What motivated the study
India’s home-based healthcare sector operates under considerable strain: high patient loads, workforce shortages and deeply hierarchical organisational structures. Nurses often find themselves constrained by bureaucracy, limited autonomy and poor job satisfaction, which in turn affects care delivery and retention. The authors noted a gap in research on how alternative organisational designs—particularly horizontal, self-managed structures—might work in India’s homecare context.
What we did
Using a Constructivist Grounded Theory approach, the authors conducted semi-structured interviews with three stakeholder groups: seven nurses, twelve management members and fifteen patients from a self-managed home-care organisation in India. The authors focused on how the structure and culture of the organisation influenced nurses’ experience, how information flows, value systems and conflict resolution worked in a horizontal model, and identified what they term “Qualitative Success Enablers”.
What we found
Three key themes emerged as vital enablers within self-managed organisations in this context:
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Insightfulness: nurses’ ability to reflect, make sense of complex patient situations, adapt their practices and find meaning in what they do.
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Enhancing Nursing Experience via Job Enrichment: provision of autonomy, skill variety, feedback and role-rich tasks lifted the experience of nursing from routine execution to engaging professional work.
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Autonomy-Enabled Intrapreneurship: when nurses were empowered to act as intrapreneurs—identifying improvements, taking initiative, shaping their job design—the entire organisation benefitted in responsiveness and satisfaction.
The case organisation managed to fare well even during the pandemic’s acute phases, suggesting that the self-managed model helped cope with uncertainty better than hierarchical incumbent models.
Why this matters
For management scholars and practitioners, this study offers a compelling example of how organisational design matters in high-stakes, service-intensive contexts like homecare. It challenges the assumption that hierarchical oversight is the only way to ensure quality and efficiency. For Indian healthcare systems and similar emerging-economy settings, it implies that decentralising authority, trusting nurses, enriching job roles and enabling innovation may yield gains in service quality, employee satisfaction and resilience.
What to watch out for
The model doesn’t come without challenges: self-managed structures need strong trust, clarity about roles, supportive coordination mechanisms, and perhaps digital tools to compensate for the reduced traditional oversight. Cultural and institutional legacies in India may slow or complicate transition. The authors note that more work is needed to test how scalable this model is, how long-term outcomes play out, and how it works across diverse geographies and patient populations.
This research takes a bold step by exploring an organisational alternative—self-managed teams—in the typically rigid world of Indian homecare nursing. What emerges is a story not just of flattening structures, but of empowerment, reflection, and intrapreneurial nursing, where the practitioner becomes a designer of their work and the organisation becomes a platform for innovation rather than control.