Boundary work in task-shifting practices – a qualitative study of reablement teams

• Published in: Physiotherapy theory and practice Vol. 39; no. 10; pp. 2106 - 2119
• Main Authors: Eliassen, Marianne, Moholt, Jill-Marit
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Ltd 03.10.2023; Taylor & Francis
• Subjects: Clinical outcomes; Health services; Job satisfaction; Medical personnel; Patients; Physical therapists; Power; Shortages; Teams; Trainers; occupational boundaries; task shifting; Boundary work; health care services; teamwork
• ISSN: 0959-3985; 1532-5040; 1532-5040
• DOI: 10.1080/09593985.2022.2064380

Health services worldwide have provided incentives for establishing teams to accommodate complex health care tasks, enhance patient outcomes and organizational efficiency, and compensate for shortages of health care professionals. Parallel to and partly due to the increased focus on teamwork, task shifting has become a health policy. Task shifting involves new tasks and responsibilities, which may result in social negotiations about occupational boundaries. The aim of this study was to explore how the division of tasks, responsibilities, and roles in reablement practices can appear as boundary work between physiotherapists (PTs) and home trainers (HTs). The study drew on data from fieldwork with seven Norwegian reablement teams, including observations and individual interviews with PTs and HTs. We conducted thematic analysis informed by a theoretical framework on professional boundaries. We identified two different practices, which we labeled as: i) "The engine and the assistant" and ii) "The symbiotic team." We drew on these practices and theory of boundary making and boundary blurring to interpret the results. The findings indicate that boundary-making processes may generate asymmetric power relations that may constrain autonomous work and job satisfaction in teams, whereas boundary-blurring processes may promote collaborative practices that enhance holistic approaches and mutual learning on reablement teams.