The Paradoxes of Leading and Managing Healthcare Professionals: Toward the Integration of Healthcare Services

M. Noordegraaf, Lawton Robert Burns

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review


Fragmentation and differentiation in healthcare unavoidably calls for corresponding integration. The more fragmentation, the more we long for integration. This paradox explains recent efforts to promote coordination programs, clinical microsystems of care, integrated delivery networks, and accountable care organizations. However, these integrative and collaborative mechanisms are largely organizational in nature. We argue that collaborative capacity may be more important than “collaborative structures,” to foster quality interactions and collaborative influence among team members. Collaborative capacity is defined as the routines and work processes—often embedded in work cultures, decision-making styles, shared commitments, and team dynamics—that foster coordinated behavior among professionals and stakeholders. This chapter reviews provider efforts to deploy structural mechanisms to promote collaboration and recent efforts to develop collaborative routines and processes. We also explore leadership and management implications, aimed at adapting healthcare institutions and their values, as well as coordinating workers and workforces.
Original languageEnglish
Title of host publicationThe Healthcare Professional Workforce
Subtitle of host publicationUnderstanding Human Capital in a Changing History
EditorsTimothy J. Hoff, Kathleen M. Sutcliffe, Gary J. Young
PublisherOxford University Press
Number of pages39
ISBN (Print)9780190215675
Publication statusPublished - 2017


  • Health care professionals
  • Professionalism
  • Integrated care
  • Boundaries
  • Fragmentation
  • Collaboration
  • Collaborative capacity
  • Leadership
  • Management


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