Shifting contours of boundaries: an exploration of inter-agency integration between hospital and community interprofessional diabetes programs.
This article reports on research into the relationships that emerged between hospital-based and community-based interprofessional diabetes programs involved in inter-agency care. Using constructivist grounded theory methodology we interviewed a purposive theoretical sample of 21 clinicians and administrators from both types of programs. Emergent themes were identified through a process of constant comparative analysis. Initial boundaries were constructed based on contrasts in beliefs, practices and expertise. In response to bureaucratic and social pressures, boundaries were redefined in a way that created role uncertainty and disempowered community programs, ultimately preventing collaboration. We illustrate the dynamic and multi-dimensional nature of social and symbolic boundaries in inter-agency diabetes care and the tacit ways in which hospitals can maintain a power position at the expense of other actors in the field. As efforts continue in Canada and elsewhere to move knowledge and resources into community sectors, we highlight the importance of hospitals seeing beyond their own interests and adopting more altruistic models of inter-agency integration.
Department of Medicine, University of Toronto , Toronto, Ontario , Canada and.
Rene
R
Wong
Petra
P
Breiner
Maria
M
Mylopoulos
D003159:Community-Institutional Relations; D003920:Diabetes Mellitus / Q000628:therapy*; D066296:Grounded Theory; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario; D036301:Qualitative Research; D014505:Urban Population
Grounded theory; integration; inter-agency; interprofessional research; professional boundaries; qualitative method