This article reflects on the skills required in trades services to people dedicated to coordinate services in complex clinical situations because of their multidimensionality and chronicity. All human activity requires for its proper effectuation, the coordination of interdependencies between actors. Coordination of interdependencies is done in ordinary mode, in everyday activities, but also in dedicated mode, that is to say, through a practice that has a primary mandate to manage them in a conscious, voluntary and accountable for intervention situations whose (...) complexity is high. This passage from the ordinary form in the form of dedicated coordination undertakes a transformation of skills and professional knowledge mobilized in the professional gesture. Further skills and knowledge relating to the disciplinary control of clinical objects, the case manager or professional figure who best embodies this form of coordination, should mobilize expertise and procedural knowledge (assessment, planning, communication, negotiation, activation networks, etc..) required to control the interfaces between technical systems and professional and organizational actors, posing as the interdependence of actants primary purpose in work. For this he must do it in a time of temporality combining organizational project in clinical time. Le présent article réfléchit aux compétences requises dans les métiers de services aux personnes dédiés à coordonner les services dans les situations cliniques complexes en raison de leur multi-dimensionnalité et leur chronicité. Toute activité humaine exige, pour sa bonne effectuation, la coordination des interdépendances entre les acteurs concernés. La coordination des interdépendances se réalise en mode ordinaire, dans les activités de tous les jours, mais aussi en mode dédié, c’est-à-dire à travers une pratique qui a pour mandat principal de les gérer de manière consciente, volontaire et imputable pour les situations d’intervention dont la complexité est grande. Ce passage de la forme ordinaire à la forme dédiée de coordination engage une transformation des compétences et savoirs professionnels mobilisés dans le geste professionnel. En outre des compétences et savoirs relatifs à la maîtrise des objets cliniques disciplinaires, le gestionnaire de cas, soit la figure professionnelle qui incarne le mieux cette modalité de coordination, doit mobiliser des compétences et savoirs procéduraux (évaluation, planification, communication, négociation, activation de réseaux, etc.) requis à la maîtrise des interfaces entre systèmes techniques et acteurs professionnels et organisationnels, en posant l’interdépendance des actants comme objet premier de son action professionnelle. Pour cela, il doit effectuer cette dernière dans une temporalité conjuguant le temps du projet organisationnel au temps clinique. (shrink)

This article reflects on the skills required in trades services to people dedicated to coordinate services in complex clinical situations because of their multidimensionality and chronicity. All human activity requires for its proper effectuation, the coordination of interdependencies between actors. Coordination of interdependencies is done in ordinary mode, in everyday activities, but also in dedicated mode, that is to say, through a practice that has a primary mandate to manage them in a conscious, voluntary and accountable for intervention situations whose (...) complexity is high. This passage from the ordinary form in the form of dedicated coordination undertakes a transformation of skills and professional knowledge mobilized in the professional gesture. Further skills and knowledge relating to the disciplinary control of clinical objects, the case manager or professional figure who best embodies this form of coordination, should mobilize expertise and procedural knowledge (assessment, planning, communication, negotiation, activation networks, etc..) required to control the interfaces between technical systems and professional and organizational actors, posing as the interdependence of actants primary purpose in work. For this he must do it in a time of temporality combining organizational project in clinical time. e présent article réfléchit aux compétences requises dans les métiers de services aux personnes dédiés à coordonner les services dans les situations cliniques complexes en raison de leur multi-dimensionnalité et leur chronicité. Toute activité humaine exige, pour sa bonne effectuation, la coordination des interdépendances entre les acteurs concernés. La coordination des interdépendances se réalise en mode ordinaire, dans les activités de tous les jours, mais aussi en mode dédié, c’est-à-dire à travers une pratique qui a pour mandat principal de les gérer de manière consciente, volontaire et imputable pour les situations d’intervention dont la complexité est grande. Ce passage de la forme ordinaire à la forme dédiée de coordination engage une transformation des compétences et savoirs professionnels mobilisés dans le geste professionnel. En outre des compétences et savoirs relatifs à la maîtrise des objets cliniques disciplinaires, le gestionnaire de cas, soit la figure professionnelle qui incarne le mieux cette modalité de coordination, doit mobiliser des compétences et savoirs procéduraux (évaluation, planification, communication, négociation, activation de réseaux, etc.) requis à la maîtrise des interfaces entre systèmes techniques et acteurs professionnels et organisationnels, en posant l’interdépendance des actants comme objet premier de son action professionnelle. Pour cela, il doit effectuer cette dernière dans une temporalité conjuguant le temps du projet organisationnel au temps clinique. (shrink)

As case management is under development in France for elderly people, this study sets out to identify and analyse key situations responsible for ethical dilemmas for French case managers. We based our study on the analyses of individual interviews made with case managers and focus-group discussions, bringing together all case managers working in local organisations running for at least a year. We identified three situations giving rise to ethical dilemmas: in the order of importance, the refusals of care, the practicalities (...) of collecting and sharing personal data and the allocation of resources. These three situations can lead to conflict between the principle of beneficence and those of respect for autonomy, non-maleficence and justice. We describe here how French case managers practically deal with these situations. (shrink)

The article focuses on the implementation of a socio-technical device aimed at integrating services for older adults living with loss of functional autonomy in France. It unfolds in three parts. The first introduces the theories of innovation, the second presents the innovative model of integrated services, and the last part deals with the relationship that practitioners have with socio-technical devices that make up the innovation in the French context. It will be seen that this report is carried out in an (...) epistemic tension between a philic representation of these devices, which are supposed to bring about an expected renewal of professional and managerial practices, and a phobic representation, projecting on the innovation different fantasies as to their more or less explicit totalitarian character. Despite this tension, the real challenge is that of the coherence- as perceived by adopters of the innovation- between the principles underlying the innovation and the real will of its political promoters. (shrink)