Table 1
Matia Foundation main figures.
| Turnover | 52 M€ —> 85% comes from different public administration, bundled, act and cash payments |
| Patients/users | +30,000/year |
| Direct Employees | 1,428 |
| Indirect Employees | 2012 (14%) –> 2016 (9%) —> 2019 (8%) |
| Volunteers | 3,418/168 organizations |
| Health Services | Geriatric Hospital (103 beds), average stay: 24 days |
| Geriatric outpatient consultations | |
| 7 Rehabilitation centers | |
| Long Term Care | 8 Nursing homes (1,072 beds) |
| 7 Day centers | |
| Two apartment blocks | |
| Home Care in the province | |
| Community | Age friendly activities in 70 towns/locations in the Spanish Basque Country |
Table 2
Focus group data collection details.
| Date | Setting | Number of Beds | Number of years this setting has been part of Matia | Participation in Etxean Ondo project | Focus group participants | Focus group size | Level of integration |
|---|---|---|---|---|---|---|---|
| 1st October 2016 | Nursing Home F | 88 | 20 years | yes | Director + multidisciplinary team + caregivers | 9 | Full |
| Nursing Home L | 143 | 12 years | yes | Multidisciplinary team + caregivers | 7 | Coordination | |
| 2nd June 2017 | Nursing Home R | 120 | 120 years | yes | Caregivers | 9 | Coordination |
| Nursing Home P | 103 | 2 years | no | Caregivers | 7 | Linkage |
Table 3
Details of the in-depth interview data collection.
| Data Source | Position | Length of service | Setting | Educational background | Experience in PCC integration | Oral communication skills | Previous experience in collaborating in R&D |
|---|---|---|---|---|---|---|---|
| In-depth interviews from June 17 to September 18 | Social Worker | 37 year | Hospital | Social | 10 year | High | Often |
| Caregiver | 38 years | Nursing Home B | Social | 7 years | Low | Rarely | |
| Psychologist | 20 years | Nursing Home L | Social | 8 years | High | Often | |
| Nurse | 30 years | Hospital | Health | 10 years | Medium | Rarely | |
| Center Manager | 19 years | Nursing Home F | Social | 8 years | High | High | |
| Procurement officer | 35 years | Support | Economics | 8 years | Medium | Never | |
| Controller | 1 year | Management | Economics | 0 years | Medium | Never | |
| Accountant Officer | 40 years | Support | Economics | 10 years | Medium | Never | |
| Chair Woman | 16 years | Board of trustees | Humanities | 4 years | High | Often | |
| Vicepresident | 20 years | Board of trustees | Economics | 6 years | High | Rarely | |
| Secretary | 6 years | Board of trustees | Administration | 2 years | High | Rarely |
Table 4
Description of the organisational categories emerging from data analysis.
| Category | Description | Citation | Subcategories |
|---|---|---|---|
| Mission of service | This category represents the organisational objective, i.e. exploring what people need as well as the level of satisfaction of the participants, both care recipients and care providers, in order to achieve their well-being. Autonomy is imbricated in the individual’s recognition of a collective purpose of service and in his/her identification with it, which gives the participants in this service a sense of purpose. | “The fundamental orientation of our service… is towards the person.” “Because we come to work to take care of their needs, we also have to take care of our own, that is, physically, mentally and emotionally”. | Well-being, certainty, security, autonomy. |
| Experiential learning | PCC incorporates new ways of working which entail new technical, interpersonal and intrapersonal skills to manage situations of great emotional burden and stress. The key lies in facilitating experimentation by encouraging collective reflection and creativity for solving the problems in the work itself. | “… what do we need then? Skills”. “The concepts are there, but what really happens is that you have to develop them. And it is practice itself… There has been blood, toil, tears and sweat! And much effort and sacrifice…” | Core competences (technical, interpersonal and intrapersonal), collective reflection, personal resignation and effort. |
| Participatory Person Centred planning | Acts as a lever that turns the mission of service into action. Focus on the exploration of needs, consensus in prioritising goals and the design of action. As all these take place at the same time, this is a multilevel structure which connects people with the organisation and the environment. | “because we have been given the autonomy and freedom to be able to develop our management plan.” | Needs analysis, consensus, prioritisation towards mission. |
| Policies and information systems | This category encompasses a whole structure of policies, information systems, standards, procedures and protocols to promote communication and participation, avoiding individualism. PCC requires flexibility and adaptation, and protocols and systems become “containers” of collective learning. Democratic IT systems are mandatory | “We are working with people, and if you want the model to work, everything needs to be integrated, and no aspect can be shut off from the others” and therefore “we need to have a complete view of the organization, a balance among all our needs: schedules, organisation, personal functioning, delegating tasks, and autonomy…” | Share-decisions to avoid opportunism, removing protocols, open information systems. |
| Formal organisational structure | Represents the functions and roles assigned to people to facilitate the delegation and information flow of formal power in decisionmaking according to required level of participatory planning. Critical aspects: the stabilisation of the teams, grouping people into small groups of up to 16 members and “home environnent”. | “Before 1 didn’t mind being with XXX, or with YYY… because we were 30 or 40 colleagues and we would be always changing. Now there are just are seven team members who meet and decide” | New professional roles, structured teamwork spaces for reflection, no rotation (team stability). |
| Informal organisational structure: “Diversity” | Recognition of the uniqueness of each individual. The deepening of relationships has allowed people to become visible as individuals and not only through the role they play. This fosters generative dialogues that boost creativity. The recruitment of new team members is a critical process. | “Well, we already saw that so much protocol and corporate rigidity and that way of working were not appropriate for taking care of people or their feelings”. | Equity, recognition of personal diversity, source of knowledge. |
| The relational style: problemsolving approach | Dialogue and fluency of information among the participants. Accompanying participants in situations of great dependence and fragility is a complex duty that requires continuous coordination of the care services and actions of the different participants, within each team, across work shifts, and across the whole organisation. This calls for the integration of the different capacities through greater communication, which is given different meanings: | “We talk a lot, share a lot, listen a lot” “… we are like facilitators of people’s lives.” “having no secrets”, “dealing with slacking”, “being informed of everything that happens”, “being coordinated and having the same objective” or “coordinating the care provided between shifts with fluent communication and informing about incidents each day”. | Active listening, problem solving approach, accompanying |
| Cooperative culture: “based on mutual trust” | Dialogue and fluency of information among all the participants in order to solve a complex duty that requires continuous coordination of the care services. | “Until we learned to respect and became aware that, actually, if we rejected something, it was because we didn’t understand it…” “Well, actually they don’t work against me, in fact, we work together well!” | Inclusion, diversity as a value of the person, intrinsic dignity, identification, being part of something bigger, affective cohesion. |
| Personal leadership | Personal leadership is empowerment, discipline and self-control, regardless of whether there is formal power. Leadership is the result of a process of renunciation and learning, where people and teams are the priority. | “Leadership has to do with self-understanding and valuing what you have, and the feeling of connecting with something bigger, with a greater being than yourself.” | Motivational quality (ability to prioritise common good), empowerment, self-knowledge. |
| “Leadership skills have to do with autonomy, don’t they? We have the power now, so let’s see how we use it.” | |||
| “You have to empower the people, which means that they are going to decide, my responsibility towards people is more informal than formal. That’s what matters to me!” |
Table 5
Description of emerging case support categories.
| Category | Description | Citation | Subcategories |
|---|---|---|---|
| The external environment | The category ‘external environment’ includes all those actors and aspects that are beyond the control or management capacity of the organisation. This category can have both a positive and negative effect on the functioning of the organisation given that it operates in the economic, social and political dimensions in which it is immersed. | “Our dependency; we depended a lot on financing and economic-political agreements. (…) At the family level we have a very protectionist culture, and that leads to the need for control.“ | Families, society, public administration, health system, long term care sector, community, ecosystem agents. |
| The internal environment: “personal scope” | This category includes all those aspects that are inside the participants themselves and within their personal environment. Especially relevant are their personal beliefs and experiences which have a direct effect on the activity of the organisation but which cannot be handled by the organisation itself. These aspects are also influenced by the external environment. | “Well, I was very young, and I was very enterprising. I was deeply committed, from an ideological point of view…” “If I have problems at home, I get emotionally affected, and bring this state of mind to work”. | Personal beliefs, values, background and experiences. |
| Personal motivation | This category represents the goals of human action; what the participants want to achieve through their action to solve their dissatisfactions. This is considered a support category because it is linked to people and not directly to the organisation. Nevertheless, it is the category through which we can connect people with the organisation through the decision-making process, given that personal motives are present both in the design of the formal organisation and in the informal relationships which arise in the organisation. These personal motives directly affect group performance and effectiveness. | ||
| Extrinsic motivation | These aspects are external and take the form of material compensation or intangible rewards such as prestige, recognition or praise. They respond to needs for security, uniqueness (recognition), belonging (v. isolation) and fun. | “I worked for the money, of course. I wanted my wages and that was all”. | Bio-material-physical needs, perceptions, security, uniqueness, belonging, fun. |
| Intrinsic motivation | These motives are internal goals that each person hopes to achieve as a result of an action. It is therefore a question of knowing one’s own personal needs regarding goals and personal growth. They respond to the need for personal improvement. | “Right now I’m very motivated, because I still have everything to learn and that way I will be able to do new things, and this makes me happy”. | Psycho-cognitive needs, personal challenge. |
| Transcendent motivation | These motives are linked to the personal satisfaction that comes from caring for other people or supporting the team (care recipients, participants, family etc.), in other words, the personal satisfaction of contributing to the collective self and feeling part of something. They respond to the need to contribute to the common good. | “I’m motivated by people, yes, people, I like dealing with people… learning about their life experiences… I’m not looking for more pay, I don’t want to be the boss, nor have a higher status and so on, just feel fine supporting.” | Socio-affective needs, sense of contribution, sense-making. |
| Fear of change | This category emerges as a living code in the narratives collected. Changes that are not in accordance with current skills, lack of information or expectations of participants can cause fear, resistance, anger, flight response, and demotivation, in short, ineffectiveness and barriers. | “There was a vision, a style of management… And we had to stick to the protocol. We took a macro approach towards everything, which I think was not very realistic, because we didn’t have the appropriate skills. And we were very scared…” “Something that is never talked about is that it is normal to be afraid, to be afraid of change and of the unknown. Because… if anyone gets angry, cries, or just ignores everything… there is a reason for this and the reason is fear” “I find this resistance to change very frustrating. It takes a lot of determination to overcome it. Change is difficult”. | Fear, resistance, anger, flight response, demotivation, sadness, fear of failure, flight. |
Table 6
Emerging relationships.
| A: Formal structure | B: Participatory planning | C: Policies & systems | D: Experiental learning | E: Informal structure | F: Relationship style | G: Personal leadership | H: Cooperative culture | I: Mission of service | |
|---|---|---|---|---|---|---|---|---|---|
| 1: Formai structure | 10 | 8 | 9 | ||||||
| 2: Participatory planning | 8 | ||||||||
| 3: Policies and systems | 8 | ||||||||
| 4: Experiental learning | 10 | 8 | 8 | ||||||
| 5: Informal | 8 | 10 | |||||||
| 6: Relationship style | 8 | 8 | 8 | 12 | |||||
| 7: Personal leadership | 8 | 10 | 10 | ||||||
| 8: Cooperative culture | 9 | 8 | 10 | ||||||
| 9: Mission of service | 8 | 12 | 10 | 10 | |||||
| Sum | 27 | 8 | 8 | 26 | 18 | 36 | 28 | 27 | 40 |
Table 7
Relationships between types of motivation and organisational categories.
| Motivation style | A: Formal structure | B: Participatory planning | C: Policies & systems | D: Experiental learning | E: Informal structure | F: Relationship style | G: Personal leadership | H: Cooperative culture | I: Mission of service |
|---|---|---|---|---|---|---|---|---|---|
| Extrinsic | 3 | 6 | 2 | 0 | 1 | 0 | 0 | 0 | 1 |
| Transcendent | 0 | 0 | 1 | 0 | 0 | 1 | 6 | 6 | 4 |
| Intrinsic | 0 | 1 | 0 | 4 | 5 | 4 | 0 | 0 | 0 |
Figure 1
Exploratory case model.
Table 8
Connections between organisational levers and management skills.
| Level of integration observed | Organisational Dimensions Managed | Organisational Goals Sought | Organisational Performance Indicators | Director’s Role | Type of Leadership | Motivation styles observed by management | Competences observed by management |
|---|---|---|---|---|---|---|---|
| Linkage | Objective | Outcomes | Effectiveness | Manager | Transactional | Extrinsic | Technical |
| Coordination | Objective Subjective | Outcomes Innovation | Effectiveness Learning | Manager Facilitator | Transformational | Extrinsic Intrinsic | Technical Interpersonal |
| Full Integration | Objective Intersubjective Subjective | Outcomes Sense-making innovation | Effectiveness Unity Learning | Manager Leader Facilitator | System | Extrinsic Transcendent Intrinsic | Technical intrapersonal Interpersonal |
Table 9
Organizational actions undertaken.
| Dimension | Organisational Goal | Organisational challenge | Actions |
|---|---|---|---|
| Intersubjective | Sensemaking in order to avoid fragmentation and opportunistic behavours | Establishing purpose and need | Review participatory organisational mission of service in order to promote: intrinsic dignity, well-being and personal autonomy |
| Review organisational culture values; to build by consensus a shared values code and behaviour framework according to the new proposed paradigm: positive attitude, recognition of diversity, fluid and open communication, trust and collaboration | |||
| Develop new leadership programmes according to above mission of service and cooperative culture | |||
| Subjective | Learning in order to innovate | Engaging and involving participants enabling them to contribute with their experience, knowledge and skills | Promote programs for empowerment and training for team work; mainly face-to-face; listening, assertiveness and empathy |
| Work to see human diversity as a source of innovation | |||
| Facilitate outside support for teams to learn to manage conflict, diversity and ambiguity | |||
| Objective | Results (outcomes) in order to be cost-effective | Working with processes and systems to adapt them to the proposed change | The implementation of small and stable teams is essential; no rotation at all |
| Establish three teamwork spaces for: care provision, learning and sensemaking | |||
| Review HR policies according to new values; establish the organisational performance indicators according to the new values | |||
| Establish new professional roles; mainly, the dual role of operational managers and case manager “new power” | |||
| Open IT systems for information flow; remove protocols, establish good practice guidelines | |||
| Team meetings are a powerful tool for information flow and learning; participation should be mandatory in team work; establish a guide and training for effective meetings. |