ARTICLE IN PRESS

Management
S C A N D I N AV I A N J O U R N A L O F

Scand. J. Mgmt. 22 (2006) 292–306

www.elsevier.com/locate/scaman

Knotting the action net, or organizing between

organizations
Kajsa Lindberg, Barbara Czarniawska
GRI, School of Business, Economics and Law at Göteborg University, Box 600, SE-405 30 Göteborg, Sweden
Received 27 June 2005; accepted 6 September 2006

Abstract

This paper presents a study of a successful organizing process, namely the knotting together of
different types of action by ‘‘translating’’ them into one another. The connections thus established
were then stabilized to form a unit that can be designated as an ‘‘action net’’. This instance of
organizing occurred in the course of a project in the Swedish health care sector, with a view to
establishing coordination between care units in three separate organizations. Different laws regulated
their tasks, their operations were financed by different principals, and the everyday work of their
members was undertaken at different point in time and in different places. Despite this, the
participants in the studied project were able to establish a lasting net of connections that contributed,
in the eyes of the environment, to an instance of ‘‘good care’’. In this paper we examine in detail the
creation of an action net, and offer a tentative theory of organizing in action nets.
r 2006 Elsevier Ltd. All rights reserved.

Keywords: Action net; Organizing; Connecting; Translation; Chain of care

1. Introduction

What do people do when they want to embark on collective action? If those concerned
are fully competent members of a contemporary western society, they probably establish
an organization; that is to say a hierarchical structure1 with various attributes that are
required of a modern organization, according to many prescriptions circulating in the
Corresponding author. Tel.: +46 31 7734484; fax: +46 31 7735619.
E-mail addresses: kajsa.lindberg@gri.gu.se (K. Lindberg), barbara.czarniawska@gri.gu.se (B. Czarniawska).
1
In Italian the term ‘‘struttura’’ is used to denote a formal organization. Indeed, the Latin ‘‘struttura’’ is
practically a synonym for the Greek ‘‘organization’’.

0956-5221/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.scaman.2006.09.001
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world today (Brunsson & Sahlin-Andersson, 2000). But it may soon become evident to
these same people that structures alone accomplish nothing and may in fact at best be no
more than stabilized processes. Although there is a lot of talk about the ‘‘construction’’ of
structures, i.e. various types of formal organization, when something actually has to be
done, action nets are created or existing ones are activated.
In their studies of existing organizations, particularly big ones, organization scholars are
usually intimidated by the larger-than-life reifications of their own concepts. Who would
ever dare to imagine General Electric, the World Bank or even Volvo as a mere ‘‘action
net’’! Yet formal organizations arose out of action nets, they are part of such action nets,
and are host to many others. In an action-net perspective, the past of these temples of
modern capitalism is revealed in tentative sketches on sheets of paper—sketches that might
never have been transformed into temples if appropriate connections among collective
actions had not been created and stabilized.
This paper describes a study that provides a rare opportunity to document a successful
process whereby different types of organizing action were tied together by being
‘‘translated’’ into one another. The study concerns a project, known as the ‘‘Högsbo
project’’, undertaken in the Swedish health care sector. The project got its name from the
locality where it occurred. Its aim was to establish coordination between care units in three
separate organizations, and thus to contribute to what could be defined as ‘‘good care’’.
And although the tasks of the three organizations were regulated by different laws, their
operations were financed by different principals, and the everyday work of their staffs was
undertaken at different times and in different places, the participants in the studied project
were able to create a durable net of connections. In the present article we examine in detail
the creation of this particular ‘‘action net’’, and offer the outlines of a tentative theory of
organizing in action nets.

2. Organizing in action nets

The concept of the action net is based on the assumption that organizing (and its special
of case: management) requires that several different collective actions be connected
according to a pattern that is institutionalized at a given time and in a given place. The
collective actions concerned need not necessarily be performed within the bounds of a
specific ‘‘organization’’. On the contrary, an action net may involve a great variety of
organizations or organized groups of people of a loose or temporary nature (Czarniawska,
2004). Thus, the action net is a general concept referring less to entities concerned with the
practice of management and more with useful ways of studying that practice.
In contemporary western societies the action of ‘‘producing’’ is connected with the
action of ‘‘selling’’, which in turn is connected with the action of ‘‘buying’’. Such actions
are always social or collective, even when they are performed by individuals. But it also
happens that new connections are created against the institutional grain (e.g. nontradi-
tional banks jump over the connection between savings and interest payments), innovative
or entrepreneurial connections are forged, or old nets are reshaped or destroyed.
An action net often involves several formal organizations to perform the various actions
required. Some of the connections established between the different actions are formalized
by contracts that are linking organizations rather than on single actions. Alternatively, one
member of an existing action net may throw a boundary around itself, creating a formal
organization. It can be safely assumed that formal organizations start as action nets, or
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parts of action nets, but that even after they have separated and become discrete units they
still need connections with other actions and other organizations. Investing, constructing,
producing, buying, and selling all provide examples of this.
The concept of the action net originated in a combination of new institutional theory
and the sociology of translation, but is tailored specifically to organization studies
(Czarniawska, 1997). Action nets differ somewhat from organization fields, networks or
actor-networks when it comes to their time and space coordinates.
The organization field (DiMaggio, 1983; Hedmo, Sahlin-Andersson, & Wedlin, 2005)
provides a way of describing the frame of reference for organizations dealing with the same
types of activity. The concept of the organization field does not necessarily capture the
interactions actually occurring in time and space: organizations in the same field may have
virtual contacts or even no direct contacts at all. An action net, on the other hand, implies
actual connections among actions. Many, although not all, of these connections are likely
to occur within one and the same organization field (Czarniawska, 1997). If a university,
for instance, is to function, it will need cleaning, catering, computer maintenance and
many other collective actions that have no connections with teaching or research. This is
not to deny that universities belong to an organization field known as ‘‘higher education’’.
It simply means that there is more to higher education than just teaching and research.
Nor is an action net the same as a network. A network, as generally understood, is a set
of connections among actors, be they people or organizations. The difference between an
action net and a network concerns time: there first have to be actors before networks can
come into being. Actors come first; networks come second; actions in a network come
third. In an action net perspective, however, actions come first and actors second with
networks possibly but not necessarily third. As a first step, actors acquire an ‘‘actorial’’
identity from actions, not the other way round. A contractor becomes a contractor not
simply by getting known as a contractor, but by providing what is required to construct a
building. Past actions build up an actor’s reputation, and it is the stability of their identities
that gives ‘‘character’’ to ‘‘actants’’. Actants, in the terminology of semiotics, are what act
or are acted upon (Greimas & Courtés, 1982).
Actors come second also in the sense that, from in an action net perspective, they are
exchangeable, whereas in a network perspective it is actions that can be so described. The
Mafia is a network: when one type of action fails to be profitable, Mafia members take
some other action—but the same actors are involved. When such a state or thing is
described, terms such as ‘‘cliques’’ and ‘‘corruption’’ often occur. To put it another way, a
change in actors or a loss of an individual actor will decisively alter the character of the
network, whereas a similar event in an action net, however important it may be, will
change the net only slightly (Czarniawska, 1997). If one nurse quits her job, the care of the
patient does not cease; someone else will take over. The care of patients is what the health
care field is for. Action nets of such a kind are shaped by institutions more durable than
individual actors. In fact it is the institutions that endow the actors with their identity
rather than the other way round.
Actor-network theory, too, assumes that actions create actors. The difference between
action net and actor-network concerns time, but here it is the time when a study begins that
is relevant. ANT studies begin when translations and connections between actions in an
action net have already begun to stabilize. In order to present themselves as macro-actors,
different actants try to stabilize their own identities and the actions in the network to which
they belong (Czarniawska & Hernes, 2005). The emergence of an action net may lead to
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the subsequent creation of networks and macro actors, but does not necessarily do so. It
may also destroy existing networks (when actors value their actions more than their
chums) or unmask macro actors (perhaps by, revealing their feet of clay or, in other words,
their network-like character).
Action nets can be observed most easily when they are being established or re-
established. Assuming that connecting is a central activity in all organizing, the main aim
of such observations will be to show how certain actions are connected. Thus, the
recognition of the existence of an action net or the forming of a new one will not be the
desired result of a study of organizing; rather it will be its point of departure. The purpose
of adopting the action net concept is to free the researcher from the limitations involved in
the traditional focus on places, people, or issues (Czarniawska, 2004). Actions may vary,
people may change, and issues can be defined differently by different sense-makers.
But how can actions of varying character be connected with one another? Although the
specific answer to this question will vary from one study to another (the answer to it is in
fact the desired result of any study of organizing), one more abstract concept may be of
help. How, for instance, can actions such as the political activities of the citizens,
architects’ dreams of an ideal city, and the drilling of a tunnel be connected with one
another at all? They need to be translated into one another. In using the concept of
translation here we have been inspired by Bruno Latour (1986), who borrowed it himself
from the philosophy of Michel Serres. This notion of translation not only applies to
linguistic translations—from the language of planners into the language of the users and
the language of financiers; it applies also to objects, images and actions. This means that
words can be translated into objects or into actions. But translation can also work the
other way round; actions and objects can be translated into words (Czarniawska, 2000).
It has been suggested that the concept of translation could contribute to our
understanding of the continuous circulation of management ideas and practices
(Czarniawska & Sevón, 1996, 2005). It can also be helpful in explaining why results are
not always as intended. Imitation and innovation can both be regarded as cases of
translation, while actions and the connections between them may be regarded in terms of
the interplay between various efforts at controlling and influencing unforeseen events
(Czarniawska & Joerges, 1996). In other words, translation can be regarded as the
mechanism whereby connecting is achieved.
To play a part in organizing objects do not necessarily have to be moved into another
place. Some objects can remain where they are, but when seen from different points of view
they can be regarded as being different from before. Star and Griesemer (1989) call them
‘‘boundary objects’’, in the sense that they belong to different realms, while remaining
intrinsically the same.
They have different meanings in different social worlds but their structure is common
enough to more than one world to make them recognizable, a means of translation.
The creation and management of boundary objects is a key process in developing and
maintaining coherence across intersecting social worlds (Star & Griesemer, 1989,
pp. 393)
Boundary objects function as a means of co-ordination and delimitation at one and the
same time: co-ordination in the sense that people can gather round and become connected
to the object, and delimitation in the sense that the object defines what they gather round
for. The study, reported here, provided us with an excellent opportunity for seeing how
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boundary objects help to establish connections among different actions, and to stabilize
connections that already exist: ‘‘Have you forgotten what you agreed to do for us? Look at
the contract!’’ Inspired by idea of routines as objects of a particular kind (Feldman &
Pentland, 2005), we suggest it is also possible to speak of ‘‘boundary procedures’’:
procedures that acquire different meaning for different actors while themselves remaining
unchanged (Lindberg, 2002). Boundary objects and boundary procedures act as stabilizers
in an action net.

3. The study

To help the reader to understand the study reported here, something should be said
about its context and background. The public administration in Sweden is currently
subject to the influence of several organizational trends.2 On the one hand, there is a
tendency to establish clearly demarcated units, each one working towards specified
objectives with its own budget and management. As suggested in Brunsson and Sahlin-
Andersson (2000) this trend can be interpreted as the almost compulsory creation of
organizations, equipped with clear boundaries, legal personalities, hierarchies etc. At the
same time, however, there is a strong emphasis on the importance of cooperation among a
variety of units, organizations and professional groups. This emphasis springs from the
assumption that cooperation will be better placed to fulfill the mission of providing
recipients—patients/clients/customers—with the best possible service (e.g. Borell &
Johansson, 1998; Danermark & Kullberg, 1999). Connections are thus needed that
transgress organizational and professional boundaries. A demand for action nets is
explicitly formulated, although not necessarily in the terminology of the present paper.
How can these two opposing principles be fulfilled at the same time? Specific projects have
been initiated to accomplish this, and one of these—which has been considered to be a
success—is described below.
The study reported here was concerned with describing and analyzing a project known
as the Högsbo project. The project itself, which was initiated and financed by the National
Institute of Working Life (NIWL) in Sweden, was concerned with the coordination of a
number of units in the care sector. Its stated aim was to develop a ‘‘chain of care’’3 for
elderly people. The chain-of-care idea can be seen as a manifestation of ‘‘horizontal
process’’ as an organizing principle in the health care sector.
The project was undertaken in a district in Gothenburg in which one-third of the
population were over the age of 65. Care workers in the local care units had encountered
problems when elderly patients had been moved from one care unit to another, i.e. from
home to hospital or the other way round. In order to ease such transfers as well as
improving the exchange of information so necessary to the care of the patients, concerned,
it was felt that the cooperation between units and organizations needed a thorough
overhaul. With financial support from NIWL, a group of seven nurses from three different
organizations launched the Högsbo-project. Four of the nurses had worked together
previously in a project concerning quality-assurance for the elderly initiated by the city
council. In the course of this earlier project they came to realize that the perspective of a
2
For a detailed review of studies of New Public Management and reforms in the Scandinavian health care
sectors, see Zeuten Bentsen, Borum, Erlingsdottir, and Sahlin-Andersson (1999).
3
‘‘Chain of care’’ is a translation from the Swedish term vårdkedja.
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simple organization was too limiting: input was needed from other organizations if the
overall quality was to be improved. Consequently they redefined the issue in terms of
‘‘coordination’’ rather than ‘‘quality’’ and invited three nurses from the University
Hospital to join them. This enlarged group constituted the project management.
Ultimately, 35 employees from three organizations (the University hospital, primary
care units, and municipality care centers) were participating in the project and attending its
meetings. In the course of the project some of the participants withdrew, due to lack of
time or changes at work etc., upon which they were replaced by other people from their
own unit. From the start, it was always a participant’s action and the practices of their
everyday work and not their person that was important. As noted above, they were all
subject to different laws, were financed by different principals, and their daily work was
undertaken at different times and in different places. But despite this, they were – at least in
part—dependent on one another for producing ‘‘good’’ care. In the project, they were
concerned to produce relations and connections: relations between actors, and connections
between actions.
Organizing between organizations necessarily means connecting actions separated in
space and time in such a way that they together form a chain or a net. But, as noted above,
organizational units and people, and what they both do, differ in different places and at
different points in time. Thus, in order to connect them, they somehow have to be
translated into one another. What do such translations look like? And, do translations
actually succeed in connecting actions to one another? If they do, how then are such
connections stabilized so as to endure? And, last but not least, what are the consequences
of such connections for the participants in the project—and here we are referring both to
individuals and the organizations that they represent?
To gather material allowing us to formulate tentative answers to these questions, one of
us monitored the Högsbo project for the course of one year, observing project meetings,
interviewing twelve of the participants on two occasions, and studying minutes and other
documents connected with the project or NIWL. The field material was thus textual,
consisting of interview notes, other observations (fieldnotes) and documents. This material
has been categorized according to observed similarities (e.g. repeated actions, recurrent
themes) and observed differences (actions or utterances that diverge from the pattern).
Next, we related the categories derived from the field to concepts stemming from the
sociology of translation (Czarniawska, 1997; Latour, 1986) and to theories concerning
various types of connections (e.g. Orton & Weick, 1990). From this, a modest grounded
theory of organizing across organizational borders has emerged.
Actions were the focal point of this study. By observing actions and their connections
with one another, it has been possible to trace the dynamics of organizing across
organizational borders. Borders in general were not only crossed; they were also
constructed and reproduced. The picture of organizing that emerged from the study reveals
a process in which organizational units and people, and the thing that they do are being
constantly connected and re-connected with one another.

4. Mapping the patient flow

The Högsbo project was part of a national program for supporting local projects
involved in horizontal processes in the health care sector. The Swedish National Board of
Health and Welfare issued new directives regarding cooperation in the sector, in which the
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importance of well-functioning cooperation throughout the chains of care was greatly

stressed. However, there was no information nor were there any guidelines about how this
work should be organized in practice. Rather, the emphasis was on local initiatives.
The aim of the Högsbo project was to coordinate the various care units so as to improve
patient transfer between units and organizations, while also to improving the information
exchange that is so important to patient care. This was conceptualized by the participants
as ‘‘working with chains of care’’. The chain-of-care idea was a fashionable one in the
health care sector of the mid-1990s, and was related to more general ideas such as quality
and effectiveness (Trägårdh & Lindberg, 2004). As a principle of horizontal organizing, the
chain of care was vague and, originally, context-free. As one participant put it:
I don’t get this talk about the ‘‘chain of care’’. Of course, it’s very trendy. For me, a
chain of care means that the cooperation between different units of care must be
better—better for the patient. It means that people in different units need to
understand better what the others are doing, so that the patient doesn’t suffer from
various mistaken ideas (Chain-of-care coordinator IV at Sahlgrenska University
Hospital).
To project managers the chain of care came to symbolize the patient’s journey through
the health care system. The exclusion of time- and space-bound features was necessary to
the translation of the idea into local practice, where it could be looked at from a new
perspective and ascribed a different meaning. It was an idea dependent upon the
coordination of certain actors. In this sense, too, it was close from the very beginning to
our concept of the action net, except that the metaphor was that of a chain rather than a
net.
The managers of the Högsbo project decided to define and delimit the chain of care both
geographically and demographically: it was to embrace elderly patients in the district of
Högsbo. The project managers stemmed from different organizations and units, but shared
the same patients. When anyone asked them why they had adopted the concept of the
chain of care they tended to refer to ‘‘cooperation for the sake of the patient’’ as if it were a
mantra, regardless of the organization they came from. Thus, patients were the pivots
around which the activities of the project participants were gathered, even if the actions
were actually undertaken at different times and in different places. In this way the patients
became what Star and Griesemer (1989) call ‘‘boundary objects’’, existing simultaneously
in different social realms.4
Thus, being a patient meant different things in different organizational settings. In the
primary care units general medical practice was the dominant mode, while in the hospital
specialized medical treatment dominated. In the municipal system for the care of the
elderly, the caring element was the main concern. Hence, in their role as boundary objects
the patients contributed to the identification of differences between the project participants
as well as to various dependencies among them. The patients were the ‘‘objects’’ upon
which the participants could act, providing a sort of collective basis for the participants.
Mapping the patient flow was the first joint action undertaken by the project managers.
For one month they observed the passage through the health care system of all the elderly
people in the Högsbo area who were registered at the emergency ward of the local hospital.
4
In answer to a possible humanitarian objection that ‘‘people must not be treated as objects’’, we would like to
point out that patients are in fact ‘‘objects of care’’.
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This mapping identified and gave a name to an already existing process in which the
patients were the objects, in our sense, of the relevant coordination. This also meant that
the idea of the chain of care began to assume more concrete form. The patients’ passage
through the health care system was illustrated in a flow chart. The patient’s journey had
thus been abstracted from the existing practices of different organizations. The mapping
represented an idealized chain of care: a description of an ideal action net ignoring local
conditions. The idea of the chain of care first acquired material form (e.g. in the flow
chart), which meant at the same time that it became disembedded (Czarniawska & Joerges,
1996).
From this mapping the project managers were able to identify situations or places in the
chain of care where dependency relations between the different organizations and units
were established, as in coordinated care planning for instance. The description showed that
merely mapping and describing was not enough, so in order to influence the everyday work
in the chain of care, the project management decided to expand the project to include more
units. The description had also made it possible to identify the units that were affected by
the chain of care for the elderly. It provided a basis for selecting employees from those
units for inclusion in a group working with the chain of care. The patient—as boundary
object—thus led to a description of the chain of care in the shape of an idealized action net,
and the description then served as a basis for identifying the potential translators, that is to
say the users of the chain-of-care idea who could partake in the translation.

5. Procedures in the project

The project managers decided to assemble a group of employees chosen on a basis of the
mapping activity. The project was expanded to a total of 35 persons. Right from the start
the project managers had decided not to adopt a standardized concept of the chain of care.
They wanted the participants to make sense of the idea in their own way and fill it with
meaning on a basis of their daily work. They saw the coordinating of the chain of care as
the participants’ task, designating them as chain-of-care coordinators.
The participants represented different units and organizations and their workplaces
were, physically speaking, apart. They had no obvious meeting-place and most of them
had only the vaguest idea of the work undertaken in other units. Expanding the project
and assembling the group was a way of giving meaning to the idea of the chain of care.
Monthly group meetings provided a context where participants could swap accounts of
their own particular daily activities. The patient—the boundary object—was not present at
these meetings, however, which made it necessary for other boundary objects to be present
at the same time and in the same place—something that in turn necessitated certain
boundary procedures (Lindberg, 2002). These can be described as planned actions of
repetitive character. A shift thus occurred away from the patient as the primary object of
coordination and towards boundary procedures focusing on the daily work of the chain-
of-care coordinators.
The group meetings followed a standard pattern. The project managers defined the
agenda and introduced specific subjects for each meeting, which meant that they could
contribute significantly to the construction of boundary objects and boundary procedures
for the chain-of-care coordinators. The very fact that the project had expanded, triggered
new sets of actions within it. For instance, the managers decided that the coordinators were
to produce ‘‘deviation reports’’ on any situations in which actions were not connected
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(the reports thus functioned as boundary objects), and to observe the work of other
coordinators at their respective workplaces (boundary procedure). Both these proce-
dures—writing deviation reports and mutual observations (as a type of shadowing)—were
already established practices in the health care sector and thus met no opposition among
the participants.
The deviation reports had to be kept simple and short, to make sure that the
coordinators would be willing to write them, that new participants in the project would
quickly grasp what was wanted of them, and that the coordinators would be able to pass
on the content to their colleagues. The form of the deviation report was gradually honed in
a process of trial and error by the very people who used them in their everyday work—a
practice that is recommended in every textbook on organizational change but rarely
observed in real life.
The contents of these reports served as a basis for discussion of the group meetings, with
the emphasis on where and why deviations occurred and how to correct them. The
participants also discussed the nature of deviations: what they are and how they can be
reported so that others can understand their import. Such discussions and the
documentation of deviations, helped people to recognize a pattern in the way deviations
arose. As one participant put it:
The discussions about deviations—when something happens that makes patient care
more difficult—provided an essential basis for mutual understanding. The purpose
was to draw attention to the problems (Chain-of-care coordinator at a municipal
care center).
The descriptions had to be detailed enough to provide information enabling participants
to act upon them. The subsequent actions, in the shape of corrective measures, stabilized
the connections between actions in the chain of care. The deviations revealed in the reports
helped to identify common problems and to indicate points of dependence between units
and organizations. Identifying and describing deviations can thus be seen as a shortcut to
inter-unit contact. Shortcuts of this kind are often resorted to when face-to-face contact is
impossible or too costly to be feasible (for a discussion of the difference between imitation
by contact and imitation by copy, see Diedrich, 2004). The meetings then made it possible
to complement the brief descriptions with more exhaustive narratives.
Storytelling at the meetings can also be described as a boundary procedure. The stories
were often based on the deviation reports, and provided examples from the various
practices, daily routines and work situations of the coordinators. The narrators voiced the
way in which they saw particularly situations. The participants listened to each other’s
stories, compared them with their own insights and looked for similarities and differences.
In this way, they learned a lot about each other’s work practices. The storytelling also
involved the sharing of actual experiences, thus contributing to a growing sense of trust
and recognition.
To start with I thought that it was all a lot of talk—I’d hoped for more lectures. But
when I look back I realize how important it was that we talked, and that room was
made for this (Chain-of-care coordinator in a primary care).
However, the intention was not to find a common strategy for action, namely the
conducting of patient care, but to identify and clarify similarities and differences. The
chain-of-care coordinators’ knowledge, both explicit and tacit, was mediated via the telling
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of stories. This storytelling served as a substitute for contact between them in their
everyday work, facilitating interaction between the participants and helping them to
understand each other’s work situations. This can be regarded as a boundary procedure
enabling a meta-connection of stories.
The storytelling can also be seen as an instance of space-limited coordination based on
shared experiences and understandings mediated by narrative. The participants shared not
what they saw, but what was told. A coordinator could begin a story, leave it for a while,
and return to it in a later discussion. In the storytelling the patient functioned as a
boundary object, in a process resembling what Julian Orr (1996) described as ‘‘talking
about machines’’, the way in which copy-machine technicians exchanged their experiences.
Stories are better than descriptions at mimicking social practice, because they facilitate re-
enactment (Czarniawska, 2004). It could be said that stories can offer templates for future
action nets: they can show how action nets are constructed at other times and in other
places, or they can simply provide information about the kind of connections that are
needed between actions.
Mutual observation of one another’s work—another boundary procedure in the
project—required the coordinators to visit each other’s workplaces and to shadow each
other for a day. This face-to-face interaction guaranteed that the situation was perceived as
‘‘real’’, which in turn encourage the connecting (tying together) of the individual
coordinator’s understanding of the organizations and work tasks of all the others. Thus,
even this observing of one another can be seen as a series of boundary procedures—one
person’s everyday work was a learning situation for another one.

After all, we have watched each other at work. For me, this was the most important
element of this project. I know now how things function in other places and I can
even explain it to my colleagues (Chain-of-care coordinator I at Sahlgrenska
University Hospital).

A shared experience and orientation in relation to a common object in a face-to-face

situation is described by Knorr Cetina and Bruegger (2002) as temporal coordination.
According to these authors, temporal coordination is a form of inter-subjectivity and
integration that arises before any concrete relationship is entered into—before durable
connections are constructed.
The participants in the Högsbo project thus gathered themselves round boundary
objects and boundary procedures. The procedures were undertaken as a part of the project
that later made it possible for participants to cross borders in their everyday work, thus
greatly facilitating the connection of actions separated in time and space or, in other
words, helping to knot the action net.

6. A model of cooperation

Carlile (2002) suggests that boundary objects facilitate the process of creating knowledge
precisely because they reveal differences and interdependencies. At the meetings in the
Högsbo project participants from different social realms were required to confront each
other, which—as Carlile would predict—made them reflect and report upon the differences
and potential interdependencies between their various organizations. The many elements
in the project such as boundary procedures, deviation reports, storytelling and mutual
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observations, all contributed to the participants’ cross-border knowledge—knowledge that

was not accessible to those of their colleagues who did not participate in the project.
Once the project was up and running its managers decided to start publicizing in order
to gain attention and legitimacy. First, they ordered a brochure to be designed by an
advertising agency and including both text and pictures. In the brochure the formal aim of
the project was described as follows: ‘‘To find functional forms and practical solutions with
a view to increasing the quality in the chain of care’’. How this was being achieved was
then described in a presentation of the procedures in the project and in accounts from the
chain-of-care coordinators of daily work activities. These last were illustrated with
pictures, while the presentation of the procedures included excerpts from recommenda-
tions issued by the National Board of Health and Welfare. Thus, the accounts in the
brochure appealed to the readers’ emotions and created credibility by way of factual
descriptions, while the quotations from the NBHW served to legitimize the project.
Another initiative was to invite politicians and managers to information meetings at
which the chain-of-care coordinators described their way of working in the project and the
way the project affected their daily work. They mentioned certain success factors, as they
called them, such as producing deviation reports to identify problems, and the mutual
observation of each other’s work that encouraged shared understandings. They also
emphasized the fact that their way of working was linked to recommendations from the
National Board of Health and Welfare.
On a basis of the project procedures, a collective description of the ways in which
different social realms might meet was drawn up. This joint product was presented as a
‘‘model of cooperation’’: an explanation of their way of translating the chain-of-care
concept into practice, based on the coordinators’ everyday work and shared experiences.
The participants claimed that the uniqueness of this model compared to the traditional
models of cooperation, was that it focused on how instead of why. They had not indulged
in speculation about motives or reasons: but had simply tried to describe a way in which
cooperation might work. By working according to the model they were able to avoid
controversy by paying attention to the way they worked.
The process of objectifying the model generated an additional ‘‘we-relationship’’ among
the participants, who began to regard themselves as the actual creators of the model. In the
course of numerous presentations of the model and the project as a whole to external
audiences, they also confirmed their own identity as chain-of-care coordinators.
The common use of boundary objects and procedures meant that different commitments
and understandings were combined, although this did not mean that the participants
always reached consensus. Their common product—the model of cooperation—contained
and preserved their multiple understandings and diverse translations, allowing them to
retain their established occupational identities at the same time as the actions of the project
identified them as care-chain coordinators. The new action net thus gave rise to a new
role—the chain-of-care coordinator role—while the same people’s roles in the organiza-
tional structures from which they came remained intact.
To make it attractive and to encourage its use beyond the limit of the specific project, the
model was packaged to include stories and images and a considerable element of rhetoric.
This packaging was crucial. Readers of the brochure, for instance, could not simply try the
model; first they had to be convinced of its usefulness. Moreover, other competing models
were also in circulation. So in order to compete for attention, this model’s package
included a mixture of local and standard procedures. This meant that other local
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K. Lindberg, B. Czarniawska / Scand. J. Mgmt. 22 (2006) 292–306 303

practitioners could make concrete use of the abstract idea, while the inclusion of standard
procedures meant that the idea could travel into new areas.
Predictably, the model itself transmuted into yet another boundary object working
across yet more boundaries. It was no longer known as the Högsbo project, but instead
became ‘‘a model of cooperation’’. When the chain-of-care idea reached Högsbo, the time-
and space-bound features had been excluded from the model, i.e. it was ‘‘disembedded’’. It
was transformed into an object that could travel in time and space, bearing with it the same
information (Latour, 1998). The same thing now happened with the new model of
cooperation. Because the content of the model consisted of objects and procedures already
existing in established practice, it was easily transported to other organizations in the
health care sector. Thus, by building on established practices, the idea was packaged to
make it readily recognizable—but it was claimed as being unique in its combination of
practices. These conditions permitted the smooth journey of the model and the continuous
expansion of the action net.

7. Translation as the connecting mechanism

What makes us see something special in the way different actions were connected to one
another in the Högsbo project? It was a question not of those who did it (the actors), but of
how it was done (the actions). The connecting or ‘‘knotting’’ that occurred can be described
as being cognitive, emotional and mimetic at the one and same time.5
The circulation of information and the mapping of patient flows generated cognitive
connections. The participants received information and made observations that provided
them with input and helped them to understand the work process. As an image of the chain
of care for the elderly emerged, cognitive connections were also established. The image
demonstrated in schematic form the way that actions in the chain were connected. These
actions did not require actors to meet, since connections could be made by way of referrals
or by sending forms from one place to another. The material from the Swedish National
Board of Health and Welfare about coordinated health care planning was perhaps the
main boundary object that served to stabilize cognitive connections. Cognitive connections
also represent a kind of coordination at a distance.
Emotional connections were established by way of direct interactions. From face-to-face
encounters between the chain-of-care coordinators a shared understanding about a
particular boundary object—e.g. the patient—could emerge. This shared understanding
helped to create an emotional connection between actions that were then performed
separately. Such encounters and the exchange of experiences can also be said to have
strengthened the loyalty felt among participants and between the participants and the
object.
Participants saw themselves as representing a certain ‘‘way of working’’, that is to say an
object that they had constructed together. The brochure thus became a boundary object
that stabilized the emotional connection, the ‘‘we-feeling’’ that existed among the joint
producers of an artifact. The emotional connections among the participants and between
5
This distinction is a terminological simplification. We take for granted that every cognitive activity has an
emotional undertone, that emotions are impossible without cognition, and that mimesis (imitation) involves both
of them. To be accurate, we should be speaking of connections in which cognitive, emotional or mimetic elements
predominate.
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the participants and the objects of care (themselves boundary objects), reinforced the
participants’ willingness to connect their actions. A desire to maintain separate traditions
and not to threaten established professional norms probably prevented any potential
resistance to the connecting of actions. In fact, project participants proved very eager to
connect actions that were separated in space and time.
Two factors encourage mimetic behavior when it came to the connecting of actions in
the Högsbo project. One was that mutual observations put participants in touch with one
another’s practices: the coordinators visited each other and ‘‘experienced’’ what others
were doing. The boundary procedures stabilized this kind of mimesis. The other was that
the participants told stories, gave examples of their own practices, and translated their own
and others people’s practices in order to connect them. Here the written deviation reports
served as stabilizers and boundary objects.
The mimetic connecting of actions was supported by an open attitude towards the
transformation of words, actions and symbols into something other, to their reinterpreta-
tion and redesigning. Mimesis does not necessarily lead to isomorphism or to the
tightening of connections between actions. But it does allow a field to be structured by
loose connections between actions. Loose connections may be as sustainable and stable as
tight connections (on the strength of weak ties, see Granovetter, 1973). They may also be
easier to achieve because they do not threaten established structures.

8. How an action net grows and becomes stable

In the course of the Högsbo project, care actions and supporting procedures were
knotted together by a combination of cognitive, emotional and mimetic connections.
Participants became allied around the idea of the chain of care, but even if the actors could
be exchanged, the actions themselves could continue. The action net was not dependent
upon specific actors, these were replaceable. Rather, the net offered a new identity—as
chain-of-care coordinator—to those wishing to join it without abandoning an old identity.
For the project to work, it was not necessary to make changes in the structure of existing
organizations, or to alter their routines or to reform their hierarchies. The connections
between actions led not to any revolutionary changes but to a modification of existing
procedures. Various organizations and organizational units retained their autonomy with
respect to their work activities and maintained their independence and flexibility.
Paradoxically, the connections between actions in the action net can be regarded as loose
and therefore as stable.
The fact that the connecting did not threaten established structures or action patterns
actually helped to sustain the action net thus created. Further, the model underlying the
net became objectified in various documents and procedures: it was possible for the action
net to show a tangible product. As Latour (1992) points out, objects—things or
technologies—are necessary if durable social connections are to be achieved. In the case
described here, the materialization of the action net in the shape of objects and
standardized procedures meant that a certain degree of determination, predictability and
stability existed and contributed to the durability of the net itself.
A loose but durable action net emerged. The looseness of the connections implies that
responsiveness and distinctiveness both characterized the elements thus connected (Orton
& Weick, 1990; Weick, 1976). Given the loose but durable connections between the
actions, the existing action net could be transformed and extended—something that could
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eventually lead to a restructuring of the organization field. The more often an action is
repeated the more likely it is to be taken for granted, which in turn strengthens its
durability.
Students of organization fields suggest three mechanisms as being responsible for the
spreading of similar forms within a field namely, coercive, normative and mimetic
mechanisms (DiMaggio & Powell, 1983/1991). The study reported here led us realize that
those who preach cooperation only too often rely on coercive and normative mechanisms
(e.g. Alter & Hage, 1993), which in fact maintain the separation between organizations and
their work activities, and raise an obstacle to cooperation. The Högsbo project overcame
these obstacles by the intensive use of imitation, leading us to conclude that mimesis—
intentional and unintentional imitation—deserves to be paid more attention in the context
of managing inter-organizational activities.

Acknowledgements

We are greatful for helpful comments from three anonymous reviewers. The editorial
assistance provided by Nancy Adler is also greatfully acknowledged.

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