Boundary Work

Abstract

This article explores the joint production and consumption of health information and advice in the context of NHS Direct, the new telephone health information and advice service. NHS Direct is an atypical call centre environment in so far as its core staff (nurses) are highly skilled professionals. These nurses are required to collaborate closely with, and are to some extent dependent upon, non-professional lower skilled staff (call handlers) to define and prioritize their work. This introduces a number of tensions between the two groups. Nurses respond to these tensions by engaging in ‘boundary work’, the micropolitical strategies through which work identities and occupational margins are negotiated, to protect their own status. Call handlers are more subject to the pressures of work ‘speed-up’, highly aware of the risks inherent in their role, but are unable to call upon professional status, either in their resistance to managerial imperatives or in their interactions with health consumers. They are required to manage the tension between offering a safe and high quality service, characterized in their training as ‘professional’, and nurses’ boundary work, which positions them as ‘non-professional’. Here we draw on qualitative research, including call interaction data between call handler and consumer, to show how call handlers’ occupation of the contested territory between professional and non-professional status leaves them wide open to the agency of consumers, as consumers attempt to shape the service in their own interests.