Professional boundaries in action: Using reflective spaces for boundary work to incorporate a new healthcare role

Vesa Puhakka,Heikki Wiik,Noora Jansson,Marjo Suhonen,Tuija Mainela,Merja Meriläinen,Nina Lunkka

doi:10.1177/00187267211010363

Vesa Puhakka, Heikki Wiik + Show 5 more

Open Access

https://doi.org/10.1177/00187267211010363

Copy DOI

Abstract

Prior research on professional boundary work emphasises the importance of subtle interactions among affected individuals when a new role is inserted into an established professional setting, which inevitably changes the prevalent division of labour. Thus, managers may set reflective spaces for professionals to collaboratively arrange their boundaries and make room for the new professional. This ethnomethodologically oriented study examines boundary arrangements in work development meetings in a university hospital, while professionals made room for a new role, a hospitalist. Examining professionals’ naturally occurring interactions in reflective spaces, the findings depict seven categorisations for the hospitalist. Elaborating on the dynamics of these categorisations, we propose that technically based categorisations sustain stability, and context-bound categorisations allow change in work practices, whereas their combination enables transformation within the institutional context. Accordingly, the study adds to the literature on the transformative potential of reflective spaces by illuminating the intertwining of engaged professionals’ boundary talk in interaction with the consequences of configurational boundary work in relation to a new professional role.

Highlights

Presenting a new professional role into a well-established professional setting changes the division of labour between the professions and may be felt as a threat (Currie et al, 2012)
Prior research on professional boundary work emphasises the importance of subtle interactions among affected individuals when a new role is inserted into an established professional setting, which inevitably changes the prevalent division of labour
We present an analysis of boundary talk-in-interaction in reflective spaces during new professional role insertion, and recorded boundary negotiation

Summary

Introduction

Presenting a new professional role into a well-established professional setting changes the division of labour between the professions and may be felt as a threat (Currie et al, 2012). The idea was that the hospitalist’s role and job description in surgical wards at the hospital would continue to develop after the piloting, and remain fluid during the recruitment and subsequent developmental processes (including the meetings described and analysed here) These meetings were used to enable and enhance dialogue between the hospitalist and the personnel, providing space and time for the health care professionals to talk about the hospitalist’s work in relation to their work practices. In ethnomethodological study, being close to the research setting is regarded as advantageous rather on than disadvantageous (Whittle et al, 2015) In this case, for example, the first author’s nuanced understanding of work practices in health care generally and the focal hospital facilitated interpretation of the social activity. The consequent interactive combination of technical and contextual practical reasoning generated role dynamics capable of transforming the social order within the institutional context

Findings

Discussion

Conclusion