How professions make intersectoral governance happen in the context of Denmark

Abstract

Abstract Background Intersectoral governance is recognised as key to achieving better healthcare, but our understanding of how to make this happen is limited. Earlier studies on individual professionals fail to acknowledge the resources of health professions as collective actors and pay very little attention to professional agency to support intersectoral governance. The aim is to add new knowledge on how professions contribute to intersectoral governance in healthcare. Methods The study develops a novel conceptual framework, distinguishing between the what, the how and the why of professional agency. The study is based on a secondary analysis of five qualitative case studies of coordination in Denmark, conducted 2011-8 and with a total of 89 hours observations, 18 focus groups, 36 interviews. The case selection identified studies from different organisational settings. Coordination was the key indicator of intersectoral governance and used for coding and for drawing up a data display for more systematic analysis. Results Health professions engage in a wide range of coordination activities; this includes documenting, monitoring, meeting, giving practical support and teaching. Health professions employ diverse mechanisms to adapt coordination activities to local contexts; this is about flexibility and combining mechanisms in a highly tailored way. When they engage in coordination activities, health professions draw on two different rationales: one relates to better healthcare services for patients, the other to professional interests, including work conditions. Conclusions Health professions engage in coordination that spans sectors, organisations and/or professional groups; thus professions are key to making intersectoral governance happen. Key messages Health professions have many resources highly relevant for coordination. Policy and administrative decision makers need to better support health professions to strengthen intersectoral governance.