The changing shape of the NHS means individual roles may straddle more than one organisation, if not several. But these “boundary spanners” are the diplomatic links that can bring success to collaborating organisations, argues Helen Scott.

While boundaries offer identify and security, they can also impede and restrict positive developments. Sometimes crossing boundaries is essential to collaborative working and mutual trust.

Organisational boundaries are changing. Some organisations are becoming larger, some smaller, new organisations are appearing and others are ceasing to exist. Within the health and social care sector these changes are happening at an accelerated pace. Leaders may be unsure how they can best support their staff in this turbulent environment while individuals can feel demoralised, confused and unhappy.

How can leaders and others be enabled to manage confidently and effectively as organisational boundaries change?

A helicopter view of the world of healthcare in England would reveal both large and small organisations, but the map would look very different today than it did even a few years ago. Commissioning organisations have been created and evolved; provider organisations have changed in size, complexity and legal structure. Staff have seen the scale and scope of their responsibilities change dramatically, and familiar organisational identities have been replaced by new alliances. The concept of “boundary spanning” may help to reconcile new and old organisational identities.

As boundaries change in the NHS, becoming more permeable and unstable, some disappearing altogether, it is likely these changes will impact profoundly on individual career trajectories. One effect may be that careers are less organisation-bounded. The need for boundary-spanners is growing.

What is boundary spanning?

Boundary spanning is the activity by which individuals within an organisation bridge external needs and provide information for internal users. Boundary spanners act as information brokers, as ambassadors or diplomats and as conduits for resources, information and influence.

Competent boundary spanners are likely to have a bundle of skills, abilities and personal characteristics that contribute to their effective inter-organisational behaviour. They will be expert at networking, at building and sustaining relationships, at managing complexity and understanding motives, roles and responsibilities. They will understand the shifting contextual agenda which characterises the health arena, and be able to anticipate the direction of travel.

Based on some anecdotal evidence, moving across organisational boundaries is not for the faint hearted. The following comments capture experiences described to me:

“Colleagues in my previous organisation did not know how to treat me when I left to join a partner organisation and I was left out of informal networks in the new organisation. Until I found a mentor I struggled to establish my identity and my self esteem plummeted. Ultimately I was valued for the difference in perspective and outlook that I brought”.

While the rewards of enhanced roles and being able to see the bigger picture are evident, there is also a risk of isolation and lack of security in the role. Loss of identity can be felt deeply, particularly by some individuals with a professional affiliation that was held in high esteem in their previous post.

“Some people in my professional networks no longer treated me the same. They felt I had moved away from the professional ‘family’.”

Systematic studies of boundary spanning yield some advice for leaders embarking on this approach:

  • The effects of re-shaped boundaries are complex and not necessarily positive. The “winners” seem to be younger, skilled specialist workers and the “losers” older, generic workers. (Currie, Tempest and Starkey, 2006).
  • Staff moving from the NHS to private organisations may feel insecure, marooned and abandoned. Those who do make this transition are found to be either “pioneers”, “guardians” or “marooned”. There is a need to manage these transitions. (Waring and Bishop, 2011)
  • Individuals who span boundaries need to be well connected internally and externally, recognised as nominally or technically competent and to have personal characteristics that enable them to link across organisations (Tushman and Scanlon, 1981)

“Diffusion fellows” as boundary spanners

The deliberate creation of boundary-spanner roles was one innovation of CLAHRC NDL (Collaboration for Leadership in Applied Health Research and Care, Nottinghamshire, Derbyshire and Lincolnshire) in its adoption of the model of “diffusion fellows”, affiliated to its research studies. These are NHS leaders seconded by their employer for one day per week to work with the CLAHRC, spanning the academic-NHS divide.  

As boundary spanners, diffusion fellows are “cultural diplomats”, providing a permeable membrane through which knowledge can be transferred across organisations. The CLAHRC-NDL infrastructure supports them to explore various mechanisms to cross boundaries, including stakeholder events to build cultural awareness and confidence in working across organisations.

These individuals belong to diverse groups and networks, therefore they can foster shared understanding among a wide and varied population. Diffusion fellows’ activities vary according to the needs of the research studies into which they work. For example, some act as ‘critical friends’; commenting on research materials, while others have negotiated access to study sites and organisations.

Diffusion fellows have pilot-tested devices to ensure they are fit for practice, and others are researchers who help with data collection. They also disseminate the work of CLAHRC-NDL and have presented at local and national conferences. What works in the CLAHRC model is being evaluated both internally and externally. 

Find out more

References

  • Currie, G., Tempest, S. and Starkey, K. 2006. New Careers for Old? Organisational and Individual Responses to Changing Boundaries. International Journal of Human Resource Management Vol 17 (4) 755 – 774.
  • Tushman, M. L. and Scanlon, T. J. 1981. Boundary Spanning Individuals: their role in Information Transfer and Their Antecedents. Academy ofManagement Journal Vol 24 (2) 289-305.
  • Waring, J. and Bishop, S. 2011. Healthcare Identities at the crossroads of Service Modernisation: the transfer of NHS clinicians to the independent sector. Sociology of Health and Illness. Published online 11 FEB 2011.
  • Williams, P. 2002. The Competent Boundary Spanner. Public Administration Vol 80 (1) 103 – 124.

Acknowledgements

Acknowledgements, for assistance with the initial ideas and writing this article, Professor Justine Schneider, Liz Lesquereux and Dr Nicola Wright, engagement, synthesis and dissemination team, CLAHRC NDL.