Promoting change through collaboration : reshaping the professional boundaries of family physicians through the Division of Family Practice

A collaborative framework is increasingly being used to promote change in the way health services are being provided. Collaborations have been studied mostly from a team perspective in health services research (HSR); system and institutional levels of analysis are underutilized. Applying an (neo) institutional perspective, this dissertation explored the role of interorganizational collaborative relationships in promoting practice change in family physicians. Specifically changes in the professional boundaries of family physicians were examined. The dissertation is comprised of two parts. The first study was a systematic qualitative examination of the HSR literature on the concept of professional boundary for family physicians. Fifty articles were reviewed. Conceptual distinctions used by family physicians to describe their role and their work were synthesized to form a multi-faceted notion of professional boundaries of family physicians (i.e., task-related, object-related, and relational). The second study was a case study of a new organizational form, the Division of Family Practice, in a suburban community in British Columbia. The new organizational form employed a collaborative framework to promote system and professional practice change in primary care. Findings were generated from interview texts, organizational documents, and participant observations. The study investigated how professional boundaries of family physicians are being reshaped through family physician’s involvement in collaborative relationships under the Division of Family Practice. Conclusion: collaborations provide a physical as well as a social space for partners (family physicians, the health authority, the government, and the medical association) to share, challenge, and shape each other’s perspectives, values, interests, and goals. The case study demonstrated the Division of Family Practice was successful at disrupting the physician institution and reshaping professional boundaries for family physicians as 1) the profession of family practice is undergoing a process of deinstitutionalization: the professional boundaries of family physicians are not as clear and distinct as they once were and have become a weakened institutional element; 2)the Division was able to disturb and reformulate the reward and sanction mechanisms for family physicians; and 3) the Division has enabled core assumptions and beliefs about family practice to be broken down and redefined.Graduate and Postdoctoral StudiesGraduat