The study follows an ethnographic multi case design examining the contribution of musical encounters in healthcare to experiences of relationship and participation. In addition to studies on music in healthcare that primarily focus on the interaction between musicians and care recipients, this study involves relational and participative processes in the context as well. Method: In three cases in healthcare where different kinds of musical encounters took place, the musical encounters were examined in their organizational contexts by observations and semi-structured interviews. Results: Inductive analysis revealed musical encounters indeed have the power to impact relationship and participation, both within the musical encounter itself and in its context. Nevertheless, the occurrence of positive impact appears to be precarious: precarious in the sense of ‘delicate’ (to be handled with care) within the musical encounters inherent to their artistic nature, and precarious in the sense of ‘being at risk’ (threatened by exclusion) referring to the context. Conclusion: To enhance the power of musical encounters in healthcare to contribute to experiences of relationship and participation, it can be recommended to pay more attention to their precarious nature: facing the threats from the organizational context, and cherishing the ‘delicateness’ of the musical encounters themselve.