Spanning Boundaries in Infection Control

By Mary Lou Manning, PhD, CRNP, CIC, FAAN, FNAP

In the Oxford Dictionary “boundary” is defined as “a line that marks the limits of an area; a dividing line; a limit of a sphere of activity.” “Spanning” is defined as “extend across.”(1) I’m sure we would all agree that organizational boundaries are common in healthcare, and transcending these boundaries presents endless opportunities to build powerful alliances to advance APIC’s mission to create a safer world through prevention of infection.

Healthcare organizations most often are organized using “groups” such as units, departments and divisions. These structures create multiple types of boundaries that separate specialized sub-units from each other and from the external environment. According to the Centers for Creative Leadership(2) boundary types include:
• Vertical boundaries: the hierarchical barriers within organizations which differentiate groups according to title, rank, power, and privilege
• Horizontal boundaries: the barriers across and within organizations, across disciplines, departments, product lines including division of labor, functions, cost center
• Stakeholder boundaries: divisions arising from the different needs, outlooks and roles of external groups including business partners, customers, regulators, communities
• Demographic boundaries: divisions arising from gender, race, age, religion, education, generation, nationality, culture, personality, ideology, life experiences
• Geographic boundaries: the impact of different locations, cultures, regions and markets as well as the technology connecting it

Infection preventionists (IPs) must be able to navigate the shifting and highly unpredictable healthcare environment and address the complex challenges it presents. Therefore, it is essential that IPs become expert boundary spanners. This requires IPs to acquire an understanding of people and organizations outside their own circle, and to acknowledge and value individual and group differences in terms of roles, responsibilities, cultures, accountabilities, and professional norms.

What is boundary spanning?
Boundary spanning is reaching across borders, margins, or sections to build relationships, interconnections and interdependencies in order to manage complex problems.(3) Boundary-spanning individuals develop partnerships and collaboration by building sustainable personal relationships, managing through influence and negotiation, and seeking to understand motives, roles and responsibilities.(3) Effective boundary spanning is considered a key to successful inter-organizational collaboration.

Infection prevention and control is an inherently boundary-spanning enterprise. The work of the infection prevention team, while specialized, cannot be performed independently and requires interdependent and coordinated action across multiple and overlapping boundaries.

In day-to-day practice, an IP's engagement is most often related to specific initiatives such as implementing interventions to prevent healthcare-associated infections or in response to acute events, such as outbreak investigations. IPs likely span vertical and horizontal boundaries and use influence and negotiation to successfully manage these scenarios. But, increasingly, IPs face unpredictable and unprecedented challenges that are complex and highly interdependent in nature, requiring collaboration and cooperation with many disparate intra- and inter-organizational stakeholders. IPs are well positioned to lead the interdependent work efforts and bridge disconnected parties by actively managing relationships external to the infection prevention team itself.

The Ebola crisis provides a timely example. As soon as Thomas Eric Duncan was admitted to a hospital in Dallas, APIC members across the U.S. were called upon as never before to oversee development and implementation of complex and detailed plans and procedures to protect patients and healthcare workers. This involved trust, coordination, and partnership among diverse stakeholders and across unlimited departments, divisions and disciplines.

Now it’s your turn. Think about what boundary spanning means to you. Think of a time when you discovered a highly valuable solution to an infection prevention challenge by reaching across and exploring beyond people or structures that surround you and the infection prevention team. Write down what happened and why it was successful.

In thinking about how to work across boundaries, ask yourself these questions:(4)
• What types of boundaries do you have to navigate in your day-to-day work? What challenges or problems do these boundaries create?
• What infection prevention challenge do you, your team, or your organization currently face that can only be solved by collaborating across boundaries?
• What types of boundaries do you need to lead across to solve the challenge?
• Across which type of boundary are you most effective at creating direction, alignment, and commitment? Across which boundaries are you least effective?  What explains the difference between the two? What are some things you could apply from your most effective boundary to improve in your least effective area?
Remember, boundaries can be experienced as two very different things. Boundaries can be borders that create barriers, limitations, and constraints leading to frustration and counterproductive outcomes. But boundaries can also be frontiers that create bridges to limitless possibilities and inspiring results.3 The decision is yours!
Mary Lou Manning, PhD, CRNP, CIC, FAAN, FNAP, is APIC's 2015 president.

References:
1. http://www.oxforddictionaries.com/us/definition/american_english/boundary.

2. Lee L, Horth DM and  Ernst C. Boundary spanning in action: Tactics for transforming today’s borders into tomorrow’s frontiers. Center for Creative Leadership 2014. Accessed March 24, 2015. Available at: http://www.ccl.org/Leadership/pdf/research/boundarySpanningAction.pdf 

3. Williams P. (2002). The competent boundary spanner. Public Administration 80;1:103-124.

4. Center for Creative Leadership. Boundary spanning leadership toolkit. Accessed May 8, 2015. Available at http://solutions.ccl.org Boundary_Spanning_Leadership_Toolkit_(beta)?_ga=1.170564580.595587631.1208307281