No one can whistle a symphony: how hospitals design for daily cross-boundary collaboration.

Purpose The purpose of this paper is to investigate how and with which mechanisms health care professionals in practice design for collaboration to solve collective hospital tasks, which cross occupational and departmental boundaries. Design/methodology/approach An in-depth multiple-case study of five departments across four hospitals facing fast to slow response task requirements was carried out using interviews and observations. The selected cases were revealing as the departments had designed and formalized their daily hospital operations differently to solve collaboration and performance issues. Findings Local collaboration across occupational and departmental boundaries requires bundles of behavioral formalization elements (e.g. standardized plans, resource allocation decisions, assigned formal roles, and handoff routines), and liaison devices (e.g. huddles, boards, and physical proximity), which are used in parallel or sequence. The authors label this "designed collaboration bundles." These bundles supplement the central organizational structures, processes, and support systems less capable of ensuring fluent coordination at the front line. Practical implications Health care professionals and hospital managers can consider designing bundles of organizational design features to proactively develop and ensure collaboration capable of solving collective tasks and bridging departmental and occupational silos to improve health care delivery. Originality/value This research paper addresses the fundamental organizational challenge of how to achieve efficient collaboration by studying how formal structures and processes are used in combination on the hospital floor, thereby going beyond previous research that studies these mechanisms individually.