Imposed evaluation questionnaires, software dictating psychosocial interventions, tedious and unproductive intervention protocols, centralized waiting lists, midwives supervised by doctors illustrate the numerous attacks on the professional autonomy of caregivers in public services.
In many cases, despite their good will, stakeholders are not able to intervene “professionally” due to the rigidity of their supervision. Two worlds oppose each other.
On the one hand, the world of managers, adopting an industrial type approach, focused on employee obedience, including rigid standards of intervention that, for greater efficiency, the employer standardizes and details more and more , including monitoring objectives, time allocated to needs assessments and interventions. Too many rules and too much rigidity demotivate and extinguish joy, creativity, inventiveness and the spirit of initiative among professionals. Customers suffer.
On the other side, the world of humanist values. These guide professionals, but without dictating standard intervention methods of general and universal application. This world is governed by very few standards. This is how the frameworks of professional orders work. They are focused on values of ethics, independence, autonomy and skills to carry out the interventions most likely to meet human needs.
The proliferation of rules interfering with professional services is also noticeable in New Brunswick. In a report submitted to the Legislative Assembly on March 11, 2024, the Office of the New Brunswick Child, Youth and Seniors Advocate wrote: “Social programs often require highly qualified team members — social workers , nurses, teachers — to provide the service. Limiting their flexibility can reduce their ability to find creative ways to solve problems in ways that work for the individual, and the resulting rule-related paralysis can actually harm recruitment and retention. these professionals. »
Autonomy
Professional autonomy includes the exercise of professional judgment to make informed decisions. The professional can thus choose a method to collect the data, analyze it and decide on its interventions. He can also adapt his actions according to the needs of the people, the context and his skills, which contributes to the effectiveness of his interventions.
The relationship of trust with the client contributes to the effectiveness of the intervention. The professional develops it by focusing on the well-being of the client rather than on the rules.
Concretely, the new management methods create a gap between, on the one hand, professionalism from an institutional and managerial point of view and, on the other hand, what the professional is trained for, his ethical duties as well as his aspirations regarding to efficient, honorable and well-done work.
“From this perspective, the conditions that would cause the most stress among social workers would be those that combine high psychological demands, low decision-making latitude and low social support,” reports researcher Stéphane Richard, social worker and professor. at the School of Social Work at Laurentian University.
Consequently, counter-models emerge to free stakeholders from these normative constraints and allow them to achieve their aspirations, such as migration to the private sector.
Collaborative management
The accelerated decline of professional autonomy has prompted the Order of Social Workers and Marriage and Family Therapists to once again produce general statements on this theme in 2023-2024, as it had already done at the end of the 1990s. The work in progress indicates that the problems are getting worse even if we see some improvements.
The pruning of certain procedures and forms announced in February by the Minister of Health and Social Services of Quebec, Christian Dubé, should continue and intensify.
We believe that a collaborative management model is more favorable to the exercise of professional autonomy. This model involves continuous collaboration between patients, professionals and managers. It aims to modulate services according to prioritized needs and available resources.
In the 1970s, Social Service Centers (CSS) renamed Local Community Service Centers (CLSC) brought together health professionals who then enjoyed great autonomy to deploy their resources according to the needs prioritized by each community. We have lost sight of the original mission.
It is still possible to go back so that social and health services can get closer to people. Health professionals can be very creative in finding effective responses to people’s needs and much more if they have the support of the community and the political-administrative apparatus.
* The authors thank social work professor Stéphane Richard for his collaboration.