A Darker Side to Interorganizational Relations

Although health care systems throughout the world recognise the need to co-ordinate health and social care, collaborative efforts tend to be based more on faith than evidence, with ad hoc and voluntary arrangements often failing to meet expressed aims or observed needs. The result has been a shift towards more mandated forms of collaboration with a view to forcing better inter-agency working, reducing costs and improving outcomes through more co-ordinated participative processes. However, the belief that wicked issues such as fragmented care, unmet needs, blocked beds and raising costs can be dealt with more effectively by the forcing of inter-organisational relations is not without its problems, particularly where national directives fail to account for local complexities and politics. Taking the UK as an example, this chapter considers the latest in a long line of attempts to improve the co-ordination of health and social care. Specifically, it analyses the creation of Health and Wellbeing Boards and their explicit mandate to drive the integration of local health and social care systems by forcing politicians, social care professionals and health professionals to collaborate at a local level. In what follows, I show how, despite new structures and good intentions, there is an unexplored dark side to intra and inter-organisational relations where referent authority and competing perspectives forestall collaborative efforts in a way that directly impacts collaborative processes and policy outcomes. The paper considers how this occurs and why narrow prescriptions for joint working fail to account for the complexities of organisational functioning.