Samarbejde på tværs: Ansats til en teori om tværfagligt samarbejde undersøgt og udviklet med udgangspunkt i tværprofessionelt samarbejde i børne- og familiesager og i byggesager

The Ph.D. title: Collaboration across borders. Pre-theory of interprofessional collaboration researched and developed on basis of interprofessional collaboration in child and family cases and in building cases/projects, reflects both the content of the thesis - that collaboration across professionals is in the center of the processes and products where differences between subjects, disciplines, professions and organizations constitute the central distinctions - and the basic premise that interprofessional collaboration in both research, education and practice has reached a point where we need new ways of thinking and working. This premise is shared by other researchers in the now extensive international research. (Lawson 2007, Barr 2008, Austin 1997). The international research is characterized by its fragmented interdisciplinary approaches and is without a scientific center.
The thesis should in particular be seen as a contribution to the research and practice within the sociological, administrative and social disciplines described as "integrative service", which is a common heading for interprofessional collaboration. Specialization leads, according to sociological approaches on professional specialization such as Durkheim, Parsons, Habermas, Giddens and Luhmann, to an increased need to coordinate and integrate (create unity and coherence) knowledge and actions in public and private organizations. The functional differentiation of society entails, according to Moe (2003) permanent problems with coordination and integration. Interdisciplinary/professional collaboration in children and family cases and building cases can be seen as a "technology" to handle these problems. The theoretical approach comes primarily from the "self-organizing" systems theory (Luhmann). The argument for choosing the theoretical approach is that a large part of the interdisciplinary research has "the traditional open systems theory" as a reference, including the empirical research in social work (Encyclopedia of Social Work, 1995: 1480), and partly the idea that the newer systems theory can integrate the traditional theory and simultaneously generate new understandings, explanations and predictions.
The Ph.D. process and strategy of analysis is investigative and exploratory, and consists of an "eidetic" process that is characterized by constantly asking new questions, making conceptual condensations, gathering theoretical knowledge, and to relate this to empirical data (four empirical and exploratory phases) and existing research. The empirical status is supportive and exemplary. The question of validity is communicative based on arguments supporting the scientific project of the thesis.
The data material is existing research, a study, dialogue and observation of the municipality Haderslev’s interprofessional collaboration in two district groups, interviews with three teachers and researchers in social work, data from building projects and children and family cases, dialogue and interviews with two architects, one engineer / carpenter, a master painter, a social worker and an educator. And a final selection of two comparable cases with data files and three accompanying interviews. The argument for selecting a building case as a case for comparison with a children and family case is that the objects of collaboration are so different, that if a theory or model applies to both subjects, it increases the probability that the theory and model is relevant and useful.
The aim of the thesis is to create knowledge and understanding (pre-theory), which can contribute to optimizing the collaboration of children and family cases for the benefit of children, families and professionals. The thesis is written as a contribution to social work research, teaching and practice, but other subject areas can profit from the thesis, since it also includes knowledge from and relevant to other interdisciplinary approaches and deals with general issues.
The research questions - which simultaneously express the progression and focus of the thesis moving from the development of general concepts to concepts of steering, leadership and followership in interprofessional collaboration – are to:
• Develop a simple, precise and coherent conceptual framework or taxonomy that is adequate and useful for the phenomenon of interprofessional / interdisciplinary and interinstitutional collaboration.
• Investigate how one can understand the concept of "collaboration" in interprofessional collaboration.
• Investigate if it is knowledge that is exchanged in interprofessional collaboration.
• Investigate interprofessional collaboration from the concepts of steering, leadership and followership.
• Collect and analyze answers to the above questions (pre-theory) in order to discuss their implications for the optimization of interprofessional practice.
The first conclusion of the thesis is that there is a need for a new taxonomy that can handle the international and Scandinavian confusion about the "interdisciplinary" concepts, models and their application. In Chapter 2, which examines concepts, subject area and the existing research, the conclusion is that research with contributions from "all" disciplines can be roughly divided into three fields or approaches. There is research that deals with the "interdisciplinary" and “knowledge” disciplines. In particular, research, education and development sectors, are in the center of this approach. There is the research that is primarily concerned with “interagency collaboration" and thus cooperation between organizational and institutional units. And finally, there is research into "interprofessional collaboration", where the collaboration between professional person is in the center of the approach. There are several interesting points in the analysis of the three approaches. One is that regardless of the research focus and field of interest, the other two approaches can be important. For example, cooperation in a child and family case can be analyzed from a knowledge dimension, a collaborative dimension and an institutional dimension. Another interesting point is that the three approaches actually correspond to the professionals' demand for other professionals. In order to do their interprofessional jobs, professionals ask questions and have wishes to all three dimensions: "Is there a need for another knowledge, other professionals or other institutional programs / support than I and my own profession in my institutional framework is capable to deliver?" Sometimes it is only knowledge that is in demand, and other times there is also a need for concrete actions and institutional resources from the other partner. There is obviously a huge difference between the three dimensions of research and demand in practice, but it is thoughtful, fruitful and plausible that research can be divided into three approaches. To further reduce complexity it is argued to use the Danish term "tværfagligt samarbejde" as a floating signifier, which covers all three fields (interdisciplinary, interprofessional and interagency collaboration), when referring to the models and taxonomies of the thesis. In chapter 5, for example, there is being argued for a circular taxonomy, which distinguishes between monodisciplinary, multidisciplinary, interdisciplinary and “united/transdisciplinary” collaboration. The taxonomy can be used within all three approaches: mono-professional, mono-disciplinary, mono-institutional, and so on. Concepts and models are central to the theory formation in the sense that they determine what is important and unimportant, and there will probably not be consensus on these, but for example the concept “tværfagligt samarbejde” is already being used as a floating signifier in practice and legislation.
The second conclusion is that “everybody” has to collaborate across disciplines, professionals and institutions within and between all sectors of society. It is a commonplace observation that gives the thesis an almost tautological character, because it also functions as an a priori assumption, but it is referring in particular to the extensive empirical research reviews from for example WHO (2010) that uniquely determines that a "functioning" interprofessional collaboration improves clinical and psychiatric outcomes. The conclusion emphasizes and confirms that systems theory (Moe 2003), which describes "interprofessional collaboration" as a basic condition and a permanent problem in a modern society with specialization and division of labor, can provide a fruitful understanding of cooperation functions and challenges. An understanding down in the specific practice where one of the key questions is: "when to collaborate, between whom, how, and with what expected effect?" It means organizing, steering, leadership and followership are going to be absolutely central as elements for optimizing collaboration. The thesis distinguishes between "tame" and "wild" tasks (Rittel and Webber 1973), where the two key cases of the thesis, a building case (tame) and a child and family case (wild), at the outset reflect their own type of task and problem. Furthermore, tasks are divided into more comparable stages of subtasks. The comparative analysis of the phases shows that "tame" and "wild" tasks and their subtasks all have their ideal form of interprofessional collaboration, that the "interdisciplinary taxonomy" can be usefull and that the permanent problems with coordination and integration can be identified and the distinction makes sense.
The third conclusion of the thesis is that in each of the different phases of collaboration dominant types of tasks can be identified, and for each of these, it can be argued that it fits a particularly ideal "interdisciplinary collaboration". This means that in some phases there will be a need for more than just coordination and thus a need for the integrational aspect of the so-called "true interdisciplinary collaboration". This will particularly apply to the initial development, decision-making and evaluation phases, where in the more executive, performance and operational phases there is only a need for coordinating "multidisciplinary collaboration" and "mono-disciplinary collaboration." It seems to apply to both construction and child and family cases, which means that the ideal collaboration in both cases varies with sub-tasks and phases. “Overall, it seems possible that construction can learn from the professional social work, with its flexible, stimulating and welcoming ferocity and, conversely, the professional social work learn to tame, focus and manage some tasks as in construction”. In practice, it stresses the importance of task focus, phase separation, of expectations, expression of cooperation and a desire to learn from each other's collaboration.
The fourth conclusion concerns concepts, models and taxonomies. A significant part of the chapters in the thesis purpose models, taxonomies, and discussions of the terms used. Theories according to Ejrnæs (2008: 129) are"simplified models of reality that help to distinguish between important and unimportant" and that is how they are used. Chapter 2 is a review of international and Scandinavian research and development of concepts. Chapter 4 is a summary and discussion of the concepts of systems theory and in Chapter 5 there is developed and supported a taxonomy for "interdisciplinary collaboration" from a theoretical model (Figure 8) with five levels of integration, where the most central discussion concerns the transition from level 2 to level 3 and thus system interconnections, common system requirements and possibly the formation of a new joint system. It is argued that other theorists than Luhmann, such as Bourdieu, Durkheim, Habermas and Wilber, have significant contributions to the understanding of "systems integration" and that their theories are helping to make the distinction between coordination and integration quite sharp. Taxonomy that can be incorporated in a Scandinavian context will consist of a circular continuum (Figure 9) with four coordination and integration levels. There is a circular continuum ranging from mono-disciplinary collaboration of multidisciplinary collaboration, interdisciplinary collaboration, united/transdisciplinary collaboration and back to monodisciplinary collaboration. It is a taxonomy, that can be used in both research, education and practice. The focus of the taxonomy is coordination and integration of knowledge, actions, etc., but it leaves us with a need to develop the cooperative concept of the "interdisciplinary" (Chapter 6). It is often taken for granted that everyone can and knows how to work together, but we are forgetting that the "quality" of cooperation has an independent effect on the interdisciplinary performance. The concept of cooperation is analyzed and discussed, based on systems theory, Lawson's taxonomy (2004) and empirical data. Lawson's collaboration taxonomy goes from "communicating", "connecting", "coorperating", "consulting", "coordinating", "co-locating", "community building", "contracting" and to "collaborating", where each concept discloses a part of what he describes as the last part of his continuum, namely the full and unrestricted “collaboration”. The two taxonomies from Chapters 5 and 6 are analyzed and discussed using examples from empirical data. And it seems clear that they complement and support each other, partly by expanding the understanding of both the transverse and the collaboration itself, and partly by maintaining coordination and integration dimensions as central to the process and content. It becomes quite clear that coordination is a prerequisite for integration. Coordination can be made with both a maximum and a minimum of knowledge exchange and a large part seems to be "by itself" (at distance).
The fifth conclusion applies to the exchange of knowledge between professionals. The question is what is actually exchanged in the collaboration, and one of the most obvious answers is knowledge and actions. Comparative analysis of the children and building case clearly shows that an exchange includes more than just knowledge, but that sharing knowledge is not just random, and that knowledge, whether it is "knowledge-that" or "knowledge-how" is contextual and has a meaning-creating function. Knowledge is treated rationally and can be used for anything - in organizations to the solution of a task and thus orientation of future action, and it still relies on Plato's understanding "of true justified belief". It is knowledge that actors both need to act and coordinate actions, and partly knowledge participants need to establish a common understanding and problem solving, which may form the basic common decision premises. The analysis shows that it is possible to think about a relationship between collaboration and knowledge. The more advanced a level of knowledge and knowledge requirements that are needed, the more advanced a form of collaboration is needed. It will in the multidisciplinary practice mean that it will primarily be very knowledge-intensive and knowledge-dependent tasks that were reserved for "real" interdisciplinary collaboration and "collaboration" in Lawson's sense. In practice, however, “real” interprofessional collaboration is no guarantee of success.
The sixth conclusion is that the coordination and integration that occurs in face-to-face meetings, is only a very small part of cooperation and the exchanges that are relevant to the task. Cooperation is also working at a distance via phone, email, action plans, drawings and agreed trade rules, as well as there is a series of informal exchanges for example knowledge both face-to-face and at a distance (see Figure 4). This nuance and expansion of the subject field of collaboration, sheds light on the complexity of the joint activities that are important for the assignment. This means that much of the knowledge, the actions and institutional support that are in demand, coordinated and exchanged are going on otherwise than face-to-face, like a very large part of the important "common" task and central exchanges are solved individually and mono-disciplinary. The conclusion is based on analysis of the collected empirical data and development of a four field model that distinguish between the dimensions face-to-face collaboration and collaboration at a distance and between formal and informal collaboration. The three fields are based on conscious action and coordination, and in the last field, coordination takes place at a distance "by itself" behind the back of the participants.
This category "by itself" is as previously mentioned interesting in respect to an efficiency and management discussion, since coordination does not cost anything, and because governance and management takes place at a distance, using steering technologies and because face-to-face leadership in interdisciplinary collaboration is rare. The thesis argues that the category "by itself" can be understood and explained by theories of institutionalization, culture, tradition and particularly from theories of indirect power, symbolic generalized media, governmentality and steering technologies. It is also argued that it is this category that is relevant to interprofessional practice, and for which is developed one new steering technology after another to lead at a distance. Steering technologies are understood as calculated measures applied by the leader to get the employee to use the leaders' premises for their own decisions. And interprofessional collaboration can be viewed as a steering technology, where leaders choose this kind of organization and collaboration to resolve a common task, but they have limited opportunities for direct leadership "in the interdisciplinary space." Direct leadership is costly and often impossible in interprofessional collaboration between professionals, each with their leaders and organizational affiliation.
The seventh conclusion relates to the issues surrounding the steering/management, leadership and followership in and outside the collaboration, thus ending one of the main questions, “when and how to collaborate?” The employee is primarily thought as part of this issue and can not be viewed as a passive recipient of leaders' announcements. They govern themselves within the organization's framework. Leadership and management transactions - whether in the case of the public or private sector - to achieve business goals through others. To be a leader, is briefly filling out a formal position in an organization. It is the right to make decisions within certain limits (given and agreed) with validity for specific employees and with the intention to realize the company's goals through performing specific tasks. But leadership is only one part of the process in which the leader creates premises for the employee's work and engage in interdependant interaction with the employees. Employees make their own choices and followership is the process by which the employee and the team translates the leader's announcements to premises for his followership. Steering and management relationships must be understood as the interdependent relationship between the leader and the employees. It is not just about orders, leaders or kings, which employees must follow, but how the conditions for governance and management is associated with interdependency "in the interdisciplinary relationship". The main distinction is again between multidisciplinary and interdisciplinary collaboration, as it is steering relation in these forms of cooperation that are most relevant in the understanding of the interdisciplinary / professional collaboration. There is a difference between having to manage and maintain a process of coordination and a process of integration. Steering mono-professional and inter-professional collaboration involves a mix of other possible conditions for management and is effectively in the main part of the professional work that deals with the multi- and interdisciplinary cooperation. The interprofessional and multiprofessional cooperation in the form of meetings is usually the exception of the daily work with children and families' matters and in construction. Meetings are usually designed to coordinate, make agreements and to qualify the monoprofessional work. The matrix in Figure 25 illustrates how the conditions changed when the specialists enter into the multi- and interdisciplinary cooperation. Objectives, methods, criteria for success and managing the relationship changed simultaneously when the organizational framework changed. This means, first of all, that the monodisciplinary/professional work is influenced and secondly that the conditions for leadership / followership and the use of steering technologies changed or are different in these forms of cooperation. It is not difficult to understand why there has been this explosive growth in "new" management/steering technologies, or why leaders may be confused as how to get employees to do the right thing at the right time - in fact the diffused right thing - that the leader do not even know what is. It is not difficult to understand why the leader, qua the new steering technologies so to speak, is trying to get into the head, heart and legs of its employees in order to get them to do “the right thing” in the interdisciplinary/professional collaboration. It is on the other side no wonder “that employees are unsure of who or what they actually should follow and how”, for example, whether one should follow the team's goals, his immediate supervisor, his colleagues, his profession, his intuition , his experience, his preferences, legislation, the task or the children and parents. There is an interdependent relation between the followership and leadership in a complex steering relationship in "the wild" interprofessional collaboration. In many municipalities, the management has implemented a number of management/steering technologies, to ensure effective goal realization. They have implemented accounting systems, contracts, manuals, measurable methods, coaching, supervision and established various feedback and monitoring systems. That is all well and good, but one of the points of the thesis is that many of these measures are based on an understanding of interprofessional collaboration and steering optics, where we know far too little about followership and the followership technologies. This means that each professional is very much left to himself to define his own followership, and thus premises for his own decisions and actions. This means that the professionals often choose the safe decisions based on their own profession and they seek consensus with partners rather than solving the common task (case subjects) effectively. This means that they prefer mono-disciplinary and multi-disciplinary collaboration. It is very understandable, and in many cases a guarantee that everything will continue as usual. The question is whether that is good enough to solve "the permanent problems with coordination and integration" related to specialization. The thesis does not answer that, but its concepts, taxonomies, models and thus pre-theory of interprofessional collaboration can hopefully contribute to the discussion by focusing on the possible conditions for leadership, followership, steering and the qualified common solution of a common task.
The final perspective of the thesis is related to the dimension of involving the users in interdisciplinary/professional collaboration. It was the most difficult decision in the thesis not to focus on the active involvement of users in interprofessional collaboration, whether they are children, families, students, the band, builder or tenants. It seemed wrong both from a democratic, ethical and efficiency point of view. Therefore, the final perspective is a discussion of the results vs. the necessary user involvement in interdisciplinary / professional collaboration. And the conclusion is that the conclusions of the thesis are not in conflict with a user perspective. The understanding, taxonomies and concepts can be applied to interprofessional collaboration with or without users and there seems to be no doubt, that there are many democratic as well as efficiency arguments for active user involvement in the collaboration, especially in the cases of "wild" problems with the use of a "true" interdisciplinary/professional collaboration with some sort of consensus about the common task. User involvement is popular these days and it is not just a question of ethics and democratization of the public sector, but also a matter of getting the right feedback to develop and produce the right product / service. Interdisciplinary/professional/agency collaboration with active and effective participation of all stakeholders is a necessity, but it does not just happen "by itself". The thesis is a contribution to the dialogue about: “how much and how we must collaborate, about what, with whom, when and with what effect?”