Care professions as heroines: Institutional work in Danish elderly care

Main issue and relevance. Internationally, there is growing agreement on the need for greater inter-professional coordination in elderly care. This is central for policy reforms concerned with improving the quality of care based on the needs of the elderly. Studies tend to focus on issues of implementation and on how professionals experience this process. In contrast, we lack knowledge about what professionals and managers actually do when practicing inter-professional coordination, and the important role professions can play in sustaining coordination across professional groups and sectors.
This is the focus of the present study. Drawing on the governance literature and the institutional sociology of professions, we analyse the informal and formal coordination of elderly care based on a case study of the introduction of an interprofessional care pathway in Aarhus in Denmark. The governance perspective helps identifying the broader steering contexts the practice of care professions is embedded in; it highlights elements of both, new public governance (NPG) and new public management (NPM). The institutional sociology of professions helps exploring the close interplay between professions and organisations through the concepts of professional agency and institutional work. Following on from this, the institutional work of care professions includes both formal and informal coordination.
The study contributes with important knowledge about the concrete practice of interprofessional coordination. It also offers insights into the positive role of professions and managers to driving organisational change in interprofessional coordination.

Methodology and data. The analysis is case study of the introduction of an interprofessional care pathway in the municipality of Aarhus in Denmark. It draws on qualitative interviews and observations collected across different organisations providing elderly care. This includes six focus groups with individual professional groups, eight interviews with managers at different levels, as well as observations of ordinary working days of different professional groups and participation in meetings.

Main findings. The preliminary results of the study highlight a number of themes: the close interplay between formal and informal practices of interprofessional coordination; the diverse interests professionals and managers have in interprofessional coordination; the different strategies professionals and managers employ in the sustainment of the care pathway; the importance of organisational contexts for facilitating interprofessional coordination. In conclusion, professionals and managers are key to sustaining workforce changes in interprofessional coordination in the way they act as heroines, and the interplay between formal and informal coordination practices needs more attention.