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Published in: BMC Primary Care 1/2015

Open Access 01-12-2015 | Research article

The challenges of boundary spanners in supporting inter-organizational collaboration in primary care – a qualitative study of general practitioners in a new role

Authors: Marius Brostrøm Kousgaard, Anne Sofie Kjær Joensen, Thorkil Thorsen

Published in: BMC Primary Care | Issue 1/2015

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Abstract

Background

The visions of more integrated care have created new roles and accountabilities for organizations and professionals. Thus, professionals are increasingly expected to engage in boundary spanning activities in order to facilitate inter-organizational and inter-sectoral collaboration. However, this task can be difficult for individual actors and it is important to investigate the work and challenges of boundary spanners in various settings. This study explores the challenges related to a new boundary spanning role for general practitioners employed to facilitate collaboration between the municipalities and general practice.

Methods

The study is based on semi-structured interviews with ten general practitioners acting as municipal practice consultants in the Capital Region of Denmark. The transcribed interviews were analyzed in several steps organizing the material into a set of coherent and distinct categories covering the different types of challenges experienced by the informants.

Results

The main challenges of the general practitioners acting as boundary spanners were: 1) defining and negotiating the role in terms of tasks and competencies; 2) representing and mobilizing colleagues in general practice; 3) navigating in an unfamiliar organizational context.

Conclusions

The results support previous studies in emphasizing the difficult and multifaceted character of the boundary spanning role. While some of these challenges are not easily dealt with due to their structural causes, organizations employing boundary spanners should take note of these challenges and support their boundary spanners with matching resources and competencies.
Literature
1.
go back to reference Hudson B. Integrated Care and Structural Change in England: The Case of Care Trusts. Pol Stud. 2002;23(2):77–95.CrossRef Hudson B. Integrated Care and Structural Change in England: The Case of Care Trusts. Pol Stud. 2002;23(2):77–95.CrossRef
2.
go back to reference Langer S, Chew-Graham CA, Drinkwater J, Afzal C, Keane K, Hunter C, et al. A motivational intervention for patients with COPD in primary care: qualitative evaluation of a new practitioner role. BMC Fam Pract. 2014;15:164.CrossRefPubMedPubMedCentral Langer S, Chew-Graham CA, Drinkwater J, Afzal C, Keane K, Hunter C, et al. A motivational intervention for patients with COPD in primary care: qualitative evaluation of a new practitioner role. BMC Fam Pract. 2014;15:164.CrossRefPubMedPubMedCentral
3.
go back to reference Howarth M, Holland K, Grant MJ. Education needs for integrated care: a literature review. J Adv Nurs. 2006;56(2):144–56.CrossRefPubMed Howarth M, Holland K, Grant MJ. Education needs for integrated care: a literature review. J Adv Nurs. 2006;56(2):144–56.CrossRefPubMed
4.
go back to reference Price E, Baker R, Krause J, Keen C. Organisation of services for people with cardiovascular disorders in primary care: transfer to primary care or to specialist-generalist multidisciplinary teams? BMC Fam Pract. 2014;15:158.CrossRefPubMedPubMedCentral Price E, Baker R, Krause J, Keen C. Organisation of services for people with cardiovascular disorders in primary care: transfer to primary care or to specialist-generalist multidisciplinary teams? BMC Fam Pract. 2014;15:158.CrossRefPubMedPubMedCentral
5.
go back to reference Vedel I, Monette M, Beland F, Monette J, Bergman H. Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada. Int J Integr Care. 2011;11(Special 10th Anniversary Edition):e004. Vedel I, Monette M, Beland F, Monette J, Bergman H. Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada. Int J Integr Care. 2011;11(Special 10th Anniversary Edition):e004.
6.
go back to reference Nicholson C, Jackson C, Marley J. A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review. BMC Health Serv Res. 2013;13:528.CrossRefPubMedPubMedCentral Nicholson C, Jackson C, Marley J. A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review. BMC Health Serv Res. 2013;13:528.CrossRefPubMedPubMedCentral
7.
go back to reference Ministry of Health. Aftale om strukturreformen. [Agreement on the Structural Reform] [in Danish]. Copenhagen; 2004. Ministry of Health. Aftale om strukturreformen. [Agreement on the Structural Reform] [in Danish]. Copenhagen; 2004.
8.
go back to reference Ministry of Health. Sundhedsloven. [The Danish Health Care Act] [in Danish]. 5. ed. Valby: Schultz Information; 2009. Ministry of Health. Sundhedsloven. [The Danish Health Care Act] [in Danish]. 5. ed. Valby: Schultz Information; 2009.
9.
go back to reference Rudkjøbing A, Olejaz M, Birk HO, Nielsen AJ, Hernandez-Quevedo C, Krasnik A. Integrated care: a Danish perspective. Br Med J. 2012;345:e4451.CrossRef Rudkjøbing A, Olejaz M, Birk HO, Nielsen AJ, Hernandez-Quevedo C, Krasnik A. Integrated care: a Danish perspective. Br Med J. 2012;345:e4451.CrossRef
12.
go back to reference Williams P. Collaboration in public policy and practice: Perspectives on boundary spanners. Bristol: The Policy Press; 2012. Williams P. Collaboration in public policy and practice: Perspectives on boundary spanners. Bristol: The Policy Press; 2012.
13.
15.
go back to reference Williams P. The life and times of the boundary spanner. J Integr Care. 2011;19(3):26–33.CrossRef Williams P. The life and times of the boundary spanner. J Integr Care. 2011;19(3):26–33.CrossRef
16.
go back to reference Curnin S, Owen C. Spanning Organizational Boundaries in Emergency Management. Int J Publ Admin. 2014;37:259–70.CrossRef Curnin S, Owen C. Spanning Organizational Boundaries in Emergency Management. Int J Publ Admin. 2014;37:259–70.CrossRef
17.
go back to reference Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13:158.CrossRefPubMedPubMedCentral Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13:158.CrossRefPubMedPubMedCentral
18.
go back to reference Vrangbæk K, Sørensen LM. Does municipal co-financing reduce hospitalisation rates in Denmark? Scand J Public Health. 2013;41:616–22.CrossRefPubMed Vrangbæk K, Sørensen LM. Does municipal co-financing reduce hospitalisation rates in Denmark? Scand J Public Health. 2013;41:616–22.CrossRefPubMed
19.
go back to reference Pedersen KM, Andersen JS, Søndergaard J. General Practice and Primary Health Care in Denmark. J Am Board Fam Med. 2012;25(1):34–8.CrossRef Pedersen KM, Andersen JS, Søndergaard J. General Practice and Primary Health Care in Denmark. J Am Board Fam Med. 2012;25(1):34–8.CrossRef
21.
go back to reference Patton MQ. Qualitative Research & Evaluation Methods. 3rd ed. Thousand Oaks, California: Sage; 2007. Patton MQ. Qualitative Research & Evaluation Methods. 3rd ed. Thousand Oaks, California: Sage; 2007.
23.
go back to reference Ebbinghaus B. When Less is More: Selection Problems in Large-N and Small-N Cross-National Comparisons. Int Sociol. 2005;20(2):133–52.CrossRef Ebbinghaus B. When Less is More: Selection Problems in Large-N and Small-N Cross-National Comparisons. Int Sociol. 2005;20(2):133–52.CrossRef
24.
go back to reference Kvale S. InterViews: An Introduction to Qualitative Research Interviewing. Thousand Oaks, CA: Sage; 1996. Kvale S. InterViews: An Introduction to Qualitative Research Interviewing. Thousand Oaks, CA: Sage; 1996.
25.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
26.
go back to reference Miles M, Huberman M. Qualitative Data Analysis. An Expanded Sourcebook. 2nd ed. London: Sage; 1994. Miles M, Huberman M. Qualitative Data Analysis. An Expanded Sourcebook. 2nd ed. London: Sage; 1994.
27.
go back to reference Vinge S, Strandberg-Larsen M. Kontinuitet og koordination i sundhedsvæsenet. [Continuity and coordination in Danish health care]. Ugeskr Laeger. 2010;172(10):775–7 [in Danish].PubMed Vinge S, Strandberg-Larsen M. Kontinuitet og koordination i sundhedsvæsenet. [Continuity and coordination in Danish health care]. Ugeskr Laeger. 2010;172(10):775–7 [in Danish].PubMed
28.
go back to reference Braithwaite J. Between-group behaviour in healthcare: gaps, edges, boundaries, disconnections, weak ties, spaces and holes. A systematic review. BMC Health Serv Res. 2010;10:330.CrossRefPubMedPubMedCentral Braithwaite J. Between-group behaviour in healthcare: gaps, edges, boundaries, disconnections, weak ties, spaces and holes. A systematic review. BMC Health Serv Res. 2010;10:330.CrossRefPubMedPubMedCentral
29.
go back to reference DiMaggio PJ, Powell WW. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. Am Sociol Rev. 1983;48:147–60.CrossRef DiMaggio PJ, Powell WW. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. Am Sociol Rev. 1983;48:147–60.CrossRef
30.
go back to reference Reay T, Golden-Biddle K, Germann K. Legitimizing a New Role: Small Wins and Microprocesses of Change. Acad Manage J. 2006;49(5):977–98.CrossRef Reay T, Golden-Biddle K, Germann K. Legitimizing a New Role: Small Wins and Microprocesses of Change. Acad Manage J. 2006;49(5):977–98.CrossRef
Metadata
Title
The challenges of boundary spanners in supporting inter-organizational collaboration in primary care – a qualitative study of general practitioners in a new role
Authors
Marius Brostrøm Kousgaard
Anne Sofie Kjær Joensen
Thorkil Thorsen
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2015
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-015-0231-z

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