By Doctors Suzana Sukovic and Kerith Duncanson
This blog post is based on our study findings published as
Sukovic, S., Eisner, J. and Duncanson, K., 2022. Observing, spanning and shifting boundaries: working with data in non-clinical practice. Global Knowledge, Memory and Communication, (ahead-of-print).
Health care depends on health professionals. It is of critical importance that they have all information they need for the optimal patient treatment. This is well understood, so researchers regularly study technologies and issues surrounding data use in clinical practice. A large health organisation also has an army of non-clinical staff who take care of anything from IT and finance to linen supply. Health services depend on them, yet factors such as their use of data have rarely been studied.
Our research started from an interest in addressing this gap. The study was designed and data gathered well before the COVID pandemic started. What happened during the pandemic put a spotlight on a vast variety of roles, which contribute to the provision of health care. It became abundantly clear that our health depends not only on a good doctor and nurse, but also on a chain of people who ensure that our masks, vaccines, ventilators and fresh news are available just as we need them. The effective and timely data flow underpins these and all other aspects of health services.
A key question in our study was, ‘How do people in non-clinical roles in a large public health organisation interact with data?’ We gathered a variety of research data, predominantly qualitative, to answer this question. When we interviewed educators, accountants, linen suppliers and data analysts, to name some, we didn’t expect that the most prominent topic of our conversations would concern organisational issues. As each participant discussed how they worked on two different projects or tasks, the issue of boundaries emerged as a prominent theme.
We defined three types of data use in relation to organisational boundaries: observing, spanning and shifting boundaries. They are defined around the following boundary issues:
- Professions and disciplines
- Work roles
- Work practices
- Access to data
- Complex organisations.
Our article explains in some detail how these issues define work around boundaries, which can provide the necessary structure as well as act as obstacles. Whatever their role, some patterns emerged in how participants worked around boundaries.
By observing boundaries people stay within limits of their professions, work roles and established practices. On a positive side, helpful structures and procedures aid work. Observing boundaries, however, is experienced predominantly as restrictive and divisive. Data work is afflicted by difficulties in establishing shared meanings; unhelpful division between professions and roles; rigid procedures and practices that stifle innovation and efficacy, and lack of communication and transparency. Hierarchical role divisions, ‘red tape’ and ‘ticking boxes’ block genuine engagement and exploration. Restricting access to data is typically part of the culture of control, which becomes particularly visible around big data management. One participant exclaimed, ‘‘Right now, I feel the data is being held hostage’. In terms of functioning as part of a complex organisation, it is often difficult to connect high-level decisions with the situation on the ground.
Spanning boundaries involves work across organisational boundaries, which is described as more effective and positive than observing boundaries. Spanning boundaries is associated with cross-professional aptitude and practice, and an ability to ‘speak a language’ of another professional group. It is enabled by employees’ ability to participate in inter-professional collaboration, a sense of support for data work, and cross-divisional assistance from people in the positions of authority. Work with other parts of organisation involves open communication, and established practices to deal with any sensitivities around data use and sharing.
Shifting boundaries happens after a period of boundary spanning when work across boundaries is not the best response to the needs and opportunities. It requires suitable conditions, and a vision to see new possibilities and actively create spaces for new roles outside existing divisions. It opens new areas of professional interests, and involves a deep understanding of other professional groups and their information use. Different groups are engaged in changes, and considerable work is invested in developing shared meanings and processes. New IT and organisational solutions connect disparate systems to enhance data access. In the larger organisational context, some people and teams work as connectors. Purposefully developed opportunities to experiment and work together across the system aid shifting boundaries.
The COVID pandemic was a unique opportunity to observe how boundaries can shift quickly, and often effectively, when stakes are high and intense effort is focused on addressing data issues. The post-pandemic period will provide valuable context to observe how shifted boundaries are reinstated in a flux of evolutionary and revolutionary changes.
In the next blog post, we will consider the role of boundary spanners who may eventually become boundary shifters working on all levels of organisational hierarchy. We will consider how they use boundary objects, and boundary process, which emerged as an important new concept in the study, to aid the change.
Dr Suzana Sukovic is the Director of Research and Library Services at PLC Sydney.
Dr Kerith Duncanson is the Rural Research Manager at HETI, NSW Health, and Senior Research Fellow at the University of Newcastle.
Co-author of our original article, Jamaica Eisner, is Senior Content and Experience Designer at Deloitte Digital Australia
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