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What is the role of the nursing profession in field level inter-organizational coordination?

Author:

Anne Doessing

Abstract

Introduction: The question of inter-organizational coordination has been widely debated in healthcare, where scholars have paid special attention to administrative coordination and the role of case managers in operative coordination. Yet, these perspectives have not adequately addressed the role of health professions in inter-organizational coordination at the operative level in public sectors. As a result, the responsibility of health professions in inter-organizational coordination remains unclear, as does the division of coordination tasks among professions.

The studies that exist are especially concerned with professions contribute to implementation failure and in turn to recurring problems of adoption and program sustainability at the operative level of health care. It is therefore highly relevant to ask whether operative coordination is actually something health professions want to be involved in.

This concern is reinforced by several empirical studies documenting the lack of engagement in coordination tasks on the part of the medical profession and by the apparent lack of jurisdictional battles over coordination tasks within the health professional division of labour. Consequently, it cannot automatically be expected that health professions will attempt to claim jurisdiction of operational coordination and there is a real possibility that inter-organizational coordination is seen as an unattractive task by professional actors. This poses a major challenge in enabling integrated care. Put bluntly, efforts to achieve integration at the administrative and political level risk being paper tigers without connection to the reality at the operative level of health care.

Thus, it is significant to gain insight into the role of other professions than the medical. In this context the nursing profession offers a particular interesting case; although the profession does not have a formal mandate, it is repeatedly ascribed a key role in operational coordination in health care.

Theory/Methods: Recent organizational studies of professions emphasize the close connection between organizational and professional development and highlight the key role professions play in field level change as institutional entrepreneurs. This means that professions have a potential to play an active role in enabling integrated care.

At the same time, other studies in organizational sociology describe how professions may not engage in tasks if these are perceived as low status, low value and do not enable them to use their specialized expertise and express their professional identity. In such situations lower status occupations can fill in the gaps, especially those involving routine and tangential work, and act as a “brokerage profession” using connecting and/or buffering practices.

Building on this, the specific aim of the paper is to examine how operative coordination connects with and is embedded in the expertise, identity and interest of the nursing professions.

Empirically the paper will be based on a qualitative case study of the nursing profession in Denmark and how nurses engage in cross-sectorial care coordination.

Results (progress report):

Data will be collected in the first trimester of 2016.

The analysis will focus on the conception of operational coordination within the nursing profession and in what ways their role in inter-organizational coordination can be described as a ‘brokerage profession’.

Discussion: The new concept of ‘brokerage professions’ will be juxtaposed against the existing theory of ‘boundary spanning’ as part of a mainstream job role. It will be discussed how the practices of ‘brokerage professions’ connect to the four main boundary spanning roles – reticulist, entrepreneur, interpreter/communicator and coordinator.

Conclusion: This study, by closely examining how operative coordination connects with the professional expertise, identity and interest of the nursing profession sheds new light on the neglected role of health professions in inter-organizational coordination and focuses on the potential of health professions as institutional entrepreneurs.

How to Cite: Doessing A. What is the role of the nursing profession in field level inter-organizational coordination?. International Journal of Integrated Care. 2016;16(6):A128. DOI: http://doi.org/10.5334/ijic.2677
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Published on 16 Dec 2016.

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