Dissertations
Dissertation

Public defence in caring science: Ann-Therese Hedqvist

Thesis title:

Collaboration in organizational borderlands – Achieving seamless care for patients with complex care needs

Third-cycle subject area:

Caring science

Faculty:

Faculty of Health and Life Sciences

Date:

Friday 28 February 2025 at 10:00

Place for thesis:

Room Fullriggaren, Building Magna, Kalmar and via Zoom

External reviewer:

Professor Siri Wiig, University of Stavanger, Norway

Examining committee:

Professor Maria Wolmesjö, University of Borås
Docent Axel Ros, Jönkoping University
Professor Catharina Gillsjö, University of Skövde

Chairperson:

Docent Kristiina Heikkila, Department of Health and Caring Sciences, Linnaeus University

Supervisor:

Mirjam Ekstedt, Department of Health and Caring Sciences, Linnaeus University

Assistant supervisor:

Catharina Lindberg and Heidi Hagerman, Department of Health and Caring Sciences, Linnaeus University, Ann Svensson, University West

Examiner:

Docent Kristiina Heikkila, Department of Health and Caring Sciences, Linnaeus University

Spikning:

Friday 7 February 2025 at 10:00 at University Library, Kalmar

In order to receive the Zoom link for the thesis defense, please contact Faculty Administrator Mirjam Lingkrans: mirjam.lingkrans@lnu.se

Abstract

Aim: The overall aim was to explore inter-organizational collaboration and adaptability in care coordination, focusing on seamless care for patients with complex care needs.

Methods: This thesis employed diverse qualitative methodologies across four studies. Studies I–III used an ethnographic approach with convergent data collection techniques, including document review, participant observations, and interviews with healthcare and social care professionals. Studies I and II applied the Functional Resonance Analysis Method to explore care transitions and identify vulnerabilities. Study III constructed a grounded theory of inter-organizational collaboration from insights across healthcare and social care domains. Study IV utilized a web-based questionnaire to collect written critical incidents reported by registered nurses in ambulance care. These incidents were analyzed using Critical Incident Technique and Interpretive Description, focusing on adaptation, decision-making, and learning in ambulance care during the COVID-19 pandemic. Lastly, findings from all studies were synthesized.

Findings: Seamless care for patients with complex needs depends on timing and precision in planning and information exchange across care provider boundaries. Gaps in these processes can increase vulnerabilities (I, II). Effective care coordination relies on bridging professional and organizational divides through established collaboration pathways while stretching across organizational boundaries, rather than dissolving them (III). Continuous learning is central, leveraging lessons learned from adaptations made under pressure to foster resilience and ensure effective care delivery (IV). Coordinating care in organizational borderlands—the spaces where professional roles and organizational boundaries intersect—requires continuous communication, negotiation, and shared decision-making. Adaptability enables healthcare professionals to navigate the complexities of real-world care and bridge the gap between protocols and practice by balancing standardized procedures with context-specific, flexible decision-making.

Conclusion: Well-defined boundaries, established collaboration pathways, and adaptability are necessary to overcome challenges in fragmented healthcare systems. When maintained with flexibility, boundaries facilitate coordination by defining roles and responsibilities while still allowing healthcare professionals to adapt to emerging situations. Rather than needing to be dissolved, boundaries provide a structure that reduces ambiguity and supports effective collaboration. Striking a balance between stability and adaptability is, therefore, essential for achieving seamless care for patients with complex care needs.

Keywords: adaptability, care coordination, care transitions, complex care needs, integrated care, inter-organizational collaboration, resilience, Roy Adaptation Model