same boundaries. This finding is important for multidisciplinary contexts, adding new knowledge to the important quest for integrating relationships across professional boundaries.

Using Loose Coupling Theory to Understand Interprofessional Collaborative Practice on a Transplantation Team

“…With this loosely coupled system, instances of tight coupling and of decoupling emerge. And while encountering a lower degree of responsiveness than expected across the three dimensions creates frustration for core team members, we would not conclude, as did Heldal [17], that tighter coupling equates to better collaboration. Rather, we contend that the relationship between coupling and effective collaborative, patient-centred care is a complicated and situated one.…”

“…We diverge from Heldal in resisting his assertion "that the benefits of multidisciplinary teamwork lie in a tighter coupling across professional boundaries" [17]. Rather than drawing general conclusions regarding the effectiveness of tightly coupled over loosely coupled systems, or vice versa, our work takes up Orton and Weick's call for researchers to conduct "descriptive" rather than "evaluative" work [30,31] that explores the domains and patterns of coupling and decoupling in a system, toward understanding their effects in particular situations.…”

“…A good example explores the multidisciplinary system of breast cancer care [17]. Combining activity theory with loose coupling, Heldal considers the role of boundary objects 1 in the integration of clinical disciplines in breast cancer care.…”

“…As we sought to deepen our understanding of this theme in the data, we turned to the organizational theory of loose coupling as an analytical resource. Recently taken up as a lens for studying multidisciplinary work in healthcare [16,17], loose coupling has promise not only for explaining how systems that seem to be in opposition can survive [18], but also for exploring the extent to which interprofessional collaboration in health care is viable "not only in spite of the loose linkage between professionals, but because of it" [19].…”

Turning to case studies as a mechanism for learning in action learning

“…Boundary spanning can also occur through the use of boundary objects, understood as objects which can be used to cross boundaries for example reports, web pages, information technology systems and procedural manuals (Heldal, 2010). In the language of action research, boundary objects are articulated units of P (programmed knowledge).…”