The purpose of this study was to contribute to increased knowledge of how issues of competence development are handled in practice in organisations, what strategies are developed and how these strategies are shaped by different internal and external conditions.

The theoretical frame of reference has two foci. First, an overview and analysis of theory and research on professional organisations is presented. Second, three theoretical perspectives on the development of strategies for competence development are outlined. The three perspectives focus on rational decision-making processes, conflicts between interest groups, and cultural-institutional factors.

The study has a combined survey and multiple case study design, comprising a survey study of central actors and department managements in the county council, and case studies of four care units.

There are at least five main findings. First, the care units were found to have different strategies for competence development. The similarities between the care units' strategies seem to be dependent mostly on the medical educational culture that predominates within health services and medical care. The differences seem to depend partly on the degree of external pressure that is experienced by the department managements, partly on the relative power of different occupational groups within the care units. Second, planned formal training has mostly a medical/technical content. Informal learning is supposed to meet the need of other competence demands. Third, a general pattern is that doctors together with paraprofessionals appear to have the relatively best possibilities of learning and development in their work. Fourth, the central actors have a vague and uncertain opinion as to how competence issues are handled in practice. Fifth, care units that have a so called integrated strategy for competence development and a non-Tayloristic division of labour seem to handle personnel cutbacks in a better way than what other care units do.