Becoming a Good Homecare Practitioner: Integrating Many Kinds of Work

Exploring Norwegian homecare healthcare professionals' perceptions of risk and the link to high-quality care: a qualitative multiple case study

OBJECTIVES

Homecare is a critical component of the ongoing restructuring of healthcare worldwide, given the shift from institution- to home-based care. The homecare evidence base still contains significant gaps: There is a lack of knowledge regarding quality and safety work and interventions. This study explores how home healthcare professionals perceive and use the concept of risk to guide them in providing high-quality healthcare while maintaining resilience.

DESIGN

The study design is a qualitative multiple case study. The phenomena explored were risk perception, sensemaking and adaptations of care delivered to patients in their homes. Inductive content analysis was conducted.

SETTING

The study was conducted in three Norwegian municipalities. Each municipality was defined as a single case.

PARTICIPANTS

Interviews with healthcare professionals were performed both individually and in focus groups of three to five persons. 19 interviews with 35 informants were conducted: 11 individual semistructured interviews and 8 focus groups.

RESULTS

Four themes were identified: 'professionalism is constantly prioritising and aligning care based on here-and-now observations' 'teamwork feels safe and enhances quality' 'taking responsibility for system risk' and 'reluctantly accepting the extended expectations from society'.

CONCLUSIONS

To make sense of risk when aspiring for high-quality care in everyday work, the healthcare professionals in this sample mainly used their clinical gaze, gut feeling and experience to detect subtle changes in the patients' condition. Assessing risk information, not only individually but also as a team, was reportedly crucial for high-quality care. Healthcare professionals emphasised the well-being, safety and soundness of the patients when acting on risk information. They felt obliged to act on their gut feeling, moral compass and clinical understanding of quality.

Becoming a Guest: On Proximity and Distance in Mental Health Home Treatment

Mental health home treatment is a service where patients with severe mental illnesses are visited by a multiprofessional psychiatric care team at their homes. In Germany, inpatient-equivalent home treatment as a specialized form of home treatment has been offered by hospitals since 2018. In its early stage, the shift of care activities out of the hospital toward the patient's home opened up a new set of problems and blurred the existing boundaries. This ethnographic study follows two home treatment teams and provides an in-depth description of their work. The findings are presented by three themes from our data analysis: (i) closeness and familiarity; (ii) bridging the distance; and (iii) tensions of proximity and distance. We then discuss the findings with the guiding lens of Becoming a Guest, which refers to the ambiguity of proximity and distance. The contribution for computer-supported cooperative work (CSCW) is twofold; on the one hand, we provide a detailed account of mental health home treatment, and on the other hand, we outline a conceptual model that helps to describe and analyze similar cases. We conclude the paper with directions for further research.

Uncovering the Complexity of Care Networks – Towards a Taxonomy of Collaboration Complexity in Homecare

In homecare, networks are formed by professional, semiprofessional, and informal actors, who collaborate to care for people in need. Modern information and communication technology (ICT) might play an important role to enhance cooperation in homecare networks. Through infrastructuring work, the authors seek to build a comprehensive understanding of the types of collaboration complexity in homecare networks to determine if, when and which technologies are most suitable. This paper examines how homecare networks can be classified according to collaboration complexity. A four-stage research design was followed to develop a taxonomy for homecare collaboration. The taxonomy was applied to 21 care networks, and five types of homecare networks were identified. The taxonomy considers network, tasks, and communication particularities across 13 dimensions, each of which includes three characteristics. Three clusters were identified as more likely than the others to benefit from increased technology use. The taxonomy and archetypes highlight which homecare network types could benefit from increased technology use. Additionally, the taxonomy allows for an iterative re-evaluation of networks to initiate measures for improvement.

Unpacking the Role of Boundaries in Computer-Supported Collaborative Teaching

In this study, we explore the role of boundaries for collaborative learning and transformation of work practices to occur. We report from a three-year action research project including well over 1800 h of participation by the authors. The empirical data are based on project participation work including observations and field notes, project reports, interviews and a questionnaire, within a school development project in Nordic elementary school. In the project, teachers and researchers from three Nordic countries, Norway, Sweden and Denmark, collaborated to develop novel, on-line teaching models for a Nordic Virtual Classroom. The virtual classroom refers to an educational setting where teaching and learning activities are conducted collaboratively in cross-national teams “in the cloud” by means of information technology. During the project, teachers were challenged in their current teaching practices and the project resulted in collaborative learning and transformation of work practice. In this paper, we explore underlying reasons for such transformation to occur by unpacking how and why boundaries can play a role in computer-supported collaborative teaching and stimulate a transformation towards digitalized teaching practices. The paper contributes with an explanation of how the composition of boundaries of a technological, organizational, and cultural nature operates and constitutes a resource for learning and principles for how boundaries can be used for such purpose.

The qualculative dimension of healthcare data interoperability

Research on interoperability and information exchange between information technology systems touts the use of secondary data for a variety of purposes, including research, management, quality improvement, and accountability. However, many studies have pointed out that this is difficult to achieve in practice. Hence, this article aims to examine the causes for this by reporting an ethnographic study of the data work performed by medical records coders and birth certificate clerks working in a hospital system to uncover the practices of creating administrative data (e.g. secondary data). The article illustrates that clerks and coders use situated qualitative judgments of the accuracy and authority of different primary medical accounts. Coders and clerks also employ their understandings of the importance of different future uses of data as they make crucial decisions about how much discretion to exercise in producing accurate data and how much effort to put toward clarifying problematic medical data. These findings suggest that information technology systems designed for interoperability and secondary data also need to be designed in ways that support the qualculative practices of data workers in order to succeed, including making future uses of data clear to data workers and finding ways to minimize conflicting data before data workers encounter it.