Inter-Organizational Coordination As a Professional Project: Nursing, Field-Level Change and Informal Coordination Mechanisms

Fragmentation in public service organizations is a salient problem, which is exacerbated by increasing functional and structural differentiation together with the highly complex problems many users experience. The literature on inter-organizational coordination focuses on integration based on administrative coordination and associated formal coordination mechanisms. Informal coordination mechanisms are described as frequent and substantial mechanisms, but there is little knowledge of how they work in practice. The same applies to the role of professions in inter-organizational coordination at the operative level of the public sector.

In contrast, recent organizational studies of professionals emphasize the close connection between organizational and professional development and describe how institutional field-level change occurs in tandem with professional projects. The nature of professional projects is dynamic and adaptive, driven by professionals as institutional entrepreneurs. Building on this, this paper analyses inter-organizational coordination as a professional project.

The specific aim of the paper is to examine how professionals use informal coordination mechanisms and what the interplay is with more formal forms of coordination. The analysis is based on a qualitative case study of nursing and cross-sectorial care coordination of multi-morbidity in Denmark. Nursing offers a particularly interesting case; although the profession does not have a formal mandate, it de facto assumes a key role in care coordination. The analysis draws on observation, focus-group interviews and written documents.