Workload management through understanding and addressing resident needs in long term care: A study to adapt, validate, implement and evaluate the Synergy Model

COVID-19 has exacerbated work overload in a female dominant and racialized sector, long term care (LTC). Heavy workloads are attributed to persistent workforce challenges in LTC, such as inadequate staffing. Ineffective workload management is costly for the health and safety of LTC staff (e.g. burnout), residents (e.g. missed care), family caregivers (e.g. anxiety) and the organization (e.g. turnover). LTC staffing decisions are based on arbitrary guidelines (e.g. 4.1 hours per resident per day) instead of resident needs. This study will adapt, validate, implement and evaluate a real-time assessment tool based on residents' acuity and dependency needs. Resident assessment scores will be used to make evidence-informed staffing assignments and workload decisions. A steering committee of key stakeholders, including residents and family members, will be established at the start of the study to inform the direction of the research. The Synergy Model consists of a validated assessment tool, the synergy tool, which can be adapted to different healthcare sectors. The tool measures eight characteristics: five acuity characteristics (e.g., complexity, stability, vulnerability) and three dependency characteristics (e.g., participation in activities of daily living). Acuity and dependency scores for individual patients are used to optimize staffing decisions (i.e., what team member (s) should provide care for residents based on their synergy scores?). Extensive use of the synergy tool in acute care settings has been linked to positive outcomes for patients, staff and organizations. The tool has never been used in LTC. In this study, we will adapt the tool for LTC residents and use it in three LTC partner homes. We will use surveys and administrative data and focus groups from multiple sources (i.e., residents, families, staff, organization) to evaluate tool use impact on workload management and resident care, and we will identify implementation facilitators and barriers.