Selective permeability of boundaries in a knowledge brokering team

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

PURPOSE

The 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/APPROACH

We 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).

FINDINGS

The 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/IMPLICATIONS

The 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 IMPLICATIONS

For practice this can build bridges between organizational and professional boundaries.

ORIGINALITY/VALUE

The 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.

Evaluation of the quality and subsequent performance of manuscripts rejected by Clinical Rheumatology: a research report

OBJECTIVES

To assess the quality and performance of manuscripts previously rejected by a rheumatology-focused journal.

METHODS

This was a cross-sectional, audit-type, exploratory study of manuscripts submitted to Clinical Rheumatology (CLRH) and rejected by one associate editor in 2019. We used a 36-item quality assessment instrument (5-point ordinal scale, 1 being worst). Performance variables included whether a rejected manuscript was published in another PubMed-listed journal, impact factor of the publishing journal (Scimago), number of citations (Web of Science), and social media attention (Altmetrics). Exploratory variables included authors' past publications, use of reporting guidelines, and text structure. Exploratory variables were assessed using non-parametric tests.

RESULTS

In total, 165 manuscripts were rejected. Reporting guidelines were used in only five (4%) manuscripts. The mean overall quality rating was 2.48 ± 0.73, with 54% of manuscripts rated 2; 40-80% were rated < 3 on crucial items. Over a 26-month follow-up, 79 (48%) rejected manuscripts were published in other journals, mostly with lower impact factors; 70% of these had at least one citation, compared with 90.5% for manuscripts published in CLRH. Altmetrics was significantly lower for manuscripts published elsewhere than for those published in CLRH. As for text structure, the methods and results sections were shorter and the discussion longer than suggested. The corresponding authors' past experience and text structure were not associated with quality or acceptance.

CONCLUSIONS

Research report quality is an area for improvement, mainly for items critical to explaining the research and findings. The use of reporting guidelines should be encouraged by journals. Key Points • The quality of research reports (in rejected manuscripts) is insufficient. • Guidelines for reporting are seldom used in rejected manuscripts. • A manuscript rejected by Clinical Rheumatology may subsequently be published in another journal with a lower impact factor and have fewer citations and less social media attention than accepted manuscripts.

Managing Boundaries in Multiteam Structures: From Parochialism to Integrated Pluralism

Multiteam structures are increasingly used to coordinate complex tasks between different groups. To realize this potential, however, the members of a multiteam structure must manage a complex set of boundary relations within, between, and beyond the various constituent teams—boundary relations that can be cooperative, competitive, or some combination of both at the same time. This multimethod study provides insight into how multiteam structures can meet this challenge. Specifically, we examined how the different organizations that utilize and support the Dutch railway system learned to manage boundaries as they transitioned from a centralized, arms-length structure to a colocated, multiteam structure for coordinating disruption responses (i.e., the Rail Operations Control Center (ROCC)). In part 1 of our study, qualitative analyses of interview, observational, and archival data suggested that learning to manage boundaries within the ROCC was not simple or linear but evolved through trial and error during various phases. Ultimately, the ROCC developed an approach we call “integrated pluralism,” establishing a dynamic balance that combines both collaborative and competitive approaches to boundary management. In this manner, the ROCC teams were able to attain integrated solutions and coordinated task accomplishment while simultaneously defending internal team operations and home organization interests. In part 2, we employed an interrupted time series analysis to demonstrate that the implementation of the ROCC resulted in significant performance improvements. Consistent with the results of part 1, we found that these improvements emerged gradually over time as teams learned to work out their boundary relations and transitioned to integrated pluralism. These findings provide new insights into how individuals and teams can work together to tackle the unique boundary management challenges presented by multiteam structures and illuminate the dynamic trial and error process by which component teams can learn to both cooperate and compete.

Dealing with Discontinuity in Cancer Care Trajectories: Patients' Solutions

Introduction

Patients with cancer require specialized care from different care providers, challenging continuity of care in terms of information, relationships, and/or management. The recognition of discontinuity of care has led to different initiatives by the healthcare system over the years. Yet, making use of the theory on boundary objects and brokers, this research explores the active role of patients themselves in resolving discontinuity along their care trajectories.

Methods

Semi-structured interviews were conducted with 33 patients to unravel the discontinuities that they experience and their attempts to resolve these. Interview data were analyzed using directed-content analysis informed by concepts from boundary crossing literature (i.e., data were searched for potential boundary objects and brokers).

Results

To re-establish continuity of care, patients actively use the objects and people provided by the healthcare system when these meet their needs. Patients also introduce own objects and people into the care trajectory. As such, information and management discontinuity can typically be resolved. Relational continuity appears to be more difficult to resolve, in some cases leaving patients to take drastic measures, such as changing care providers.

Discussion

The use of boundary crossing theory in improving care from a patient perspective is relatively novel. When patients and providers together address the objects and people that support establishing continuity of care, a continuous care process may be encouraged. We advocate an integrated approach, rather than provider or healthcare system initiatives exclusively, to patient care and continuity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40271-021-00535-x.

How far does an emphasis on stakeholder engagement and co-production in research present a threat to academic identity and autonomy? A prospective study across five European countries

There is a growing recognition that needs more to be done to ensure that research contributes to better health services and patient outcomes. Stakeholder engagement in research, including co-production, has been identified as a promising mechanism for improving the value, relevance and utilization of research. This article presents findings from a prospective study which explored the impact of stakeholder engagement in a 3-year European tobacco control research project. That research project aimed to engage stakeholders in the development, testing and dissemination of a return-on-investment tool across five EU countries (the Netherlands, Spain, Hungary, Germany and the UK). The prospective study comprised interviews, observations and document review. The analysis focused on the extent to which the project team recognized, conceptualized and operationalized stakeholder engagement over the course of the research project. Stakeholder engagement in the European research project was conceptualized as a key feature of pre-designated spaces within their work programme. Over the course of the project, however, the tool development work and stakeholder engagement activities decoupled. While the modelling and tool development became more secluded, stakeholder engagement activities subtly transformed from co-production, to consultation, to something more recognizable as research participation. The contribution of this article is not to argue against the potential contribution of stakeholder engagement and co-production, but to show how even well-planned engagement activities can be diverted within the existing research funding and research production systems where non-research stakeholders remain at the margins and can even be seen as a threat to academic identify and autonomy.

Boundary organising in healthcare: theoretical perspectives, empirical insights and future prospects

Purpose

The purpose of this paper is to introduce a special issue on boundary organising in healthcare bringing together a selection of six leading papers accepted for presentation at the 12th Organisational Behaviour in Health Care (OBHC 2020) Conference.

Design/methodology/approach

In this introductory paper, the guest editors position the special issue papers in relation to the theoretical literature on boundaries and boundary organising and highlight how these contributions advance our understanding of boundary phenomena in healthcare.

Findings

Three strands of thinking – practice-based, systems theory and place-based approaches – are briefly described, followed by an analytical summary of the six papers included in the special issue. The papers illustrate how the dynamic processes of boundary organising, stemming from the dual nature of boundaries and boundary objects, can be constrained and enabled by the complexity of broader multi-layered boundary landscapes, in which local clinical and managerial practices are embedded.

Originality/value

The authors set the scene for the papers included in the special issue, summarise their contributions and implications, and suggest directions for future research.

Research implications/limitations

The authors call for interdisciplinary and multi-theoretical investigations of boundary phenomena in health organisation and management, with a particular attention to (1) the interplay between multiple types of boundaries, actors and objects operating in complex multi-layered boundary systems; (2) diversity of the backgrounds, experiences and preferences of patients and services users and (3) the role of artificial intelligence and other non-human actors in boundary organising.

Practical implications

Developing strategies of reflection, mitigation, justification and relational work is crucial for the success of boundary organising initiatives.

Metaphors of organizations in patient involvement programs: connections and contradictions

PURPOSE

In this paper, we contribute to the theorizing of patient involvement in organizational improvement by exploring concepts of "learning from patients" as mechanisms of organizational change. Using the concept of metaphor as a theoretical bridge, we analyse interview data (n = 20) from participants in patient engagement activities from two case study organizations in Ontario, Canada. Inspired by classic organizational scholars, we ask "what is the organization that it might learn from patients?"

DESIGN/METHODOLOGY/APPROACH

Patient involvement activities are used as part of quality improvement efforts in healthcare organizations worldwide. One fundamental assumption underpinning this activity is the notion that organizations must "learn from patients" in order to enact positive organizational change. Despite this emphasis on learning, there is a paucity of research that theorizes learning or connects concepts of learning to organizational change within the domain of patient involvement.

FINDINGS

Through our analysis, we interpret a range of metaphors of the organization, including organizations as (1) power and politics, (2) systems and (3) narratives. Through these metaphors, we display a range of possibilities for interpreting how organizations might learn from patients and associated implications for organizational change.

ORIGINALITY/VALUE

This analysis has implications for how the framing of the organization matters for concepts of learning in patient engagement activities and how misalignments might stymie engagement efforts. We argue that the concept and commitment to "learning from patients" would be enriched by further engagement with the sociology of knowledge and critical concepts from theories of organizational learning.

Functional Leadership in Interteam Contexts: Understanding 'What' in the Context of Why? Where? When? and Who?

Research on team leadership has primarily focused on leadership processes targeted within teams, in support of team objectives. Yet, teams are open systems that interact with other teams to achieve proximal as well as distal goals. This review clarifies that defining 'what' constitutes functionally effective leadership in interteam contexts requires greater precision with regard to where (within teams, across teams) and why (team goals, system goals) leadership processes are enacted, as well as greater consideration of when and among whom leadership processes arise. We begin by synthesizing findings from empirical studies published over the past 30 years that shed light on questions of what, where, why, when, and who related to interteam leadership and end by providing three overarching recommendations for how research should proceed in order to provide a more comprehensive picture of leadership in interteam contexts.