Interprofessional collaboration is increasingly being promoted as a mechanism to respond to the challenges of the health care system by reducing costs, improving quality of care, and improving staff retention and job satisfaction . Accompanying this trend towards teamwork are issues around the management of professional boundaries and the relationship among health care providers . For example, Byrnes et al. observe that placing health care providers of different professional backgrounds on a team does not mean that they will have the knowledge and skills necessary to work together and collaborate . Similarly, D’Amour et al.  state that “one of the major challenges facing interprofessional practice is how professional territories are carved out and distributed within a complex system.” The current emphasis on interprofessional collaboration, and the necessity of synergizing professional roles, suggest the need to better understand how roles are constructed on interprofessional health care teams.
A variety of studies have made contributions to the body of knowledge on health care teams, yet the diversity of, and the numerous dynamics found in these groups means that they cannot be accounted for by a ‘one-size-fits-all’ framework. In their review of team research, Mathieu et al.  call for researchers to “ensure that we are capturing and embracing the complexities of current team arrangements and seeking to better understand them rather than to fit them into our current frameworks.” Accordingly, this study aims to understand how roles are constructed within interprofessional health care teams in primary care. Our focus is on the types of role boundaries and the influences on role construction. Through the thematic content analysis of interview and observation data obtained from two primary health care teams, we have generated a model to reflect the elements of role construction.
Primary health care has a mandate to provide services delivered by a collaborative team of professionals while emphasizing the quality of care and health status of patients . According to Saba et al.  newer models of primary care necessitate a shift in practice, from the historical system of a lone physician to that of a high functioning primary health care team. In Canada, different primary care models offer an aggregation of health services within one organization (e.g. Community Health Centre, Family Health Team). As with team-based models in other settings, many challenges are encountered when trying to provide care across a diverse set of professionals. Difficulties include coordinating the roles of the different professionals to create a cohesive and complementary set of services for the benefit of the patients and the team members ; and overcoming a lack of trust and respect between team members . These challenges are often experienced in micro-sites which are arenas for ongoing boundary work  through which professional roles are negotiated and constructed.
Professional role construction can be defined as the creation and negotiation of taskwork, where taskwork refers to the functions that individuals must perform to accomplish the team’s task . This concept is similar to Forsyth’s outline of task roles within a group, where task roles are aimed at the completion of a group’s goals and at supporting team members’ efforts to do the same .
In order to examine role construction, it is pertinent to consider literature on role boundaries. The roles performed by different members of interprofessional teams are subject to professional boundaries [12, 13]. These boundaries have been described as contested spheres of practice produced by a ‘labour of division’ . For example, Abbott points out that professions cultivate unique knowledge systems in order to maintain their ‘exclusive property’ and sphere of influence . However, Bourgeault and Mulvale have highlighted the efforts of regulatory agencies to break down exclusive professional boundaries on health teams given that overlapping scopes of practice allow teams to be more responsive to changing conditions . This stream of research has pointed to macro influences on role construction. Role boundaries can also be negotiated and constructed in micro sites where they are shaped by local forces and the interactions among members [15, 16]. Chreim et al.  point to the importance of meanings, actions and interactions of professionals in organizational settings for an understanding of role construction. In this study, we focus on the construction of role boundaries in micro-sites but acknowledge that this phenomenon takes place within macro-level constraints.
As part of our focus on role construction at the team level, we are examining boundaries that form around team member interactions and around role distribution between professions. In team studies, the intensity of interactions between team members is frequently characterized using the terms ‘autonomy’ and ‘collaboration’. Collaboration is an interpersonal process that entails joint involvement in intellectual activities  whereas autonomy suggests independent and self-determined practice . Although these two concepts may appear by definition to be opposed to each other, in practice professional work involves both independent and interdependent elements . A study by Rafferty et al.  proposes that the interaction between collaboration and autonomy “suggests synergy rather than conflict”. In other words, autonomy can be complementary to team work and enhance collaboration by promoting collegial relationships between team members . While some findings have pointed towards the potential for a positive association between collaboration and autonomy, researchers have also raised the issue of silos, where members of a team operate in separate and unconnected roles. This concept suggests a more profound form of detachment and autonomy between professions that goes beyond the boundaries around tasks. Thus, collaboration and autonomy have been suggested as complementary aspects that can enhance health service delivery although, in extreme forms the latter may inhibit team functioning.
Boundaries between professions on a team can form not only around interactions, but also around the distribution of responsibilities of different professionals. The construction of these boundaries in interprofessional settings may result in a separation of responsibilities or a decrease in formal role demarcations  (role blurring) between professions. Hall discusses the possibility that role blurring will occur because of overlapping competencies . Role blurring is considered beneficial by some while others oppose it and link it to role strain and confusion . For example, certain professionals on the team might believe that their role is being encroached upon and that their sense of professional identity is eroding [21, 22]. Others may be overwhelmed because they are trying to do everything and are experiencing uncertainty about the limits of their responsibilities [8, 21, 22]. While some professionals may perceive role blurring as a threat, others may see an opportunity to expand their responsibilities or to make the team more flexible and responsive to its client population .
Research describing role distribution and interactions between team members can be complemented by knowledge about within-team dynamics and how these may contribute to shaping role boundaries. Different elements can influence how professional boundaries are constructed. At the micro-level (our level of analysis), these influences include structural elements (the characteristics of the workplace) such as workload [21, 23] and physical space [24, 25]; interpersonal elements (dynamics between team members) including leadership  and education ; and individual attributes (dynamics that individual practitioners bring to the interprofessional team) such as attitudes and values [4, 6].
On different teams, certain influences may be more significant than others, leading to different manifestations of role distribution and interdependency between team members. The manner in which role boundaries are manifested may have implications for teams and their clients. Several authors have provided insights into the implications around collaborative endeavours and sharing of responsibilities for professionals and patients. These include easing workloads ; shorter wait times ; and continuity of care .
Although much of extant research looks at themes related to interprofessional collaboration, few studies have focused specifically on roles or proposed integrative models of role boundaries and influences on role construction. The reviewed literature, while mentioning phenomena such as role overlap  and role clarification  does not specifically consider the elements of role construction as a main focus. More research is needed to study methods of promoting collaboration in the workplace , to understand the complex relationship between collaboration and autonomy [20, 29], and to further examine the implications of interprofessional collaboration for professionals and patients . In addition, Cameron  advises that researchers should be seeking team members’ individual accounts and perceptions of professional boundaries in order to inform structural changes to the provision of health care services. Investigation into micro-level processes of boundary work can provide insights that may aid in improving interprofessional collaboration and the integration of roles . In this study we help respond to these gaps by exploring how task roles are constructed on interprofessional teams. We consider the types of roles boundaries that are present, the influences on the construction of these boundaries, and the implications for practitioners and patients. In doing so, we provide an integrated overview of the elements of role construction rather than a detailed examination of one component over another. The following question guided this study:
How are roles constructed within interprofessional health care teams? More specifically, we ask: What types of role boundaries are present within an interprofessional team? What are the influences on the construction of roles and role boundaries?