Abstract

Care for patients with multiple illnesses is often provided by several professionals from different parts of the health care system. In these cases, there seem to arise new demands for the communication and the cooperation between different professionals in the primary and the specialized care. In this paper, I shall describe how these challenges are met in an encounter which is a part of interventions called “Implementation Laboratories”. In these encounters, a new tool (care agreement) and a new practice (care negotiation) are introduced and elaborated in internal-medicine patient care. I conceptualized the Implementation Laboratories as “border zones” where the learning processes between different communities are intensified. Learning in the Implementation Laboratories resembles learning at the Boundary Crossing Laboratory described by Engeström, Engeström &Vähäaho (1999a; 1999b). It is interwoven into the process of analyzing problems, planning and testing of solutions in order to improve the medical patient care. Learning appears as collisions between the different perspectives of the patient and professionals of different organizations, and may sometimes lead to reconstruction of boundaries