Center for Activity Theory and Developmental Work Research

Kerosuo, H. (2008). Putting the patient in the middle: managing chronic illness across organisational boundaries. In R. Sorensen and R. Iedema (Eds.) Managing Clinical Processes in the Health Services. Sydney: Elsevier.

Managing the boundaries in chronic illness is an urgent task. As advanced medical technology, pharmacology and treatment help people live longer, they require care for longer periods of time. How, then, can we improve the organisation of health care that requires clinicians with different clinical and professional orientations to collaborate, particularly where care relationships are characterised by individual clinicians delivering episodic care to individual patients? This chapter considers the impact of organisational, professional and practice boundaries on patient care, specifically the care of patients with multiple and chronic illnesses.Ameliorating the effect of boundaries means reinterpreting the outcomes of care, the role of the patient and the responsibility of treating clinicians that in turn mean creating new ways to conceptualise and deliver care within the context of organisation and organisations.