Paradoxes of Multi-Level Leadership: Insights from an Integrated Care System

Bolden, Richard; Kars-Unluoglu, Selen; Jarvis, Carol; Sheffield, Rob

doi:10.1080/14697017.2023.2234388

Cited by 8 publications

(6 citation statements)

References 41 publications

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“…For professionals or managers this means that rather than focusing on dissolving diversity and diverging understandings, attention should be directed towards accepting and embracing diversity and divergence (Bolden et al ., 2023). We therefore argue for a stronger focus on the processes whereby people contribute to the production of organizational culture by ascribing meaning to practices.…”

Section: Discussionmentioning

confidence: 99%

“…Coordination and collaboration between health care providers across organizational and/or sectoral boundaries have become a way to improve quality of health care and to reduce health care costs (Raus et al, 2020). However, the implementation of more integrated health care delivery solutions seems to be "painfully slow" (Bolden et al, 2023). This highlights the complexity of coordinating and collaborating across organizations and sectors (Bilodeau et al, 2018;Bryson et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…The concept organizational culture rooted in a management tradition seems to offer a solution to promote organizational performance in healthcare (Bolden et al, 2023;Mondal et al, 2021;Johnson et al, 2016). Building on Hofstede's (1980) work, organizational culture emerges as a singular identity of an organization (Johnson et al, 2016) to enhance organizational performance.…”

Section: Introductionmentioning

confidence: 99%

“…Well-known barriers to successful implementation include lack of commitment and opposing objectives across organizations, as well as conflicts within teams and resistance to change (Cheragi et al ., 2023; Kozlowska et al ., 2018). New roles and working environments may challenge professional identities (Bolden et al ., 2023; Bussu and Marshall, 2020). Hence, the implementation of coordination and collaboration across organizations and sectors seems to require more deep-seated changes to health care delivery (Bussu and Marshall, 2020; Josi et al ., 2020; Walston and Chou, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…The concept organizational culture rooted in a management tradition seems to offer a solution to promote organizational performance in healthcare (Bolden et al ., 2023; Mondal et al. , 2021; Johnson et al ., 2016).…”

Section: Introductionmentioning

confidence: 99%

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

Fehsenfeld,

Maindal,

Burau

2024

JHOM

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PurposeThe purpose of this paper is to rethink the concept of organizational culture as something that emerges bottom-up by using the sociological concepts of boundary object and boundary work as an analytical lens and to show how this approach can help understand and facilitate intersectoral coordination.Design/methodology/approachWe used observations and qualitative interviews to develop “deep” knowledge about processes of intersectoral coordination. The study draws on a conceptual framework of “boundary work” and “boundary objects” to show how a bottom-up perspective on organizational culture can produce better understanding of and pave the way for intersectoral coordination. We use a case of health professionals engaged in two Danish intersectoral programs developing and providing health promotion services for women with gestational diabetes mellitus (GDM).FindingsThe study showed how boundary work revolves around negotiations on how to define, understand and act on the diagnosis of GDM. This diagnosis has the characteristics of a “boundary object”, being more loosely structured in general terms, but strongly structured in local settings. Boundary objects help connect different professionals and facilitate coordination. The analysis showed how the introduction of time and the concept of “lifelong health promotion” helped to transgress existing organizational and professional boundaries.Research limitations/implicationsThe findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination and collaboration. While the theoretical implications will be general applicable when studying organizational culture, the implications for practice are sensitive to context and the processes we have described as the outcomes of boundary work are generated from cases that were most likely to provide deep insight into our research topic.Practical implicationsFor practice this can build bridges between organizational and professional boundaries.Originality/valueThe findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination. This may build bridges between organizational and professional boundaries in practice settings.

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Section: Discussionmentioning

confidence: 99%