Book Review

Managing Boundaries in the Health Professions

N Engl J Med 1993; 329:1750December 2, 1993

Article

Managing Boundaries in the Health Professions
By John G. Bruhn, Harold G. Levine, and Paula L. Levine. 253 pp. Springfield, Ill., Charles C Thomas, 1993. $52.75. ISBN: 0-398-05863-6

It is unusual for a book to be timely and innovative when published. This book concerning boundaries and territoriality in the health professions is both. In these times of budget cuts, cross-training, restructuring, seamless systems, and health care reform, the importance of boundaries in the health professions is enormous. How boundaries are managed can make the difference between unity and disharmony and determine the success or failure of the changes that must be made in the health professions.

The authors speak credibly from their knowledge of academic health centers. They show an appreciation of the issues from the perspectives of the various health care disciplines. Citing the scarcity of information in the literature about boundaries and territoriality, the authors manage to provide references that are fairly extensive but generally not current; in fact, many are over 20 years old.

This book describes numerous types of boundaries -- physical, psychological, economic, gender-related, elitist, hierarchical, and professional, to name but a few. Specific cases of boundary problems are presented. The authors give an excellent analysis of the variables in each situation but do not describe specific strategies to correct the difficulty. Vignettes for discussion are also offered.

The illustrations, tables, and lists are well done and concise. One example of the currency of this book is the discussion of learning-based organizations, or learning communities, which form when boundaries are redrawn to include the diverse perspectives represented by each stakeholder group. The authors do not neglect to relate the importance of good boundary management to good organizational leadership and management.

This book has relevance for students and practitioners in the health professions and especially for those in administrative positions. Clearly, there are many issues related to boundaries and territoriality in the health care professions that must be addressed as we move into the 21st century. This interesting and absorbing work makes a contribution by increasing our awareness of issues that are often not acknowledged or, if acknowledged, allowed to persist. In doing so, the book may help bring about needed changes in health care organizations and disciplines.

Deanna R. Pearlmutter, R.N., Ed.D.
Massachusetts General Hospital, Boston, MA 02114