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Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care

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  • Liberati, Elisa Giulia
  • Gorli, Mara
  • Scaratti, Giuseppe

Abstract

Delivery of interdisciplinary integrated care is central to contemporary health policy. Hospitals worldwide are therefore attempting to move away from a functional organisation of care, built around discipline-based specialisation, towards an approach of delivering care through multidisciplinary teams. However, the mere existence of such teams may not guarantee integrated and collaborative work across medical disciplines, which can be hindered by boundaries between and within professions. This paper analyses the boundaries that affect collaboration and care integration in newly created multidisciplinary teams. Empirical data are drawn from an ethnographic research conducted in the sub-intensive stroke unit of an Italian public hospital. Data collection involved 180 h of observations and conversations with 42 healthcare providers. Findings show that disciplinary boundaries hinder both intra-professional and inter-professional collaboration. Doctors from different disciplines adopt different, and sometimes conflicting, clinical approaches, doctors and nurses construct discipline-specific professional identities, and conflicts emerge between doctors and nurses from different disciplines over the regulation of the medical–nursing boundary. Achieving collaboration and integration between professionals from different disciplines may be particularly challenging when the group with less institutional power (nurses, in this case) has developed a high level of expertise on the needs of the patients targeted by the team. Effective interdisciplinary work thus requires not only bridging boundaries within the medical professional group, but also addressing the dynamics of resistance in merging doctors and nurses with different disciplinary backgrounds. In the paper, we summarise these results in a framework that contributes knowledge to the field of professional boundaries in healthcare while offering practical insights to forge new interdisciplinary relationships, which are more embedded in the daily experience of care providers.

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  • Liberati, Elisa Giulia & Gorli, Mara & Scaratti, Giuseppe, 2016. "Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care," Social Science & Medicine, Elsevier, vol. 150(C), pages 31-39.
    • Handle: RePEc:eee:socmed:v:150:y:2016:i:c:p:31-39
    DOI: 10.1016/j.socscimed.2015.12.002
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    1. Liberati, Elisa Giulia, 2017. "Separating, replacing, intersecting: The influence of context on the construction of the medical-nursing boundary," Social Science & Medicine, Elsevier, vol. 172(C), pages 135-143.
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    3. Miner, Skye A., 2019. "Demarcating the dirty work: Canadian Fertility professionals’ use of boundary-work in contentious egg donation," Social Science & Medicine, Elsevier, vol. 221(C), pages 19-26.
    4. Chiung‐Jung (Jo) Wu & Mary‐Anne Ramis & Helen Skerman, 2019. "Integrated approaches for comorbidity," Nursing & Health Sciences, John Wiley & Sons, vol. 21(4), pages 413-415, December.
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    6. Bertin, Giovanni & Pantalone, Marta, 2019. "Professional identity in community care: The case of specialist physicians in outpatient services in Italy," Social Science & Medicine, Elsevier, vol. 226(C), pages 21-28.
    7. Caronia, Letizia & Saglietti, Marzia & Chieregato, Arturo, 2020. "Challenging the interprofessional epistemic boundaries: The practices of informing in nurse-physician interaction," Social Science & Medicine, Elsevier, vol. 246(C).

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