Table 2 Summary of themes, key findings and examples

1) Physical boundary objects within the clinic

1.1) Clinic floor plan and positioning of rooms

Arrangement of treatment rooms in the clinic either strengthened or weakened professional boundaries.

The two clinics had different arrangements that in each case strengthened the boundaries separating COP professions (distinct sections of the clinic for each profession) or weakened the boundaries between COPs (interspersed rooms with doors entering a single hallway).

1.2) Large equipment

Large equipment used by only one profession strengthened professional boundaries.

Chiropractic ‘drop-tables’ only used by chiropractors, delineating their workspace. General treatment plinths used by the osteopath and physiotherapists. Osteopath further attempted to highlight differences between himself and chiropractors through ideological boundary-work.

1.3) Small equipment

Small equipment stored in certain rooms/areas of the clinics, further reinforced differences between COPs.

Treatment tools such as activators (chiropractic) and exercise bands (physiotherapy) physically located in respective rooms. Participants also discuss these items in a way to distinguish themselves (their beliefs and practice) from other COPs– performing boundary-work.

2) Social boundary objects: identities and discourse

2.1) Identities

Dominance of personal identity over professional affiliation of COPs.

In a dialogue with a chiropractor and a physiotherapist, they both spoke about how they did not focus too much on professional titles. In another example, a physiotherapist reports cross-referring to a chiropractor based on his experience with managing patients with headaches, as opposed to it being solely based on his title.

2.2) Discourse

Words and concepts used between COPs weakened or strengthened professional boundaries depending on their use.

Participants utilised common biomedical terminology in their discussions to weaken boundaries. There were occasions where profession-specific jargon strengthened boundaries between COPs. Additionally, ambiguous terminology such as the concept of a ‘subluxation’ was discussed, which may have reinforced boundaries.

3) Organisational boundary objects

3.1) Appointment fees and duration

Differences with durations and fees for COP appointments reinforce boundaries.

Chiropractic appointments were shorter in duration and had lower fees than those for physiotherapy or osteopathy. This strengthened the structural differences and boundaries between chiropractic and the others, while weakening the boundaries between physiotherapy and osteopathy.

3.2) Remuneration structure around joint consultations

Clinic policies attempted to promote COP collaboration; however contractor arrangement may have reinforced boundaries.

Policies were in place to promote and incentivise COP collaboration in both clinics. Contractor arrangements however may have de-incentivised COP collaboration, further reinforcing boundaries.

3.3) Health insurance benefit codes

Clinics had to, at times, treat the boundaries between COPs more fluidly to comply with health fund benefit requirements.

Health fund rebates are restricted to specific professions for specific services. One clinic had to use a more fluid definition of professional roles and boundaries in order to comply with these restrictions– enabling a chiropractor to run an exercise class which was normally run by a physiotherapist.