BOUNDARIES IN ACTION

This study examines boundaries in health care organizations. Boundaries are often considered harmful; things to be avoided in everyday living. This study suggests, however, that boundaries can be important temporally and spatially emerging locations of development, learning, and change in organizations and work practices. Boundaries are established distinctions and differences between and within activity systems that are created and agreed on by groups and individual actors over a long period of time while they are involved in those activities. As traces of past activities and emerging futures, boundaries trigger learning and development. The data of the study was gathered in an intervention project during the years 2000-2002 in Helsinki in which the care of patients with multiple and chronic illnesses was improved. The research project used the Change Laboratory method that enables the development of work and work practices in organizations. The findings of the study contribute to the development of health care for multiple and chronic illnesses by identifying the current challenges and their possible solutions in the Finnish health care organization. The study identifies two complementary models for the development of health care in Finland. The care package model, which is based on productivity and process models adopted from engineering, and market values and the model of negotiated care, which is based on co-configuration, the public good, and care agreements.