Emergent modes of work and communities of practice

This paper argues that the recent emphasis on teams in the health services research literature tends to be attributed to our rising recognition that flexible and self-organizing teams are in the best position to handle the increasing complexity and fragmentation of health services. With a brief review of two papers on health-care teams as its point of departure, this paper argues that the concern with teams harbours a realization that the organizational-managerial point of gravity of most clinical work lies with those who do the work. In the context of health reforms sweeping across most countries in the industrialized world, this means that teams are to embody dynamic self-organization as do 'communities of practice (CoPs)', and be the origin of the managerial and documentary realities that describe, define and validate them. Following through on this last point, the paper reflects on some of the constitutive facets of teams as CoPs, and proposes that in the context of health reform such emergent teamness encompass participating, knowledging and boundary spanning. Fusing contextual, attributional and processual dimensions of team conduct, these notions are elaborated to show how descriptions of teamness can be rendered sensitive to the prerogatives of health reform. The paper concludes with outlining some of the implications of this proposal for how we reconceptualize health services management.