Exploring Evolving Models of Care During the COVID19 Pandemic

Globally alternative models of care have become essential to increase HHR capacity in both acute and critical care settings amid the COVID19 pandemic crisis. Although deploying alternative models of care (e.g. team based models of care where flexible teams practice differently from their traditional scope) were initially planned as a temporary solution to ensure the safe patient care, this approach may need to be used to manage future crises (e.g. impending nursing shortages). To date, no empirical literature on the impact of alternative models of care during COVID19 were found. Given the ongoing need to develop and adapt models of care to ensure the provision of safe care, addressing this gap is paramount. In this context, an embedded case design using a realist evaluation guided by REAIM and the Consolidated Framework for Implementation Research is proposed to capture models of care employed in acute care hospitals including experiences, contextual factors, measures, and lessons learned during implementation. A purposeful sampling strategy will be used to recruit participants (up to 20 per site) from regional, organizational, team, and health care providers from 4 teaching hospitals and 2 community hospitals. Data will be collected through interviews and document analyses with both deductive and inductive analyses. A comprehensive case study database will be created and undergo cross syntheses, in addition to other methodological rigor strategies. An integrated knowledge translation plan with collaborators and knowledge users will be employed. Our proposed research study aligns with CIHR's research areas of understanding the impact of COVID19 pandemic on workforce safety concerns; healthcare workforce concerns; and burnouts, resilience, and health behaviours. Study findings may inform other hospitals in their efforts to optimize safe and quality HHR and care delivery regionally, across Canada, and beyond amid COVID19 pandemic and pandemic recovery.