Supporting Health Care Resilience Through "Reflexive Spaces" in Home Care Services: A Multiple Embedded Case Study.

Objectives: The aim of this study was to explore where and how managers facilitate arenas for collective reflections and knowledge sharing ("reflexive spaces") in homecare services during the COVID-19 pandemic. Moreover, we sought to understand how these "reflexive spaces" contributed to adaptations to challenges induced by the pandemic. Finally, we aimed to discuss how these spaces might incorporate resilience into health care.

Methods: This multiple embedded case study includes interviews with health care staff (n=16) and managers at different system levels (n=21) from 4 Norwegian municipalities. The data were analyzed in accordance with reflexive thematic analysis.

Findings: The analysis identified 2 overarching themes: (1) arenas for reflection, communication, and dialogue, and (2) establishing new solutions through collective reflection facilitated by managers. Managers who initiated dialogue and established arenas for reflection and communication were highlighted as important for discussing and sharing knowledge about challenges created by the pandemic. In these spaces, both managers and staff reflected, collaborated, and learned from each other and then designed a tactical and resilient response to the ongoing challenges.

Conclusions: Managers had a key role as facilitators for "reflexive spaces" within and across levels of responsibilities. Moreover, managers had a mediating role in bridging knowledge and understanding across levels within the health care system. Using "reflexive spaces" as part of daily practice appeared as an important measure to balance demands and capacity and respond both to crises and to everyday challenges.