Abstract
Substantial organizational change in many health institutions has eliminated profession-based departments and replaced them with program management structures. This article aims to explore practitioners' perceptions of their professional work in a large urban centre for addiction and mental health that has undergone such change. Seventy-six practitioners from six professions participated in focus groups that were transcribed and analyzed. Practitioners' perceptions about their professional competence, performance, development, and job satisfaction were affected by three interrelated factors: available supervision from experts who validate practitioners' subjective work experiences and provide population-specific knowledge for effective interventions; teams that provide a home base and support through positive interpersonal relations, collaboration and informal feedback; and organizations and managers who provide assistance and training while expecting quality performance and productivity. Effective clinical and organizational leaders manage tensions between providing supportive environments and expecting accountability throughout the workplace.