Mutual Adjustment

This paper provides a transdisciplinary critical review of the literature on maternity management in small and medium-sized enterprises (SMEs), embedded within the wider literatures on maternity in the workplace. The key objectives are to describe what is known about the relations that shape maternity management in smaller workplaces and to identify research directions to enhance this knowledge. The review is guided by theory of organizational gendering and small business management, conceptualizing adaptions to maternity as a process of mutual adjustment and dynamic capability within smaller firms' informally negotiated order, resource endowments and wider labour and product/service markets. A context-sensitive lens is also applied. The review highlights the complex range of processes involved in SME maternity management and identifies major research gaps in relation to pregnancy, maternity leave and the return to work (family-friendly working and breastfeeding) in these contexts. This blind spot is surprising, as SMEs employ the majority of women worldwide. A detailed agenda for future research is outlined, building on the gaps identified by the review and founded on renewed theoretical direction.

Cet article porte sur l’organisation globale des systèmes multi-organisationnels de santé et de services sociaux et utilise le cas québécois pour approfondir la question. Il adopte une perspective ancrée dans les sciences de l’organisation et s’inspire essentiellement de travaux anglo-saxons pour analyser le principe central de bien des réformes structurelles, celui de l’intégration hiérarchique et formelle des systèmes dont il fait une analyse critique. Il met ensuite en valeur le recours à des mécanismes à base d’ajustement mutuel pour assurer l’organisation d’ensemble des systèmes multi-organisationnels de santé et de services sociaux.

– The governance of multi-organisational systems – The example of the health and social services system in Quebec –
This article looks at the overall coordination of multi-organisational health and social services systems, and examines the specific case of Quebec. Written from the  standpoint of organisational science and inspired mainly by Anglo-Saxon research, it analyses the hierarchical and formal “integration” of systems, which is a central principle in many structural reforms. This idea does not appear to have a great deal of support, and this article makes a critical analysis of it. It goes on to highlight some operational mechanisms based on mutual adjustment which serve to ensure the overall coordination of multi-organisational health and social services systems.

Sommaire : Notre étude de l’organisation du secteur de l’aide et des services aux sans-abri à Montréal Centre met en lumière un système multiorganisationnel de services
de santé et de services sociaux qui n’est pas intégré hiérarchiquement dans son ensemble et qui n’est pas soumis à une entente de gestion et d’imputabilité globale
propre à une gestion fondée sur la normalisation des résultats. L’étude présente un
système d’ensemble de type organique plutôt que bureaucratique, largement
fondé sur des ajustements mutuels entre les nombreux acteurs publics et communautaires de ce secteur. La coordination des services se réalise alors
essentiellement dans les interactions entre les intervenants alors qu’ils accomplissent
leur travail, et ce avec le soutien des gestionnaires. À l’aide de nombreux extraits
d’entrevues, nous étudions le fonctionnement de ce système organique sous la
forme de trois catégories de processus d’ajustement mutuel qui se superposent et se
complètent pour assurer la valeur des services : disjoint unilatéral, conjoint bilatéral et
conjoint multilatéral. Selon les sciences de l’organisation, un tel système est potentiellement mieux adapté à composer avec la complexité des connaissances et des valeurs caractéristiques des services humains, qu’un système formellement intégré et et contrôlé par des règles, des indicateurs et des cibles quantifiables.

Abstract: This study of the organization of the sector dedicated to providing aid and
services to the homeless in Central Montreal reveals a multiorganizational health and
social services system that is neither hierarchically integrated as a whole nor subject to a comprehensive ‘‘management and accountability agreement’’ specific to standardized results-based management. The study details a comprehensive system that is ‘‘organic,’’ rather than bureaucratic, and broadly organized based on mutual adjustments among the numerous public and ‘‘community’’ practitioners in this sector. The coordination of services is therefore essentially achieved through the interaction of the workers as they perform their jobs, with the support of management. This study
draws on a number of extracts from interviews to examine how this ‘‘organic’’ system
operates, in the form of three distinct processes of mutual adjustment that are super-imposed and complementary to ensure the value of the services: ‘‘unilateral disjoined,’’
‘‘bilateral joined’’ and ‘‘multilateral joined.’’ According to organizational science, this
type of system is potentially more likely to address the complexities inherent in the
knowledge and values that are characteristic of human services than a formally integrated system that is controlled by rules, indicators and quantifiable targets.