Frontline professionals’ experiences of navigating boundaries in a layered care and support system for individuals with complex care needs in the Netherlands

Fragmented care systems, characterized by horizontal and vertical boundaries, hinder interprofessional collaboration for individuals with complex care needs. This study explores how frontline professionals navigate these boundaries to foster collaboration within a national program promoting integrated care for individuals with ‘misunderstood behaviour’ in the Netherlands. Using a boundary work lens, we analysed 44 semi-structured interviews with frontline professionals from the social, care, and safety domains. Our findings reveal that frontline professionals employ a multifaceted repertoire of collaborative boundary work strategies. These strategies include adjusting boundaries (expanding roles and tasks to address individuals' needs), spanning boundaries (creating boundary spanners, co-locations, and boundary objects), and working around boundaries (finding creative solutions to overcome financial and legislative limitations). The choice of strategy deployed depended on the agency professionals experienced in relation to specific types of boundaries. Professionals' limited agency regularly constrained the effectiveness of strategies. In these cases, professionals relied on interventions of higher-level actors. This reliance involved both direct interventions by managers and administrators to rearrange boundaries and indirect support, empowering frontline professionals with the flexibility and autonomy to navigate boundaries themselves. These findings introduce a power dimension to the conceptualization of boundary work and underscore the importance of addressing the interconnectedness of different types of boundaries at various levels.