Adaptive Capacity Within the Homecare Setting: The Importance and Value of a Shared Perception of Risk.

Objectives: Patients receiving homecare are living their everyday lives in their own homes. Adapting care to individual needs, preferences, risks, and family situations is seen as essential. The overall aim of this study was to develop empirical knowledge of risk perception in homecare services. The research question that guided the study was: How is a shared perception of risk between health care professionals and leaders a part of providing high-quality care within a homecare setting?

Methods: The research design was a multiple-embedded case study including 3 single cases. Participants were recruited from 3 Norwegian municipalities. Two focus group interviews were conducted in each municipality. In total, 19 informants participated, including 11 homecare department leaders and 8 health care professionals. The data were analyzed using thematic analysis according to Braun and Clarke's 6-phase thematic analysis.

Findings: Two higher-order themes were developed from the data: "Risk perception is a collective understanding" and "A flawed system requires adapting just to make it work." The study showed that, in the homecare departments, leaders' and health care professionals' opinion, flexibility and professional discussions are key to enhancing the system's adaptive capacity. High-quality care is always perceived as person-centered and adaptive. Overgeneralizations and the use of guidelines were perceived as demanding. The findings also showed that making sense of and managing risks within a homecare setting is complex.

Conclusions: Bridging the gaps by conceptualizing and acting upon risks in the homecare setting constitutes a fundamental part of adaptive capacity at a system level. However, better alignment of system demands to local risks is needed for sustainable and safe services.