The authors discuss a theoretical and conceptual management methodology based on reference teams and matrix support. Reference team is a structural organization intended to combine managerial power and interdisciplinary work. Matrix support changes the way traditional health systems work, with specialists organically linked to other teams who periodically require specialized consultation. Besides care support, there is another goal: to build new knowledge for each health professional through a continuing education process. The article analyzes the structural, political, cultural, theoretical, and subjective obstacles to this new model.23399-407