Differentiation, Integration, and Control Dynamics in Multidisciplinary Teams: An Ethnographic Study of Northern Italian Public Addiction Services

This ethnographic study explores the complex dynamics of differentiation and integration within multidisciplinary teams in Northern Italian Public Services for Addictions. This study investigates the challenges arising from ambiguous role boundaries and overlapping functions as well as the control mechanisms that maintain system equilibrium. Through participant observation and semistructured interviews with 28 professionals from three addiction services, this study reveals a nuanced interplay among professional roles, team structures, and organizational control. The findings highlight the varying degrees of formalization among specialized subsystems, leading to overlapping responsibilities and blurred boundaries that impact professional recognition and identity. Three distinct levels of control were identified: hierarchical, horizontal, and decision-making control at the collegial team level. These control mechanisms, coupled with various sanctioning strategies, play a crucial role in enforcing adherence to organizational norms. The microteam structure emerges as a fundamental unit of control, shaping role expectations and behavioral norms through continuous social interaction. This study underscores the importance of balancing differentiation and integration as well as the critical role of control mechanisms in maintaining system functionality. These findings have implications for policymaking, service quality improvement, and enhancement of multidisciplinary approaches to address addiction-related challenges in healthcare system.