Logistics of care: Trust-reform and self-managing teams in municipal home care services

Abstract

The central idea in trust-reform is to improve service delivery by granting professional autonomy and acknowledging the experiential knowledge of professionals. In this article, we study trust-reform bottom-up from the perspective of frontline care workers. Our aim is to discuss the challenges for care work and care workers who have been organised in self-managing teams, paying particular attention to the organising of the daily work in the teams. This study draws on data from four months of fieldwork in Norwegian municipal home care services for older people. The article sheds light on some problematic aspects in trust-reform regarding the relationship between frontline workers’ autonomy and responsibility on the one hand and the lack of authority and managerial support on the other hand. The study demonstrates that trust-reforms within public service delivery can be experienced as delegation of logistical tasks and enhanced responsibility instead of delegation of the authority that is necessary for professional care work to be performed. As such, trust-reforms risk obstructing rather than advancing their declared intentions of strengthening professional agency in care work, and rather than distributing management tasks, trust-reforms need to strengthen the management function in order to succeed.