Services integration, professional autonomy and standardization. Representations of standardization among case managers in the case of integrated service networks implementations

PURPOSE: Social work (SW) practices are undergoing major transformations generated by change in the governance of health and social policies. These transformations are based on two logical performance, one managerial, resting on New Public Management principles, and another clinic, supported by evidence based practices. The implementation of integrated services is traversed by these two logics that shape it and call a relative standardization of clinical practice. THEORY: Standardization of practices should be conceived as bi-dimensional, like a normative system heterogeneous to practice of SW but also like a set of incorporated and collective routines sustaining the professional autonomy of SW. METHODS: Qualitative analysis of representations of standardization from a corpus of interviews with 10 case managers on two implantation sites of PRISMA-France pilot project. RESULTS AND CONCLUSION: Standardization appears weakly conceptualized in social workers practices. Managerial dimensions of standardization dominating in their representations. However, some forms of standardization associated to tools for information exchange and evaluation are seen by SW as vectors of efficiency in clinical practice. SW have a complex relationship to the multifaceted nature of the standardization that requires a nuanced analysis of its effects on their practices.