ABSTRACT
Boundaries, whether they be between individuals, groups or organizations, are frequently the site of failures of communication, understanding, cooperation and respect. Within a health care system, patients have many stories to tell of these failures. It is understandable that they should wish to find their way through the system without finding that its internal boundaries serve as barriers, causing confusion, delays, duplication, inefficiency and poor quality care. It is equally understandable that the system should wish to respond by offering to provide a 'seamless service'. Primary health care is a much broader concept than the system of health care delivery. An essential element of the organizational culture is how the organization feels about itself and how individuals feel about themselves within the organization. Working at a boundary requires an understanding of the 'other' organization as well as one's 'own' organization; and an understanding of the same factors are important – structure, culture, vision, aims, and policy options.
