The NHS Medium Term Planning Framework (MTPF) marks a milestone moment in system reform - a shift from the short-term transactional planning, to multi-year, place-based planning and co-ordination at a neighbourhood level. It asks neighbourhoods to become the organising unit for joined up care - where primary care, social care, local government, VCSE organisations and others align around local population need.
But this is not integration by structure. It cannot be commanded. It requires integration by relationship: the ability to work collaboratively across organisational, professional and jurisdictional boundaries in the pursuit of creating public value - through trust, negotiation and shared learning.
As with all my articles, I'll be looking at the management literature on boundary-spanning through the eyes of a medical doctor and Chartered Manager, to help you engage critically with theories, models and frameworks for managing and leading. I will examine:
- Why neighbourhood health services depend on boundary-spanning and relational governance
- What the theories around collaborative advantage, new public governance, absorptive capacity and boundary-spanning teach about managing in these complex partnerships
- How boundary-spanning, supported both structurally and relationally, builds the learning capacity that neighbourhood services need to thrive.
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Why neighbourhood health services depend on boundary-spanning
Neighbourhood partnerships operative in an inherently complex and messy environment. They bring together statutory, voluntary and community actors, each with distinct missions, sources of legitimacy, incentives and accountability regimes.
The connective work that binds these elements together is boundary-spanning:
- building trust and shared purpose across organisational divides
- translating between different professional and institutional languages
- negotiating resources, legitimacy and expectations
- maintaining joint momentum amid conflicting and competing pressures.
Research by Satheesh et al. (2002) shows boundary-spanning activities by public service managers directly enhance collaboration quality, and that higher quality collaboration results in improved performance. Effective partnerships, therefore, are those that deliberately and purposefully cultivate relational and mediating functions, that than assuming they will occur organically.
Collaborative Advantage and New Public Governance
Huxham and Vangen's Theory of Collaborative Advantage explains that the success of partnerships create value only when structural enablers (such as governance, leadership and resources) and social enablers (such as trust, mutual understanding and shared purpose) work together. Governance frameworks and shared budgets matter - but so do trust, mutual understanding and reciprocity...
Ferlie and Ongaro's work on New Public Governance reframes public leadership as a matter of network stewardship. Positive outcomes emerge not from commands or control, but the quality of interactions between actors. In this view, relational governance is not "soft" leadership: it is the hard infrastructure of collaboration.
Boundary-spanning as the engine of collaborative governance
Boundary-spanning is where these ideas come alive in practice. It includes:
- relational work - building trust, shared understanding, reciprocity
- mediating work - resolving conflicts and aligning priorities
- informational work - translating data, evidence and language
- coordinating work - sequencing actions and sustaining shared direction.
For boundary-spanning to be useful in neighbourhood services, it needs to operate at two levels:
- strategic boundary-spanning - leaders connecting systems and negotiating legitimacy across neighbourhood, ICB and local authority levels
- operational boundary-spanning - frontline professional joining services around local citizen need and lived experience.
Successful neighbourhoods will recognise these are core system functions, not nice-to-do add-ons.
Boundary-spanning across levels and structures
Conteh and Harding (2021) argue that in multilevel governance systems, boundary-spanning is vertical as well as horizontal: leaders must connect the micro level of neighbourhood action, the meso level of place-based coordination, and the macro level of regional and national policy.
In neighbourhood health systems, this means linking insight from local practice to the strategic levers of ICBs and national frameworks — ensuring that local experience informs system design and vice versa.
Klindt, Baadsgaard & Jørgensen (2023) add a structural perspective: partnership performance improves when organisations resource and institutionalise boundary-spanning. They call this coupling competence — the system’s ability to connect actors through stable yet flexible arrangements such as dedicated roles, shared data and managerial support.
So, boundary-spanning must be both relational and structural capabilities, not simply informal behaviour. It needs both relational legitimacy and structural support: people empowered to span boundaries, and systems designed to make that possible.
Relational governance and the emergence of learning capacity
When supported properly, boundary-spanning forms the basis of relational governance — governance that operates through trust, reciprocity and reflection rather than hierarchy.
Relational governance builds the social architecture for continuous improvement:
- cross-sector reflective forums
- joint reviews of data and community insights
- transparent decision-making
- shared accountability
- safe space for disagreement and experimentation.
From this, systems develop what is referred to as Absorptive Capacity. In the context of public service partnerships, Butler (2014) and Salehi (2012), describe it as the ability of organisations or networks to recognise valuable knowledge, assimilate it, and apply it for improved performance.
In neighbourhood health systems, absorptive capacity is inherently collaborative: it is generated through dialogue, translation and co-creation across organisational boundaries. It enables the network to learn collectively and adapt to changing circumstances — whether that means redesigning referral pathways, integrating community data, or co-producing prevention strategies.
Boundary-spanning and relational governance, then, are not just about coordination — they are the mechanisms through which systems learn and evolve. Systems start to learn faster than their environment changes — a hallmark of maturity in complex adaptive systems.
Practical “must-do” actions to embed boundary-spanning
Formalise boundary-spanning roles in job descriptions, partnership agreements and give these roles authority, time and visibility.
Resource relational work by allocating protected time and funds for cross-sector meetings, reflection and joint planning.
Design governance for connection, by establishing neighbourhood forums that blend decision-making processes with shared refection, that include both horizontal (sectoral) and vertical (system to neighbourhood) connections.
Develop capability and shared language by offering all partners development opportunities on negotiation, mediation and systems thinking, and by using shared frameworks (eg: outcome maps, logical models) to bridge professional dialects.
Create feedback and learning loops by using joint dashboards that are interpreted collectively (not competitively) and build rapid cycle reviews into innovations.
Invest in boundary spanning structural supports such as secure information sharing agreements, joint analytics and resourcing for joint posts.
Anchor relationships in purpose, but keeping the shared value proposition alive: why are we doing this together. Public value creation (not institutional preservation) must be a unifying motive.
Some pitfalls to avoid
Don't assume collaboration happens naturally. Without explicit investment, relational work will be crowded out by operational pressures.
Don't over-rely on individual goodwill - although personal relationships matter, they need institutional scaffolding.
Avoid focussing on structure without culture
Don't neglect vertical boundaries - connections between neighbourhood, place, and system often remains weak, but boundary-spanning must link all three.
Don't ignore power asymmetry - smaller partners (and indeed the public) may lack voice and agency: relational governance must aim to correct this imbalance.
Don't fail to capture learning - learning needs to be codified and reflected upon, otherwise partnerships will lose absorptive capacity and repeat mistakes.
Don't mistake co-ordination for collaboration - aligning activity is not the same as co-producing solutions or co-creating value.
Final Reflections
All complex partnerships can succeed when they treat relationships as a key part of their infrastructure and capability. Neighbourhood health partnerships will be no different. Neighbourhood working is not a programme to be implemented, but a social process to be cultivated - boundary-spanning research shows that collaboration works best when relationships and structural enablers align.
Boundary-spanning is not peripheral, nice-to-do work - it is the work.
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Published on the Open University Business School Professional Knowledge Bank
