Changing organisational practices through the integration of health and social care : implications for boundary work and identity tactics

In response to well-documented pressures on healthcare systems, many countries have explored new ‘integrated’ models for the provision of health and care. However, integration presents deep challenges to professional work in both health and care, reflecting enduring boundaries of expertise, remit, budget, and practices. Through a qualitative evaluation of the integration of health and social care services in an English city, Tazzyman and colleagues investigate the impact of integration on professional identity and boundaries for health and social work staff and the implications for organisational change. Their analysis shows how the top-down reconfiguration of services generated a degree of competitive boundary work. Where collaboration took place, however, this was not the result of breaking down boundaries but rather a reiteration and acknowledgment of them.