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Short abstract:

Multilevel boundaries stifle interprofessional collaboration. Actors create boundary organizations to bridge social worlds and enable collaboration. However, these initiatives organized at professional and organizational levels face hindrances from national-level boundaries.

Long abstract:

Fragmented care delivery, driven by specialization and liberalization, is increasingly prevalent in Western countries. Especially for individuals with ‘complex care needs’ facing difficulties on multiple facets of life, service delivery takes place within an institutionally layered context. Diverse actors from numerous organizations with distinct values, interests, and epistemic cultures are involved. To traverse the different social worlds of these actor groups and enable collaboration, professionals engage in boundary work. Previous studies on boundary work focus on specific professional or organizational levels. This study, however, explores the layered and interconnected nature of boundaries and the boundary work frontline professionals conduct to enable interprofessional collaboration.

We used the service delivery for people with ‘misunderstood behaviour’ in the Netherlands as a case study. This constructed group, involving the support from professionals of both the care, safety, and social domain, is an example of people with complex care needs par excellence. We conducted 67 interviews with frontline professionals from 40 organizations such as public health services, municipalities, police, mental health organizations and housing cooperatives.

Frontline professionals employ three types of boundary work, with cross-sector boundary organizations aiding in bridging epistemic cultures and social worlds. However, professionals were limited in their boundary work by national-level boundaries. Continuity in collaboration necessitates ongoing boundary work at multiple levels. As such, boundary organizations in the form of cross-level learning networks, emerge as a sustainable infrastructure to transform collaborations. The impact of national-level boundaries on interprofessional collaboration is underexplored in the literature; our contribution is recognizing this layered complexity.