Continuing our series of articles aimed at offering insight into the key challenges facing the care system, today we focus on organisational issues within care services. This article complements our previous reflections on the types of professionals best suited to the future of the sector, as well as the skills and capabilities they should embody and apply in practice.
Organisational design is critical to successfully addressing the challenges facing support and care systems. While financing, workforce shortages, and access to better technology are all essential topics, it is equally important to recognise that a significant part of the care sector still operates under structures designed for a reality that is rapidly disappearing. These organisational models are built around “stable” realities, assuming little variability among the people receiving support, and are characterised by limited flexibility, fragmentation, hierarchy, and a strong task-oriented focus.
The sector is increasingly required to support people with greater frailty, higher levels of multimorbidity, and more diverse life experiences and generational trajectories, alongside clearer expectations regarding autonomy, continuity, and personalised care. In this context, traditional organisational models will become progressively less capable of delivering effective responses while also ensuring quality and sustainability.
An Approach Losing Relevance
In summary, the organisational model still dominant across much of the Spanish health and social care sector is characterised by:
- Rigid division of professional roles by category
- Limited autonomy for frontline care professionals
- High levels of task supervision
- Limited supervision of practice quality and relational care
- Excessively bureaucratic processes
- Low interoperability between social and healthcare information systems
- Weak coordination and interaction with community services and agents
While this organisational approach offers operational advantages by maintaining order in high-pressure environments, it also generates structural costs:
- It hinders genuine personalisation of support because the organisation prioritises stabilising internal processes rather than adapting support to individual trajectories, situations, or changing needs.
- It penalises interdisciplinary and cross-departmental coordination by encouraging professionals to protect their own areas of responsibility.
- It fails to capitalise on the capabilities and talent of professionals: frontline staff are expected to execute more and decide less, while technical professionals spend more time assessing and intervening within their discipline than influencing the person’s everyday life.
The World Health Organization (WHO), along with other international institutions, has long advocated for integrated, person-centred systems of support based on stable and meaningful relationships, shared information, coordinated decision-making, and services capable of being delivered at the right time and place, with a strong community-based focus.
This framework proposed by the WHO goes beyond traditional organisational logic and compels us to rethink a fundamental issue: how to move away from prioritising the administration of scarce resources and internal routines, and instead gradually develop the capacity to organise support around people’s life projects while improving organisational quality, effectiveness, and efficiency.
Reflections on the Organisational Approach
Although we recognise the need for increased staffing levels — as highlighted in the report Estimation of Long-Term Care Workforce Needs by 2030, published by the Spanish Ministry of Social Rights and Agenda 2030 — simply adding more staff to an existing structure will not, by itself, solve the problems generated by a specific organisational design.
For this reason, we believe that expanding the workforce within support systems must be accompanied by a transition towards organisational models characterised by:
- Greater professional flexibility
- Enhanced responsible professional autonomy
- Quality-focused supervision
- Reduced bureaucracy
- Integrated information systems
- Strong community coordination
Ultimately, organisations must become more aligned with the delivery of high-quality care capable of responding to the evolving challenges of the care sector.
Many of the organisational shifts required for the future are already well understood. At Connect Group, we would like to highlight and reflect on several additional principles that we believe are essential for implementing these changes and redefining future organisational models.
Principle One: Organising Around the Person, Not the Service
Drawing from the principles of Person-Centred Care, organisations must complete the transition towards defining themselves around the person and their life trajectory, rather than around the unit, department, or service itself.
This vision requires less compartmentalised organisations with greater flexibility to respond to the infinite variety of realities and contingencies that person-centred care presents.
Assessment, support planning, goal review, and responses to changing circumstances must form part of a continuous process — one that is valued equally by professionals whether the person lives in a residential setting or receives support at home or within the community.
Continuity — always a core principle of Person-Centred Care — must now be recognised as a critical organisational objective. It should guide organisations towards optimising the delivery of appropriate support in terms of timing, form, and intensity across healthcare, functional support, prevention, rehabilitation, and daily care. All of this must contribute to each individual’s life project, the full exercise of their rights, and the wellbeing and dignity they define for themselves.
Principle Two: Real Interdisciplinary Practice and Intelligent Decentralisation
Having different professional profiles within an organisation is not operationally sufficient on its own. What matters is the ability of professionals to share useful information, review complex situations collaboratively, and create flexible chains of decision-making and implementation that lead to meaningful — and measurable — improvements in people’s daily lives.
The OECD has repeatedly warned over the past decade that integrated care is not achieved simply by bringing professionals together, but through shared assessment, joint planning, information exchange, and alignment of responsibilities among all actors within the system.
A system designed around personalised support cannot depend on every decision moving through hierarchical structures before action can be taken. Information and professional judgement must be closer to where care actually happens: within the unit, the home, and the person’s everyday interactions. This requires rethinking the role of every professional level in decision-making processes.
Intelligent decentralisation means transferring decision-making capacity to those who truly understand the specific situation, while maintaining coherence regarding professional competencies and responsibilities. Responsibility must be understood as the ability to respond appropriately to changing situations, justify decisions, and assume accountability within a shared organisational framework.
This approach also requires redefining the systems that support decision-making through reliable information, adequate training, trust, balanced supervision, coordination, and accountability.
Principle Three: Digitalisation with Organisational Purpose
To maximise the value of information and fully support professionals, data must be accessible, traceable, shared, understandable, and meaningful. Information systems should help coordinate, anticipate, and review care — not simply record activity for bureaucratic or compliance purposes.
A useful information system enables professionals to work from a shared understanding of reality, avoiding duplication, fragmented interpretations, or decisions based on incomplete data. It supports continuity between assessment, planning, and intervention, while enabling rapid responses to changes in a person’s situation.
From an organisational perspective, this requires clearly defining which information is relevant, who records it, who uses it, and how it translates into concrete decisions.
Beyond this, digitalisation with organisational purpose also means ensuring systems serve professionals and the goals of care itself. Recording information should be simple, accessing it should be fast, and understanding it should be straightforward. Technology can — and should — free up more time for care while helping professionals think and act more effectively.
Supporting Organisational Transformation
In this context, moving towards more flexible, coordinated, and person-centred organisational models also depends on having the right tools and guidance.
At Connect Group, we specialise in working at the intersection of care models, organisational design, and real-world practice. We support organisations in redesigning processes, training professionals, and implementing information systems that turn Person-Centred Care, interdisciplinary coordination, and meaningful digitalisation into measurable and sustainable outcomes.
If your organisation is currently undergoing this transformation process, we invite you to learn more about us and explore how we can help make the necessary changes possible, sustainable, and measurable in everyday practice.