Abstract
In recent years, ambitions to create better quality and more attractive workplaces in eldercare have come on the agenda in Danish municipalities. Drawing inspiration from the Dutch organization Buurtzog, municipalities have begun to reorganize eldercare and implement fixed, interprofessional and self-managing teams. Municipalities are inspired by Buurtzogs positive results in relation to satisfaction rates among clients and employees, as well as the promise to provide a sustainable economy. Furthermore, the model is often highlighted as a possible solution to the challenges of eldercare. At the same time, this development is inscribed in a larger political reform program where self-managing teams
are intended to 'liberate' citizens, and eldercare. With the implementation of self-managing teams in eldercare new perceptions of care, the role of clients and care workers’ professional practices and identities are introduced, and, in relation to this, also an ambition that self-managing teams are the path to a more attractive work environment. These ideals are translated into a Danish eldercare system where previous reforms are not replaced but are meant to coexist with these new ambitions. In self-managing teams, employees are simultaneously assigned a central role in reforming eldercare, as they are now tasked with managing, deciding, and planning care in cooperation with the clients. The implementation of self-managing teams thus addresses both governance understandings and employee practices. This dissertation investigates these changes based on the following research question:
How are the understandings of care, as well as employees’ practices, collaborative relationships and professional identities, affected and developed, when the municipalities implement self-managing teams in eldercare? And how can these developments contribute to the ambition of creating more attractive working
conditions?
The dissertation is based on an ethnographic study consisting of central and local policy documents as well as fieldwork focusing on two eldercare units in two Danish municipalities. Theoretically, the dissertation builds on existing research on self-managing teams and combines insights from this with theoretical inspirations from governmentality literature, feminist care research, sociological professional theory, as well as the concepts of accountability work and boundary work.
The dissertation's analyses are structured around four research articles that, in various ways, examine how self-managing teams influence and are actively created in eldercare, and how these changes can be seen in light of ambitions to create more attractive workplaces. Overall, the findings of the dissertation indicate that the implementation of fixed, interdisciplinary, and self-managing teams in eldercare in Denmark entails significant tensions and dilemmas. The dissertation illustrates how the implementation of self-managing teams is informed by new understandings of care, where quality is translated into continuity, flexibility, and person-centered care, and where care is to be created in close and trusting relationships between clients and employees. It must, to a greater extent, be
the clients' wishes that primarily inform care work. At the same time, self-managing teams are connoted as the path to creating more attractive workplaces by giving employees greater autonomy and more professional discretion. In this dissertation, I demonstrate how these ideals are accompanied by changes in employees' practices. Employees gain greater self-management and freedom to plan work schedules (rotas), as well as to allocate and schedule time with clients. At the same time, they also bear a greater collective responsibility for ensuring that schedules align, that clients experience continuity, personcentered care, and equitable treatment, and that the allocation of services and time is economically sustainable. The increased self-management is accompanied by various
forms of vertical and horizontal control, transforming the relational landscape of eldercare and creating tensions between the organization's need for visibility and control over employees' work and the ideals of increased professional discretion. Finally, the dissertation points out how increased interprofessional collaboration both challenges and reinforces existing professional hierarchies in elderly care and influences the construction of professional identities, where being a good colleague involves being willing to flexibly transcend professional boundaries to ensure continuity.
I argue that employees generally perceive the new organizations based on self-managing teams as a positive improvement of their working conditions. Self-managing work schedules, fewer colleagues, and increased influence over the delivery of care contribute to creating calm, predictability, and job satisfaction. At the same time, increased interprofessional collaboration and transformations of responsibility, freedom, and control create new relational collaborations with both positive and negative potentials for the work environment. The increased responsibility and freedom are accompanied by potential power dynamics and conflicts in the self-managing teams, where employees now have to negotiate work schedules, professionalism, tasks, and time allocations with each other to
a greater extent. The interprofessional collaboration strengthens the experience of delivering high-quality care and professional development, especially for social and healthcare helpers and assistants. Conversely, the increased informal interprofessional collaboration may leave nurses feeling constantly on call and experiencing their daily workload expanding as social and healthcare helpers and assistants pass on professional observations. The interprofessional collaboration is linked to ideals of care as person-centered and based on continuity, creating a need for employees with generalist competences. This appears particularly for nurses as a contrast to specialist functions and a vertical professional hi-
erarchy.
The dissertation contributes to existing research by incorporating new theoretical perspectives on how we can examine transformations of responsibility, freedom, and control; the construction of identities, and collaboration in self-managing teams. The dissertation also contributes to existing research on care and caregiving in eldercare by examining the introduction of self-managing teams in line with the extensive existing research on eldercare, its development, and organization.
are intended to 'liberate' citizens, and eldercare. With the implementation of self-managing teams in eldercare new perceptions of care, the role of clients and care workers’ professional practices and identities are introduced, and, in relation to this, also an ambition that self-managing teams are the path to a more attractive work environment. These ideals are translated into a Danish eldercare system where previous reforms are not replaced but are meant to coexist with these new ambitions. In self-managing teams, employees are simultaneously assigned a central role in reforming eldercare, as they are now tasked with managing, deciding, and planning care in cooperation with the clients. The implementation of self-managing teams thus addresses both governance understandings and employee practices. This dissertation investigates these changes based on the following research question:
How are the understandings of care, as well as employees’ practices, collaborative relationships and professional identities, affected and developed, when the municipalities implement self-managing teams in eldercare? And how can these developments contribute to the ambition of creating more attractive working
conditions?
The dissertation is based on an ethnographic study consisting of central and local policy documents as well as fieldwork focusing on two eldercare units in two Danish municipalities. Theoretically, the dissertation builds on existing research on self-managing teams and combines insights from this with theoretical inspirations from governmentality literature, feminist care research, sociological professional theory, as well as the concepts of accountability work and boundary work.
The dissertation's analyses are structured around four research articles that, in various ways, examine how self-managing teams influence and are actively created in eldercare, and how these changes can be seen in light of ambitions to create more attractive workplaces. Overall, the findings of the dissertation indicate that the implementation of fixed, interdisciplinary, and self-managing teams in eldercare in Denmark entails significant tensions and dilemmas. The dissertation illustrates how the implementation of self-managing teams is informed by new understandings of care, where quality is translated into continuity, flexibility, and person-centered care, and where care is to be created in close and trusting relationships between clients and employees. It must, to a greater extent, be
the clients' wishes that primarily inform care work. At the same time, self-managing teams are connoted as the path to creating more attractive workplaces by giving employees greater autonomy and more professional discretion. In this dissertation, I demonstrate how these ideals are accompanied by changes in employees' practices. Employees gain greater self-management and freedom to plan work schedules (rotas), as well as to allocate and schedule time with clients. At the same time, they also bear a greater collective responsibility for ensuring that schedules align, that clients experience continuity, personcentered care, and equitable treatment, and that the allocation of services and time is economically sustainable. The increased self-management is accompanied by various
forms of vertical and horizontal control, transforming the relational landscape of eldercare and creating tensions between the organization's need for visibility and control over employees' work and the ideals of increased professional discretion. Finally, the dissertation points out how increased interprofessional collaboration both challenges and reinforces existing professional hierarchies in elderly care and influences the construction of professional identities, where being a good colleague involves being willing to flexibly transcend professional boundaries to ensure continuity.
I argue that employees generally perceive the new organizations based on self-managing teams as a positive improvement of their working conditions. Self-managing work schedules, fewer colleagues, and increased influence over the delivery of care contribute to creating calm, predictability, and job satisfaction. At the same time, increased interprofessional collaboration and transformations of responsibility, freedom, and control create new relational collaborations with both positive and negative potentials for the work environment. The increased responsibility and freedom are accompanied by potential power dynamics and conflicts in the self-managing teams, where employees now have to negotiate work schedules, professionalism, tasks, and time allocations with each other to
a greater extent. The interprofessional collaboration strengthens the experience of delivering high-quality care and professional development, especially for social and healthcare helpers and assistants. Conversely, the increased informal interprofessional collaboration may leave nurses feeling constantly on call and experiencing their daily workload expanding as social and healthcare helpers and assistants pass on professional observations. The interprofessional collaboration is linked to ideals of care as person-centered and based on continuity, creating a need for employees with generalist competences. This appears particularly for nurses as a contrast to specialist functions and a vertical professional hi-
erarchy.
The dissertation contributes to existing research by incorporating new theoretical perspectives on how we can examine transformations of responsibility, freedom, and control; the construction of identities, and collaboration in self-managing teams. The dissertation also contributes to existing research on care and caregiving in eldercare by examining the introduction of self-managing teams in line with the extensive existing research on eldercare, its development, and organization.
| Original language | Danish |
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| Publisher | Roskilde Universitet |
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| Publication status | Published - 2024 |