La spirale culture–compétence en EHPAD : une lecture cognitivo-situationnelle du travail réel en contexte médico-social

Nursing homes (EHPADs) are organizations characterized by high relational intensity, strong regulatory pressure, and increasing structural instability. While the medico-social management literature has extensively examined issues of quality, governance, and human resource management, it has paid less attention to the dialectical dynamic between organizational culture and situated competence. This article proposes a transposition of the culture–competence spiral model—initially developed in an industrial context—to the medico-social sector. Drawing on a qualitative study conducted in six nursing homes (32 semi-structured interviews with registered nurses, nurse coordinators, care assistants, and directors), we demonstrate that situated competence mobilized in everyday interactions progressively generates an implicit organizational culture, which in turn restructures the architecture of mobilizable competencies. This dynamic may evolve in an upward direction (collective learning, symbolic stabilization) or in a downward direction (cultural fragmentation, erosion of tacit knowledge). The article contributes to a dynamic understanding of care organizations and offers managerial implications for sustaining virtuous spirals.