Coordination as Integration – The Dilemmas When Organizing Inter-professional Teams at a Hospice

This chapter presents a case involving the organization of teams for interprofessional coordination of care. We explore knowledge-sharing processes by discussing the practical dilemmas when organizing teams, drawing on interventionist research at a hospice. Management had organized the hospice into four singleprofessional teams of nurses and one cross-professional team comprising all other professionals. This set-up caused tension and a sense of exclusion among the nurses. Based on focus group interviews, observations and meetings during a four-month period, one of the authors proposed an alternative team organization, with interprofessional teams including nurses. However, the management rejected this proposal. We use this incident as a jumping-off point for a discussion of the dilemmas when organizing inter-professional teams. We draw on Follett’s notion of coordination as integration to discuss knowledge sharing across teams. In line with Follett, we see the challenge when coordinating between different groups as a matter of integrating differences, which always implies a re-evaluation of interests. She outlines three factors that may help coordinate unity among difference: (1) an understanding of integration as a method of settling differences; (2) a system of crossfunctioning that allows both horizontal and vertical lines of communication within organizational hierarchies; and (3) a sense of collective responsibility for ensuring the interweaving of differences. We discuss these three factors as sensitizing lenses in relation to three discourses concerning inter-professionalism identified at the hospice. This chapter’s contribution is to highlight three dilemmas that may complicate the coordination of inter-professional teams: (A) differences in tasks and time, (B) a different sense of responsibility, and (C) knowledge hierarchies. Hereby, the chapter brings forward an understanding of coordination as knowledge sharing relations across differences that involve and engage learning accomplished not only through consensus, but also through tensions and conflict.