Teamwork and collective autonomy: experience in home care nursing

Abstract

Teamwork is often identified as being a core value in care work. Studies on this topic often focus on pluri-professional configurations, whereas mono-professional teamwork has not aroused the same interest. In this study, we examine teamwork among a group of nurses providing homecare within a new organization, Soignons Humain (SoHu). SoHu was inspired by Buurtzorg, a Dutch homecare company composed of self-organized nursing teams. Given that the healthcare context for French and Dutch nurses is different, SoHu chose to focus primary on teamwork as a mechanism for improving the quality of care. The article examines how this objective was implemented through the practices and representations of work: to what extent do these self-organized teams lead to deeper collaborations with other homecare actors? How does this type of organizational model differ from other forms of homecare nursing in France? How does SoHu's experience allow us to rethink nurses' autonomy in their work? SoHu's organizational model differs from both private nursing clinics and traditional nursing care centers. The SoHu nurses' salaried status makes it possible for them to focus on delivering holistic care and highlights their autonomous nursing role, which they claim as being central to their profession. SoHu's originality lies in its highly developed instrumentation of teamwork and its work organization that is attentive to the construction of a collective competence. The use of coaches appears to be one ofthe organization's key investments in sustainably supporting teamwork and, paradoxically, their collective autonomy. Following an initial learning phase, and through other types of support work (workshops and facilitation meetings), the association has attempted to create and support a propitious environment for teamwork. Our work calls attention to the necessary conditions for real collaborative practices to take place, wether these are inter or intra-organizational. SoHu's case shows what an organization can do to create an environment favorable to team collaboration. This consists in building reflexivity into care work with a focus on the patient and the family; investments in developing teamwork skills; ensuring a frequency and specific type of exchange between the nursing teams; using both ad hoc arrangements and formalization of these collaborations; and finally by recognizing and objectivizing these invisible coordination practices.