Collaborazione e coordinamento nelle pratiche di cura. Forme emergenti di relazione tra pressioni istituzionali e accordi informali

The article reflects on collaborative practices and coordination processes in health care. In the last decades these topics have gained greater importance due to the (at least partial) containment effect that they make possible on the growing fragmentation in the contemporary health care scene. The article focuses on the irreducibility of collaboration to its formal aspects, showing how daily collaborative practices and bottom-up coordination help to reduce the fragmentation generated by the proliferation of professional figures, specialized knowledge, organizational compartments and new actors. We will focus on some emerging forms of interaction that characterize care and assistance in two specific contexts that we believe to be particularly significant in the current health care scene: in
the case of health and social care integration, daily informal routines and analogic communicative patterns strengthen interprofessional collaboration that derives from an institutional mandate (topdown); in the case of the patients’ active role in the management of the care network, the emerging and informal forms of coordination (bottom-up) are carried out through the invisible work made by patients and family members.