Accountability and performance optimization are intended to improve the performance of homecare services (HS) but do not seem to have the desired effects. The lack of decision-making latitude of professionals and, consequently, their insufficient responsiveness would be at fault. This responsiveness is, however, part of their role as change agent, a role that is poorly invested. This article has three objectives : 1) To synthesize knowledge on the role of accountability and performance optimization in the practice of HS professionals ; (...) 2) To describe the role of change agent ; and 3) To explore its teaching. (shrink)