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Kerosuo, H. (2003). Boundaries in Health Care Discussions: An Activity Theoretical Approach to the Analysis of Boundaries. in Paulsen, N. & Hernes, T. (2003) Managing Boundaries in Organizations: Multiple Perspectives. Basingstoke: Palgrave Macmillan.
In organisational studies, boundaries are often approached as structural forms, or as systemic multi-level relationships directing the material, social and mental aspects of evolving organizations and their conceptualizations. These depictions of boundaries emphasize the complex, unstable and negotiable nature of boundaries, which is also assumed in this volume. My contribution to this discussion is to introduce an activity-theoretical methodology for understanding boundaries in inter-organizational interaction. From the activity theoretical perspective, boundaries are always part of an activity, and they retain features and elements of past activities. For instance, the boundaries that exist in health care have evolved over long periods of time, along with the development of institutional practices. Present-day boundaries have historical layers, and may appear as professional hierarchies. Following the logic of activity theory, I suggest that boundaries emerge on all three levels of activity: the activity (system) level, the action level, and the level of operations. Between the levels, boundaries appear through co-constitutive relationships. I illustrate this methodology with a case example from internal medicine in which the care of patients with many illnesses creates new challenges for managing boundaries in health-care services.
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