Analysing boundaries of health and social care in policy and media reform narratives

Abstract

Collaboration has become an imperative of many new healthcare policies; however, little attention has been paid to how system-level narratives in both policy documents and the media create boundaries that shape implementation processes. By using boundary work as a theoretical lens, this article critically analyses the discourse found in both policy documents and the media surrounding the 2015 Dutch LTC reform. This discourse analysis contributes, first, by revealing two separate narratives – one epic, one tragic – which we argue represent different rhetorical styles used to (de-)legitimise symbolic boundaries. Second, we contribute by unravelling boundary work in both the social and symbolic dimensions to show how the design of the 2015 reform led to a tension-ridden position for local actors: symbolic boundaries demanded integration, while social boundaries imposed differentiation. These findings have implications for literature on boundary work as well as for policy design and its local implementation.