Paradoxes, challenges and opportunities of boundary organising: An ethnographic study of a large-scale system reconfiguration in healthcare

Research output: Contribution to conferencePaperpeer-review


The past decade has seen a number of important contributions to our understanding of boundary management. However, the dynamics of collectively enacted inter-organisational boundary reconfigurations, especially in their early stages and in policy-dependent contexts, remain poorly understood. To fill this gap, we report the findings of an ethnographic case study of a large-scale partnership aiming to improve the provision of healthcare services in one of the UK regions by designing and implementing a policy-mandated reconfiguration of boundaries between and within two groups of organisations: those that commission services and those that provide them to the public.

Drawing on the ‘boundary organising’ framework, which views inter-organisational collective action as the interplay between the destabilisation and (re)stabilisation of multiple boundaries, we address the following research questions. How are the early stages of boundary organising shaped by multiple stakeholders operating in inconsistent policy contexts? How do the tactics of boundary organising reconcile the destabilisation and (re)stabilisation of boundaries across multiple organisations and groups involved? We draw on 187 hours of non-participant observation within the partnership, supplementing them by 20 semi-structured interviews with the top managers representing both the ‘provider’ and ‘commissioner’ organisations involved.

Our theoretical contribution is three-fold. First, we highlight the ambiguous and paradoxical nature of the early stages of boundary organising in situations where the policy context combines both collaborative and competitive trends. Second, we explore the tactics deployed by multiple stakeholders to cope with ambivalences and paradoxes of boundary organising and discuss their implications for complex boundary systems. Finally, by highlighting the multiple foci of power, internal differentiation within the groups and cross-boundary alliance formation we illuminate our understanding of distributed agency in collective action.

Whilst the previous accounts present the stabilisation and (re)stabilisation of boundaries as either spatially or temporally separated, we show that these processes can co-exist at the same boundary, potentially delaying attempted boundary reconfigurations or rendering them incomplete. We demonstrate that the maintenance of this paradoxical situation is enabled by the following two mechanisms: (1) compartmentalisation of opposing boundary narratives, whereby their relative importance and ‘expressibility’ significantly vary across different boundary interactions and forums; (2) switching between alternative boundary classifications, reflecting the attempts to shift the discursive focus from more contentious (e.g. organisational) towards less contentious (e.g. geographical) sets of boundaries.

Finally, we reflect on the use of ethnography for exploring large-scale boundary reconfigurations in real time, noting the advantages it provides for capturing the ambiguities and paradoxes emerging in the contested boundary landscape. On the other hand, we raise a number of questions such ethnography has to address. How to get insights into what happens ‘behind the scenes’ as opposed to the more easily observable public arena? How to adequately represent multiple voices, especially where the same actor is likely to ‘wear different hats’ depending on the type of a boundary encounter? How to reconcile the need to maintain critical independence and the expectation to achieve instrumental impact when feeding back the results of an ethnographic study in the politically charged boundary landscape?
Original languageEnglish
Publication statusUnpublished - 2017
Eventthe 12th Annual International Ethnography Symposium - Manchester, United Kingdom
Duration: 29 Aug 20171 Sept 2017


Conferencethe 12th Annual International Ethnography Symposium
Country/TerritoryUnited Kingdom
Internet address


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