Boundaries in Health Care Discussions: An Activity Theoretical Approach to the Analysis of Boundaries

Abstract

In organizational studies, boundaries are often approached as structural forms (Scott 1998), or as systemic multilevel relationships directing the material, social, and mental aspects of evolving organizations and their conceptualizations (Schneider 1987; Hannan and Freeman 1989; Hernes, this volume). These depictions of boundaries emphasize the complex, unstable, and negotiable nature of boundaries, which is also assumed in this volume. My contribution to this discussion is to introduce an activity-theoretical methodology for understanding boundaries in interorganizational interaction. I illustrate this methodology with a case example from internal medicine in which the care of patients with many illnesses creates new challenges for managing boundaries in health-care services. Cultural-historical activity theory (CHAT) derives from the developmental psychology of the cultural historical school in Russia, and the former Soviet Union. Vygotsky (1978), the founder of the school, conceptualized human actions as culturally and historically grounded, and as mediated by signs and tools. Leont’ev’s (1978) contribution was to emphasize the object-oriented and collective nature of actions. Leont’ev depicted the general structure of activity as threefold: (1) collective, object-oriented activity directed by motives; (2) actions directed by goals; and (3) operations directed by the circumstances and tools at hand. These aspects of activity are important for the analysis of boundaries from the activity-theoretical perspective.