The logic of relations and the logic of management.
BACKGROUND
Increasing emphasis on financial and administrative control processes is affecting service culture in support organisations for persons with intellectual disability. This phenomenon is currently obvious in Dutch service organisations that find themselves in transition towards more community care and at the same time under pressure from new administrative and funding managerial bureaucracy. As a result, the logic of management is becoming more dominant in direct support settings and risk to overshadow the logic of relationships between staff and clients.


METHODS
The article presents a reflection on this phenomenon, starting from a description of service team characteristics as found in the literature. Next, findings about direct support staff (DSS) continuity are summarised from four Dutch studies. Following up these findings, the concept of 'microsystems' is explored as a possible answer to the organisational challenges demonstrated in the studies.


RESULTS
Team characteristics, especially team size and membership continuity for DSS, appear relevant factors for assuring supportive relationships and service quality in direct support teams. The structure of the primary support team shows to be of special interest. The organisational concept of 'microsystems' is explored with respect to transcending the present conflict between bureaucratic managerial pressure and the need for supportive relationships.


CONCLUSIONS
Service organisations need to create structural conditions for the efficacy of direct support teams in terms of client relationships and relevant client outcomes. At the same time, the need for administrative and control processes can not be denied. The concept of 'microsystems', application of a Quality of Life framework and the use of new instruments, such as the Supports Intensity Scale, can contribute to an organisational solution for the present conflicting logic of relations and management.
Maastricht University, Maastricht, Netherlands. w.buntinx@beoz.unimaas.nl
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D003153:Community Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration; D016352:Group Homes / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D008607:Intellectual Disability / Q000534:rehabilitation*; D033183:Interdisciplinary Communication; D007588:Job Satisfaction; D008128:Logic; D008329:Managed Care Programs / Q000458:organization & administration*; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D010563:Personnel Turnover; D017009:Professional Autonomy; D024382:Professional Role; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D011788:Quality of Life; D012944:Social Support; D012947:Social Work / Q000458:organization & administration*