The demand for home-based care is rising across the world, intensifying the shortage of qualified healthcare professionals and increasing workloads and emotional strain for care professionals in these settings (OECD,2020). However, many continue to deliver high-quality care. From a Resilience in Healthcare perspective (Hollnagel, et al., 2019), understanding what supports their ability to adapt, sustain their mental well-being, and resilient performance under pressure is essential.
A recent qualitative study, part of the Support4Resilience project, explores the factors that contribute to resilient performance and mental well-being among healthcare professionals working in Norwegian home care settings (Kidanemariam, et al.,2026)
Beyond Individual Effort
Home care services operate under conditions of high variability, limited resources, and increasing care complexity. Unlike institutional settings, healthcare professionals in home care settings must continuously adapt their work, manage competing demands, and maintain safe and effective care.
However, despite physically working alone in patients’ homes, health care professionals experience a strong sense of team unity through informal learning, routine interactions, shift handovers, and mutual support. Beyond distributing tasks, these interactions generate shared understanding and improved adaptive capacity, enabling teams anticipate and respond to unforeseen challenges.
Resilient performance, in this context, is not an individual trait alone but rather emerges from interactions among team members, processes, and organizational structures.
Leadership Practices
This study also found that accessible, engaged, and visible leadership was a key factor that supports both resilient performance and mental well-being. Leaders who exercised open communication increased mutual trust and enabled care professionals raise concerns and seek guidance without hesitation. Such leadership practices not only facilitated problem-solving but also reinforced healthcare professionals’ psychological safety.
Interestingly, however, health care professionals also framed autonomy as both demanding and rewarding. The responsibility to make independent decisions fostered a sense of competence, but only when accompanied by clarity about decision boundaries and when leaders remained approachable.
Structured Work and Organizational Clarity
This study also showed that organizational elements such as clear roles, routines, and tools were critical for reducing uncertainty and sustaining performance. Participants highlighted the importance of documentation systems, task distribution platforms, and supportive digital tools. Up-to-date patient records and documentation were beyond administrative requirements but central to communication, planning, and patient safety. Moreover, when roles and procedures were well defined, care professionals felt more confident in handling unpredictable demands. On the other hand, unclear expectations were a source of stress.
Individual Coping and Adaptive Strategies
A central insight from the study is that resilient performance and mental well-being are not separate outcomes but deeply interconnected. Although health care professionals employ individual coping strategies such as task prioritization, flexibility, and emotional regulation, these competencies are most effective when supported by a collaborative culture and clear organizational structure. Resilience, thus, is best understood as a relational and context-dependent process rather than an isolated individual capacity
Implications for Home Care Systems
This study points toward practical areas for improvement in home care settings. These include:
- Clarity in organizational roles.
- Continued investment in leadership development.
- Accessible and participatory tools that enhance communication and continuity of care.
- Ensuring staff development opportunities and adaptive strategies through peer learning and structured reflection
Concluding Remarks
Based on qualitative data from municipal home care settings in Norway, this study underscores that improving resilience and mental well-being is not a matter of addressing personal traits alone. It requires systemic, relational, and structural support. If we want sustainable care in home care settings, we must strengthen organizational clarity, leadership accessibility, collaborative cultures, and individual adaptive capacities. Though it may not represent the conditions in the whole of Europe, this study has described the contextual conditions to enable others to assess the relevance of the results for their healthcare systems
Writtten by: Teklay Tesfay Kidanemariam, from Universitetet i Stavanger
References:
OECD. (2020). Who cares? Attracting and retaining care workers for the elderly. OECD Publishing. https://doi.org/10.1787/92c0ef68-en
Erik Hollnagel, Jeff Braithwaite, & Robert Wears (Eds.). (2019). Resilient health care, volume 3: Reconciling work-as-imagined and work-as-done. Springer.
Kidanemariam, T. T., Raknes Sogstad, M. K., & Wiig, S., et al. (2026). Factors supporting resilient performance and mental well-being among health care professionals in home care settings: A qualitative study. BMC Health Services Research, 26, Article 39. https://doi.org/10.1186/s12913-025-13917-w