Rethinking organizational culture in intersectoral coordination: the perspective of boundary work
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 28 May 2024
Issue publication date: 3 June 2024
Abstract
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.
Keywords
Acknowledgements
We are grateful to the two health care programs involved in our research for the support and access they provided, and in particular we thank the project coordinator of the Face-it study, Inger Katrine Dahl-Petersen, and all the informants who participated in the interviews. Their engagement and insights have been invaluable. We also wish to thank the anonymous reviewers for their constructive comments on earlier drafts of this article and the Journal of Health Organization and Management editorial team for their support. Finally we would like to acknowledge the financial support of Helsefonden and Steno Diabetes Center Aarhus.
Citation
Fehsenfeld, M., Maindal, H.T. and Burau, V. (2024), "Rethinking organizational culture in intersectoral coordination: the perspective of boundary work", Journal of Health Organization and Management, Vol. 38 No. 3, pp. 414-429. https://doi.org/10.1108/JHOM-03-2023-0063
Publisher
:Emerald Publishing Limited
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