Dynamic boundary work between health professions

Professional boundaries within the healthcare workforce are increasingly coming under new pressures due to staffing shortages, economic demands and changing care models. Task-shifting between physicians and other health professionals is progressively used as a strategy to meet these new demands. The current study explores task-shifting as dynamic boundary work between rheumatologists and occupational therapists (OTs) and we apply hand osteoarthritis care in a Norwegian healthcare setting as our empirical case. In-depth semi-structured qualitative interviews were conducted with 17 participants; 9 rheumatologists and 8 OTs, at 2 different hospitals where task-shifting had taken place. We explore the dynamic role processes within professions, as well as between professions. The theoretical lens used to explore the data is inspired by Susan Nancarrow’s (2005) work on dynamic role boundaries. Nancarrow’s analytical terms Diversification and Specification are employed to analyse processes occurring within the roles of the OTs and the rheumatologists (intraprofessional change), and Horizontal and Vertical Substitution is used to explore processes occurring between professions (interprofessional change). Our preliminary results show that there were both formal and informal shifting of tasks between OTs and rheumatologists. OTs were diversified by gaining tasks and responsibilities outside the traditional scope of their role. However, some reported added responsibility to be anxiety-inducing and highlighted the need for further training. Rheumatologists expressed a wish to retain traditional doctor-related tasks that fall exclusively under their jurisdiction, leading to increased specification of their role and profession. Vertical substitution took place when rheumatologists delegated tasks formerly carried out by them, to OTs.