Strengthening interprofessional collaboration by working with cross-sectoral boundaries: introducing mental health...

Interprofessional collaboration across sectors is a major challenge for the health and care workforce. Collaboration often remains weak, as fragmented services cannot match complex needs. Working with the underlying professional, organizational, and administrative boundaries may help to address the challenge, but we know little about how managers and professionals do this. This study examines how boundary work can strengthen interprofessional collaboration, based on the introduction of mental health teams in three Danish municipalities. A qualitative case study was conducted involving three intersectoral teams consisting of health and social care professionals in Central Denmark Region. Data collection included observations of interactions, 27 semi-structured interviews with users, professionals, and middle managers, and three focus group interviews. Key themes and dynamics in boundary work were identified using thematic network analysis. Findings indicate that boundary work by management established shared frameworks for interprofessional collaboration, such as weekly board meetings and risk categorization systems. In two municipalities, these frameworks fostered collaborative boundary work among professionals, agreeing on how to share information and adjust care plans collectively. However, in the third municipality, professionals competed to defend existing boundaries, hindering the introduction of new collaborative practices. Working with boundaries can help to address the challenge of interprofessional collaboration across sectors by combining top-down and bottom-up strategies by managers and professionals. However, implementation needs fine-tuning to existing professional hierarchies and local organizational contexts. Managers also need to acknowledge the limits of steering boundary work, which thrives on autonomy in daily interactions among professionals.