“Closing the Physician-Staff Divide: A Step Toward Creating the Medical Home” [April 2008] left me with two questions: First, the authors refer to “our research program.” I notice, though, that the authors come from several different institutions. Could they clarify whose research they are referring to? Second, the article talks at some length about the importance of “boundary spanning.” This sounds like little more than good communication. Is the fancy term really justified?

Authors' response:

The AAFP funded a multisite research center more than 10 years ago that included Robert Wood Johnson Medical School (Benjamin F. Crabtree, PhD), Lehigh Valley Hospital (William L. Miller, MD, MA), Case Western Reserve University (Kurt C. Stange, MD, PhD), University of Colorado (Paul A. Nutting, MD, MSPH) and University of Texas Health Sciences Center at San Antonio (Carlos Jaén, MD, PhD). This collaboration has been enriched by consultations that Reuben R. McDaniel, EdD, of the University of Texas, Austin, an expert in the study of complex systems, has conducted across projects. This investigative team forms the Center for Research in Family Practice and Primary Care, which has been studying primary care practices for more than 10 years with a series of eight grants from the National Institutes of Health and other related funding. Each project is headed up by a specific team from one of these institutions and carefully builds on the growing experience and insight from the previous studies. This collaborative program of research has resulted in more than 100 peer-reviewed publications.

The term “boundary spanning” comes from the organizational literature and seeks to distinguish other forms of organizational communication and connecting, such as gatekeeping. “Bridge building” might convey a similar idea, but boundary spanning includes more than just communication. You can think of a boundary spanner as someone who pays attention to multiple organizational functions and creates and maintains connections across potentially disparate organizational components. Certainly this includes communication but also other activities such as creating opportunities for sharing ideas and experiences and enhancing working relationships.