Beyond Enabling Perspectives: How Organizational Conditions Shape Intertwined Forms of Professional Agency in Health and Social Care

Abstract The need to deepen our understanding of how organizational conditions shape the enactment of professional agency in the context of rapidly changing health and social care organizations is growing. Professional agency is understood in this study as a temporally embedded, relational, and situated process through which professionals shape their work and work‑related identities while individually and collectively interacting with the sociocultural conditions of their practice, including in interprofessional collaboration. Specifically, the present study examined how professional agency is enacted in two Finnish settings—adolescent psychiatry and adolescent residential care—using semi‑structured interviews with 14 professionals to explore how organizational conditions shape agency in complex care environments. The interview transcripts were abductively analyzed, revealing three interrelated dimensions that influence the enactment of professional agency: managerial and leadership practices (i.e., how leaders act and communicate), structural and professional developmental conditions (i.e., resources and processes, such as training), and organizational climate and interprofessional collaboration (i.e., relational conditions, including trust). These organizational conditions individually and jointly shape the forms that professional agency takes, ranging from proactive and collective to constrained and compensatory. The findings also highlight reflective work, encompassing both reflection and reflexivity, as a cross-cutting process through which professionals navigate tensions and make sense of organizational demands. Importantly, agency was expressed not only through participation and development-oriented action but also through professionals’ active negotiation, adaptation, and improvisation in response to organizational constraints. These insights deepen our understanding of professional agency by extending conceptualizations of agency beyond enabling organizational conditions and positive expressions.