Social Community Teams' Creation of Service Integration Through Boundary Work and Play with Their Stakeholders.

Abstract

In many European countries, responsibilities for social care have been shifted to municipalities to enhance accessibility and stimulate integration of care and social services, and to cut costs. Multidisciplinary local Social Community Teams (SCTs) have become increasingly responsible for the provision of these integrated services, requiring them to collaborate with local health and societal organisations. To collaborate and to integrate services the SCTs must work across their own and stakeholders' boundaries (e.g., domain specific boundaries). We investigated how boundary work in SCTs' practices contributes to service integration in a dynamic multi-stakeholder context. In our embedded case study, for 18 months, we followed three SCTs in their efforts to integrate services, and used data from multiple sources, including bi-weekly questionnaires in which SCT members reflect on their stakeholder-directed goal achievements. The case analysis yielded four takeaways. First, it demonstrates how SCTs' bottom-up formulation of a long-term service integration vision brought internal coherence (boundary reinforcement), while the short-term action-goals increased collaboration with stakeholders (boundary spanning). Second, only SCTs that managed to incorporate constraints into their action-goals and practices, and to span and play with boundaries, continued with integrating services just-by-doing. Third, two stakeholder characteristics facilitated the SCTs' boundary spanning: well-organized stakeholders and prior familiarity with the stakeholder. Fourth, a new boundary work type emerged, "boundary play", consisting of informal, experimental collaboration efforts with stakeholders contributing to emergent service integration.