Cultivating Psychological Safety in Healthcare: Insights from Naz Havai on the Synergy Tool (#016)
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[00:00:00] We actually looked at predictors. We looked at factors that contribute to nurses, professional turnover, a bunch of them, um, you know, infection control policies or access to, you know, um, PPS and whatnot. And interestingly, among all the factors that we looked at, we actually found that staffing and workload.
[00:00:20] Had the largest impact on on people's, um, professional turnover intents. Welcome to Safe Space Made Simple, a practical podcast that guides clinical leaders and healthcare managers to create trust and support with their teams. I'm your host, Trace Hobson. Join me for weekly interviews, practical tools, and inspiring transformational stories of bringing people together in healthcare.
[00:00:47] Now let's dive in. Hi, everyone. Welcome to another episode of Safe Space Made Simple. I'm incredibly excited to have Naz Havai on the show today. Naz is [00:01:00] an assistant at the UBC School of Nursing and an avid researcher in the area of nursing and has also done extensive research in long term care with the Synergy Tool.
[00:01:12] In today's episode, we go in depth in looking at what NAS is experiencing in the field of nursing as it relates to staffing shortages and psychological health and safety. I enjoyed today's conversation very much, and I know you will too. So without further ado, let's get right into the show. Naz, I want to welcome you here to Safe Space Made Simple.
[00:01:32] Really, really excited to talk to you today. Um, and first of all, it would be great to just understand, you know, what you do, what the work is that you do and how you got into it. Yeah, well, thank you so much for having me. Um, I am an assistant professor at UBC School of Nursing and the other hat that I wear is a health system, health services researcher, um, really how I got interested in, [00:02:00] um, health system and health services research.
[00:02:02] I, I would say that I actually owe it to my. Mentor, my PhD mentor, Dr. who introduced me to the literature in this area. And, you know, the more I read, the more I felt like there was a need for research on, um, I guess, factors, workplace factors and other factors that impact quality and safety of patient care delivery.
[00:02:28] And so I started after doing my. Um, bachelors in nursing at UBC, I, um, started thinking about, you know, graduate studies. I enrolled myself in the master's program. And then that was the place where I sort of fell in love with research and so decided to, you know, you know, I definitely want to do a PhD. And so from there on, I decided to fast track.
[00:02:54] Um, so I didn't quite finish my master's degree. I fast tracked the PhD program. [00:03:00] I took it from there. And here you are. So how do you fall in love with research? Tell me what you love about your work generally, but even that comment you just made, I'd love to hear more about what do you love about your work?
[00:03:13] I think, um, About research, it's, it's, um, the curiosity that goes with, you know, coming up with an important research question, coming up with a hypothesis, delving into the previous literature to see what has been done on that particular topic. And just, I guess, having a curious mind, you know, because I think personally speaking, I, I, I am a curious person in every respect.
[00:03:43] And so I think because of that, um, you know, my interest in research. Um, that's where it comes from. It's it's you need to have a curious mind. You need to have an interest in critical thinking and thinking outside of the box and constantly questioning [00:04:00] and sort of having this need for understanding, um, understanding and, you know, gaining information and making informed data driven evidence based decisions.
[00:04:12] Does that answer your question? Yeah, that's great. In fact, it kind of answers a little bit deeper because I think about the work you're doing right now. And now I'm getting what's been driving it. And some of the work that I noticed that you're doing when I was doing some research for this interview, uh, is incredible.
[00:04:30] So if, if you could tell us a little bit, what is hope lab and what is the long term care synergy project that you're working on? Yeah, so when I actually started my position at UBC school of nursing as an assistant off, um, like, after doing what I'm supposed to be doing as a faculty person after a couple of years, I actually established a research lab called the UBC.
[00:04:57] Hope lab, let me see if I can get the acronym [00:05:00] right. Healthy outcomes through improving patient and provider experiences. That's what the acronym stands for. So, really, in the hope lab, just in line with what I said earlier, in terms of my interests, being studying and addressing those factors that enable care providers, nursing providers in particular to deliver quality and safe.
[00:05:25] Patient care, I established this lab with that exact purpose and vision and mission. And so, you know, most of my research prior to the pandemic was within the acute care sector, a hospital settings. Um, but, you know, when the pandemic happened with everything that went wrong. In in the long term care sector, there was there was a need for for us and our research team to pivot from acute care to to the sector.
[00:05:53] And so I got very lucky and I was, you know, I received multiple research grants, um, and [00:06:00] was able to actually, you know, start studying the sector, understanding the pandemic management strategies that were being implemented. What were the barriers facilitators? How are they impacting providers and and residents and their family members that these pandemic policies that they have any unintended consequences?
[00:06:21] For this population of residents and family members and also a staff member. So, as we were doing some of these research studies, um, you know, I was, I was faced with, as we always do in, in healthcare, um, this issue of, you know, workload management and staffing and whether or not the way we staff, um, in this sector is appropriate, etc.
[00:06:46] Evidence based data driven, and, um, you know, the answer that we came up with my team and myself was that we're actually using very arbitrary standards. Nobody knows [00:07:00] where the HPRD hours per resident, the recommended HPRD is coming from. Specifically looked into the literature, and I wasn't able to locate anything beside a study, um, from the United States.
[00:07:14] That's probably about a decade or 2 decades old. So, because of some of the work that I had done in acute care and through my mentor, I was introduced. To this, um, patient needs assessment tool called the synergy tool, which is a really holistic, I guess, approach to, um, understanding, not just understanding, but also quantifying, um, patient needs.
[00:07:42] So, we actually, because of that gap in the way that we staff in long term care, we actually decided to, you know, sort of bring in and adapt our synergy tool from acute care to the long term care sector to [00:08:00] understand really the needs of the resident population in this sector and also to quantify it and then to use that information to understand.
[00:08:09] From the Synergy tool to inform our staffing decisions. Um, Now, before we go on to what you found, let's just double click a little bit on what the differences are operationally between sort of the model that existed before you started to implement the Synergy tool. And the synergy tool and what the differences are.
[00:08:32] So, you know, what I heard you say is that you found that there was really arbitrary information driving decisions about how to do patient care. And so I'm curious, what did you discover that were sort of, you know, aside from evidence based reasons, what was driving that those decisions operationally? Do you think the decision for the recommended HPR?
[00:08:54] Do you mean correct? Yeah. Uh, I mean, I'm going to take a wide [00:09:00] guess here. Um, perhaps availability of resources, right? Cause that always happens. I'm sensing a little sarcasm there, Naz. Oh, I'm, I'm trying to be very respectful. No, no, it's true, but it's, but it's like the huge, that is the, the million dollar.
[00:09:20] Challenge for everybody and the one that comes up over and over again. So, so availability of resources is driving that decision. So that makes me feel like maybe it was more of a reactive process rather than like you're talking about an evidence based process, right? Okay. So, and how was the synergy tool?
[00:09:41] Like when you look at that holistic approach, um, if I was using the synergy tool on the ground or on the floor. What would be different about that approach compared to the old approach? I think the, um, standard approach that we're using right [00:10:00] now is not, is not very systematic and it's not, um, it's not systematic and it's not, um, quantifiable, right?
[00:10:11] Because, you know, nurses go in, do their assessment, um, complete their documentation and, and go through the entire care delivery process without having an understanding. At least in objective terms and in quantifiable terms of their patient needs. Um, so what the synergy tool actually does is, is it looks at 8 patient characteristics.
[00:10:38] 5 of them are acuity characteristics. 3 of them are, they get into the patient's level of dependency, their ability to participate in activities of daily living, their ability to. Make decisions on their own, their resources, availability and so on and so forth. And so. [00:11:00] And then, so what you do with these 8 characteristics is that you go in and after doing your, your patient assessment, you actually based on a series of indicators that we actually identify together with subject matter experts, meaning our, our nurses and other care providers, they determine whether or not that particular patient or resident.
[00:11:24] Um, and then the other thing that we're looking at is high needs, moderate needs or low needs in relation to that specific patient characteristics, so they have a number to work with. Um, and so they, they can essentially use the number to, um, maybe talk to their nurse, nursing leader or manager to say, Hey, this is really my workload.
[00:11:45] This is really, um, increasing. It's rising. I need some help. Or can you think of a way to reject the patient assignment or, you know, get, get creative and, and you essentially use the information the patient needs [00:12:00] scores from the synergy to, to inform Form their decisions, you know, and the decision staffing decisions could be in relation to patient assignment.
[00:12:08] It could be related to maybe bringing in the float person, maybe calling in a workload, um, uh, staff to come in and help the unit because just the unit workload on that particular shift is, is really high. So, it gives you a more systematic, the tool essentially gives you a more systematic way. To think about.
[00:12:33] Workload to understand the holistic needs of of your patients think beyond their physical physical needs and think beyond, you know, activities of daily living vital signs, all that think holistically about the person and to measure those needs. So I think it, it just, I guess, gets that, um, patient care delivery from various respects.
[00:12:55] Right. So what did you find in your research? Maybe describe [00:13:00] the, the research projects that you've done with this particular tool and then what were the discoveries? Let me actually pull up the paper because it's been a while. Um, so what we did was we actually got a research grant. 1st of all, from to do this work.
[00:13:19] So, it's really important, important work when your research gets funded. That's a very good sign. It's, it's addressing an important topic. So we actually, um. The purpose of our research, I would, I would say was probably multiple fold. The 1st goal was to adapt the synergy tool for the context of long term care, because prior to that point, and the tool, it was never used in this context was always used in acute care settings, medical, surgical areas, maternity.
[00:13:57] Oncology settings. Actually, we had a [00:14:00] project back in 2018, where we implemented the tool to understand oncology patients needs here in in B. C. So we wanted to, we had to 1st, adapt the tool for, for this context, the sector. And then to implement it to understand the resident needs. And then to evaluate the impact, does it have, does the use of the tool or the implementation of the tool, does it have any impact on, um, our care delivery on staff's ability to more effectively meet the needs of their residents and their patients?
[00:14:44] So. Describe the which, which long term care research studies did you do the and what were the discoveries that you made with using the synergy tool compared to the older [00:15:00] models? Yeah, so, you know, I have to say that 1st of all, we had to deviate a little bit, um, from our research, the research proposal that we had submitted.
[00:15:13] And was funded by CRHR because of resource constraints. And, you know, we were still during the pandemic and, you know, the stressful context of staffing inadequacies, work overload, all that we have to adjust something. So, originally, we wanted to implement the tool in 3. Long term care organizations, meaning all of the units within the organized, the 3 care homes would, um, would, would essentially participate.
[00:15:44] But, um, because of the pandemic and some of these shortcomings that I mentioned. 1 of our partner care homes actually withdrew from the study, so they did not have the means or the resources, but the 2 other. That state [00:16:00] with the research, they wanted us to go with the implementation in only 2 units, 2 of their units, they purposefully selected 2 units that were different enough.
[00:16:15] From 1 another, um, so that we could actually see if our tool would would capture those differences in acuity needs and dependency. So, in total, we had 4 long term care units that participated 2 from 1 care home and another 2 from a different care home. And so, in terms of our findings, I would say, um, we did.
[00:16:40] Um, see a positive impact we implemented the tool. For 6 months, so the care team within that of those those units or the care homes, they implemented the synergy tool. They scored the residents that participated in the study in those units [00:17:00] for a total of 6 months on a weekly basis. So, we had data for 24 weeks and, um, what we found was that the use of the tool resulted in some decrease in resident falls, which, which is a really important thing.
[00:17:20] Although I have to be. Um, very careful with saying that we are 100 percent confidence that the decline in residence halls is because of the tool because of, you know, so many other factors going on. There are always these limitations in research, especially when you're not using the RCT or an experiment approach, but we did see some decline in those units that participated in the project and then qualitatively, um, We found that, you know, the use of the tool actually improved care delivery.
[00:17:58] It resulted in better [00:18:00] communication among the care team and also between the care team and the residents and their family members. And overall, it really helped improve, um, family and staff relationships. Um, I, I remember one of our study participants, um, talked about a family member in particular, talked about how as a result of the tool, since the implementation of the tool, they had seen a positive change in, in the nurse who was giving care to their loved one, they were, you know, more proactive with their communication with the family member, because one of the things that the tool does Is that it really helps providers detect subtle changes in the status of the resident.
[00:18:50] So, um, the, the care provider then took that information to the family member to investigate and explore and, um, you know. [00:19:00] Essentially be a bit more proactive with their care delivery. Okay, that's great. So this is kind of making me think about a conversation we've had previously about how psychological health and safety relates to this, because one of the things that this podcast is attempting to answer is how can we create psychological safety, a safe space in in.
[00:19:24] Settings that are oftentimes really complex and also sometimes even chaotic and then what happens when we do. And so what I hear your research and the synergy tool specifically is that you're using that to create, um, a space with, uh, practitioners and families and care providers. And so I'm just curious, what have you thought about in relationship to psychological health and safety and how that might be showing up as a result of the use of your tool?
[00:19:53] Yeah, we actually, interestingly, um, we, we also [00:20:00] evaluated the impact of the tool on staff, specifically their mental health. I mean, it's not surprising to the most to most of us in the healthcare sector that. You know, rates of burnout are really high among healthcare workers, particularly nurses. Um, I mean, I looked at some research recently that actually showed that the impact of the COVID 19 pandemic on healthcare workers, mental health, it hasn't really that impact hasn't really decreased.
[00:20:34] Throughout the waves of the pandemic, as opposed to, you know, some of the other impacts like exposure to covid or contracting covid and all that because of vaccination and so many other factors, um, mental health, mental health impacts are not really going anywhere. So, we did evaluate the impact of the synergy tool on mental health, and we did see some positive impacts, particularly in relation [00:21:00] to, um, 1 of the burnout indicators, um, I believe, um.
[00:21:08] Personal accomplishment and depersonalization where the 2 burnout elements that we saw some positive changes after the implementation of the synergy tool. And the, the, the way we went about explaining, um, this, this finding or this impact is because the synergy tool actually provides an opportunity for staff to engage in decisions regarding, um, you know, workload management, their care delivery, and all that.
[00:21:39] Those decisions are not made for them without them using this approach, right? Because, you know, they're going to be doing the scoring and they're going to be talking to their nurse manager and leader. To, um, let them know, hey, this is this is my how my patient is doing or my patient load. You know, this is how the scores are [00:22:00] changing compared to yesterday.
[00:22:01] And so it gets them and gives them an opportunity to be involved in decision making, which we know from previous research is a really important contributing factor to. Decreasing and reducing the rates of burnout because what is burnout? Anyways, burnout is essentially a, um, a syndrome of workplace syndrome.
[00:22:22] Um, that essentially, if we were to sort of say it in in lay language, it's it's the result. It results in disengagement. This care worker, an employee to get disengaged from their work, so giving them those opportunities for engagement and being a part of the decision making. I think, um, as we found in our study, actually, it resulted in some positive impact.
[00:22:50] So let me see what, if I answered your question, what was your question again? No, no, you got it. I was curious about how this might be creating a psychologically [00:23:00] healthy and safe space. And you just mentioned, you know, a couple of the psychosocial factors that come right out of the Canadian standard for psychological health and safety.
[00:23:08] So you know, workload management is connected to that as well as, um, involvement, you know, involvement. And the other thing, when you were talking about burnout indicators, I, I think. One thing that I think, um, just from my lay person's perspective, um, on burnout, I'm not, you know, a researcher, but, uh, is that burnout goes up when people are out of alignment with their values and the reason why they got into health care in the first place.
[00:23:34] And so if they're not engaged and involved in the process of care and making decisions in and have having some agency to do that. Then how can they be aligned with the reason why they got into health care in the first place and their own values? Because I noticed that people that get into nursing and and are really on the front line taking care of people They have a huge value for being able to do things.
[00:23:59] They're going to have a [00:24:00] meaningful impact on their patients And so to me, it just makes total sense that that's what you've found I'm so glad you're mentioning the important work of Dr. Christina Maslach, Dr. Michael Leiter, um, and, you know, their whole research was on the importance of consistency and a match between.
[00:24:23] People's values and wishes in the workplace and what they can actually deliver because of, you know, constraints and human resources or financial resources, so on and so forth. Absolutely. Especially I can comment as a registered nurse. I can comment on. Nurses and their desire for delivering, you know.
[00:24:46] Quality and safe patient care, um, really valuing an ability to be able to, you know, um, adhere to the professional standards of practice. And unfortunately, because of some of these shortcomings, [00:25:00] um, in the workplace, um. Sometimes we do have to cut corners and that comes with implications and consequences for that particular provider.
[00:25:09] It causes moral distress and it causes, you know, burnout. And then from there on, we know that burnout is essentially associated with people. Calling in more calling in sick more frequently, or maybe even leaving thinking about leaving their jobs or even actually leaving their jobs or the profession. So, um, I mean, which is, which is, is the researcher who's looking at this at such a granular.
[00:25:36] Level and evidence based level. As you hear the stats coming from the government of Canada saying that nurses are leaving the profession like never before. And that I can't remember the stat, what the percentage of nurses looking at leaving over the next three ish years is, but it's, it's very high. Do you remember that stat?
[00:25:54] I can't remember what it was, but it's, it's incredibly high B and it's because of this. I [00:26:00] cannot remember that stat, but we actually recently published a paper on professional turnover of nurses, and I wish I could actually pull up the paper and give you the statistics that we found because, um, I think it was if I'm not mistaken, if my memory is not failing me.
[00:26:18] I think it might have been maybe 25 percent 20 to 25 percent of nurses are thinking about leaving the profession within the next year, year or two years. I mean, it's do you sense? I mean, I'm making a bit of a leap in terms of what the cause of that is. I'm sure there are other factors too, but the ones that you've mentioned have got to be.
[00:26:42] You know, at the, in that root cluster, you know, actually, in our turnover paper, professional turnover paper, and I mean, if people want to look at it, the paper is actually published, so it is available online and it's open access. Um, we actually looked at predictors. [00:27:00] We looked at factors that contribute to nurses, professional turnover.
[00:27:05] A bunch of them, um, you know, infection control policies or access to, you know, um, PPEs and whatnot. And interestingly, among all the factors that we looked at, we actually found that staffing and workload. Had the largest impact on on people's, um, professional turnover intent, and usually what happens because we did look at a bunch of, I guess, mediators because we were interested in the mechanism through which this relationship happened.
[00:27:39] What we found was that, um, workload. And staffing inadequacies, they result in mental health challenges. And then from there on, people actually start thinking about leaving the profession. Okay, so we'll, we'll link that up in the show notes for this, this episode. So, so. [00:28:00] Back to the Synergy Tool. So, so of course now the Synergy Tool is being rolled out everywhere in Canada.
[00:28:06] It's being implemented in all long term care homes. It's being used because it's, it's such a great way. So that's what's happening now, right? It's not the synergy tool is I wish, I wish we were, I wish we were there, but we're not. See, now that's sarcasm, Naz. That was some sarcasm. But you just said it with such a straight face that it was hard to know.
[00:28:32] So why aren't people, if this is a good, what did you find about the cost of implementation and the cost of delivering through the synergy tool or evaluating through the synergy tool compared to old models? And if it's not, if it's, you know, if it's not a cost prohibitive thing, then why isn't it being more widely used?
[00:28:53] That's it. That's a very good question. Cause in our study, the one in longterm care, we actually did [00:29:00] an economic evaluation of the tool, and we actually found that. The tool, the use of the tool actually resulted in some cost saving for for the care homes. And this was something that was never looked at before.
[00:29:17] I mean, to be very honest, I don't know. I don't know why the uptake of the tool has been so slow, but, um, from a researcher perspective, we are certainly pushing for the use of the synergy tool. And, you know, I'm actually working, um. With a number of colleagues in, um, the University of Toronto Metropolitan University, and we have essentially put in an application where we're essentially proposing to use the synergy tool.
[00:29:53] Resident needs from the synergy tool and combine it with simulation modeling [00:30:00] approaches to. Gain not only gain an understanding of, um, patient needs, resident needs, but also use that information to more objectively make decisions regarding staffing. That application is currently on the review. Um, so we don't know if it's.
[00:30:20] We're going to be receiving funding or not, but we certainly like our goal is to continue to try to push for the tool because, as I said earlier, really, the tool helps us gain an understanding of the patient needs using a systematic. Quantifiable approach something that is currently. Missing in our, in our care delivery approaches.
[00:30:46] I mean, there are other ways that we're quantifying patient needs with at least within long term care, the CMI or case mix index. But the problem with some of those other ways of quantifying is [00:31:00] that they're not used frequently as frequently as far as I know, something like the CMI. Is is only being used on newly admitted patients and it's done only quarterly as opposed to something like the synergy tool that can be implemented.
[00:31:17] You know, it really depends on how frequently you want to implement it because our research actually show that the use of the tool. Does not take more than 1 minute when units are 1st introduced to the tool. It's probably more in the lines of like, 1 minute per patient per resident. And then after care providers get familiar with the, um, the tool and the indicators, it sort of the length of the use of the tool reduces to 30 seconds per patient.
[00:31:46] I mean. That's that to me is a very reasonable, so there must be a team approach here. I'm just thinking about the whole clinical leadership team supporting the front line or point of care [00:32:00] nursing team. So, you're at the bad side with the synergy tool, but I'm assuming that it also must be used in the background for patient care coordinators, clinical nurse educators must be involved in some way like it's, it's.
[00:32:13] Being used systemically, or how is it being used by the clinical leaders as well? So, um. In our research project, we actually, um, the 1 in long term care, there are various approaches to how units or departments or care teams decide to actually use and implement the tool. In our long term care project, we actually started with the training workshop for the adaptation purpose of the synergy tool and our training workshop had subject matter experts.
[00:32:48] Were multidisciplinary, we had, you know, personal support workers or care aids, RNs, LPNs, um, we even had Allied Health involved because some of those synergy tool, uh, [00:33:00] characteristics, they require multidisciplinary, um, care team involvement. Right? And, um, they, they were involved in the adaptation process and identifying indicators.
[00:33:12] And we actually also had. A family representative resident representative, who were a part of the discussion at the training workshop, because, I mean, you don't want to be doing things that are important to residents and their families without their voices being included in the decision process. And so the, this was a training workshop.
[00:33:35] After the training workshop, in terms of the actual use of the synergy tool and scoring residents, um, again, because of some of these issues that we have been dealing with in long term care and, you know, specifically heightened during the pandemic. We actually had to go with a select team of scorers, which to me is not an [00:34:00] ideal approach for scoring residents.
[00:34:03] But this was what we could do at that time, given the shortages and the vacancies that care homes were dealing with. So we had a team of scorers. Mostly registered nurses and licensed practical nurses that would talk to the providers about their residents and then based on the conversations and discussions with individual providers.
[00:34:29] They would go in and do the scoring for that resident in hindsight. Um, again, I, I would do this differently if if I were to repeat this research or replicate this research and, you know. Based on some of the other implementations of the synergy tool in other sectors that we've done, we usually get the individual provider.
[00:34:53] To do the scoring for their assigned patients, rather than working with the team and then in terms of how [00:35:00] the scores are used, I mean, again, it really depends on some of those conversations and discussions that the providers have with their. Management team leadership team and decide together. You know, how do we want to use the scores?
[00:35:15] Are we using it mainly for the purpose of creating patient assignments? Or are we using it for maybe requesting additional staff? Maybe the unit? Needs a full time RN to be added to their, um, human resources. So in one of our projects, um, in, um, surgical areas in one acute care hospital here in B. C. We actually use the synergy scores.
[00:35:46] It's not it's not obvious. It's not a long term care setting, but again, acute care setting. We actually use the synergy scores obtained from their surgical units. To come up with staffing recommendations and [00:36:00] scale makes recommendations. I'm again, happy to share that paper if people are interested, but, you know.
[00:36:07] The synergy tools essentially suggested for some of the units, you need an extra RN for the patient, or maybe 2 RNs for the night shift and maybe an LPN for this other unit, right? After the synergy scores. Are collected, we typically bring those subject matter experts together again and use the patient profiles, the synergy scores.
[00:36:31] To come up staffing recommendations, what is the staffing level and the type of skill mix required. To more appropriately and effectively meet your patient needs, given this understanding, um, based on the Synergy Score. So then you're right sizing your team. It also makes me a bit curious about whether or not you noticed any effect on discharge planning too, on the patient side.
[00:36:59] Was there [00:37:00] any sort of, um, Throughput that helped discharge planning to accelerate or to have people leave hospital, um, in a more accelerated way at an appropriate time differently than the old system to that's a very good question. That's actually something that we haven't done yet. Um, and it's certainly in our long list of to do's with respect to the synergy tool.
[00:37:28] Um, we haven't done that, but I think the reason we haven't been able to do that yet is because, um, most of the time, the implementation of the synergy tool has not been long enough to be able to essentially capture that impact. I mean, within long term care, completely a different environment, different context, but within acute care, um.
[00:37:52] We do need to implement the tool for a longer duration of time, like six months or one year to be able to essentially [00:38:00] capture that impact. So, in British Columbia, seeing as that's where you've done your research for the most part here, I'm curious whether in either acute or long term care, did the Synergy tool get picked up as a, as an adopted way to move forward or did it fall by the wayside?
[00:38:19] It hasn't always fallen by the wayside. I mean, um, with the, uh, surgical services research that I mentioned earlier, we actually have been contacted to sort of pick up the project and reintroduce the synergy tool. I actually did have a conversation yesterday with someone in our long term care partners from the long term care study, and they also want to sort of pick up the implementation.
[00:38:46] What's driving that? Why do they want to pick it up again? I think it likely is because of some of the positive impacts that they may have noticed as a result of the implementation of it. Right? I mean, [00:39:00] if if the tool gives you an opportunity to be more objective, more purposeful with your care delivery with your workload management.
[00:39:10] I mean. You're essentially enabling your staff as a leader as a manager, you're giving them a tool to be able to make more informed decisions along along their care delivery process. Um, 1 of the other really good things about about the synergy tool beyond workload management and understanding patient needs is, I think it's a very good way of educating your new hires.
[00:39:39] Your newly graduated nurses, because it's essentially highlights to them those indicators that they should be concerned about. If your patient has these indicators, these characteristics. This is, this is important. You need to elevate the level of care. You need to go to [00:40:00] your senior staff person, get consultation, maybe involve a multidisciplinary care team, call the physician, so on and so forth.
[00:40:08] So, 1 of our findings actually from the long term care study was the potential impact of the tool on, um, like, educating, educating new care providers, new grads. That must also provide some relief for those that are senior as well, because even though they still One of the things I get from new grads hitting the floor and coming out of nursing programs when I talk to them is that it can be really difficult to ask questions, just to have a psychologically safe space where they feel like it's okay to engage and to ask questions.
[00:40:46] What you're describing gives them some framework, maybe a little bit more sort of things to grab onto to feel a little more confident, um, and also to maybe facilitate more [00:41:00] relationship and conversations between them and obviously the patient or the patient's families, but also their colleagues who may not always feel like they've got a lot of time to devote to them.
[00:41:12] Absolutely. I, you know, if. You actually look at our paper, we include a copy of the tool, the synergy tool that we developed for long term care as part of our supplementary material. And what's really interesting is that it's, it's a 1 pager document and it has all of those important indicators that would suggest to someone, you know, that your patient is not well.
[00:41:37] That you need to elevate your care. You need to take this up, talk to someone more experienced and, you know, maybe change the care plan. Um, so it's a really good educational tool and yes, absolutely. It creates that environment for new grads, for new hires to know it's okay. It's okay to take this to someone, go [00:42:00] to someone more experienced and say, This is what I'm seeing.
[00:42:04] This is what the tool shows. My patient is having these, these indicators that are essentially suggestive of, you know, high needs. What do I do? Yeah, it gives you a bit of a buffer. You have a little bit of, it's not about you. It's about this, right? So you can have that conversation. And it's a one pager.
[00:42:22] It's, it's very practical. It's not like, you know, a book or, or. A manual that's long and not very accessible. It's a 1 pager and it's a document that is very accessible because at the end of the day, it was developed by or it is developed by subject matter experts. That are from within that unit and really the patient population.
[00:42:48] That's amazing. That's that's so how long does it take to implement this program in, uh, say one unit in a long term care facility? Um, what could [00:43:00] a manager or leader expect to take in terms of time to use this new approach? Yeah, so, as I said before, the actual scoring is very quick to do. It takes somewhere between 30 seconds to 1 minute.
[00:43:15] You know, when people get comfortable with the tool, it's more in the line of 30 seconds in the beginning, maybe around 1 minute per patient. The actual program, it, it really depends on how long, um, units and departments. Actually want to and have the resources to implement the synergy synergy tool with their patients.
[00:43:40] I've seen a variation. I've done a variation. I've been in projects where the synergy tool was implemented on a daily basis for 2 months. I've been involved in projects where they have done the implementation for. I don't know. 6 months on a weekly basis, my overall [00:44:00] recommendation would be that the longer and the more frequent that the synergy tool is used, the more robust and trustworthy the data in terms of the training workshop.
[00:44:13] It usually takes 2 full days. I mean, in long term care, we did it about a year and a sorry a day and a half. And the reason being is that we actually had an opportunity for a pilot before the start of the research project. So we had the backbone of a tool before. The actual CI project got started, so we were able to sort of shorten shorten the time frame of the training workshop to a day and a half, but typically around 2 days is what we recommend.
[00:44:44] And then after the data collection period, it usually takes our team probably somewhere in the realm of. 1 to 2 months to analyze analyze the data and create those patient profiles based on the synergy scores. And then [00:45:00] if. Units and departments are actually interested in, um, informing their staffing decisions, staffing models based on the patient profiles.
[00:45:10] There needs to be a 1 day, typically a 1 day, um. Training or discussion or workshop where again, you bring subject matter experts together, look at the patient profiles, and maybe you want to even have your. HR director involved that, you know, have them be a part of the discussion and then decide together what our staffing amazing, excuse me.
[00:45:38] That's amazing as so we're going to start wrapping up before we wrap up. I'd love to hear what you're seeing in your. Engagement with, uh, nursing students, because obviously you're teaching nursing students all the time, they're, they're in your class, and then they're, you know, coming out, what are you [00:46:00] learning?
[00:46:00] What are you noticing that you think is important for people to know, especially, uh, leaders and managers? In relation to the synergy tool or generally speaking, well, I mean, just whatever comes to mind that you feel like is important that as a, as a professor, you're noticing and engaging with those students.
[00:46:22] Yeah, very, very good question. I mean, there's a long list of recommendations that I could share, but, um, I would suggest that. Um, you know, take mental health and psychological health and safety seriously vendors, leaders and nurse managers. If you see those. Early signs or warning signs in, in your staff person, take it seriously.
[00:46:48] It has serious implications. Burnout has serious implications. Um, exhaustion has serious implications for not just for patient care delivery, but for the [00:47:00] organization, for the unit and for our workforce, um, generally speaking. So are you, are you finding that nursing students are concerned about that? Are they talking about this?
[00:47:10] Oh, absolutely. Absolutely. I mean, I don't teach in our in the undergraduate program anymore, but when I did. Our undergraduate students, I would say there was almost a sense of surprise and shock when they would go to clinical rotation. They're like, wow, like, this is this is very different from what I, what I anticipated or what I was sort of thinking.
[00:47:36] I would see it's it's tough and it takes a lot of resilience and a lot of self care to be able to survive and survive. Wow. What about the master's students? What are they talking about? Master's students, um, I would say they're mostly issues that are of concern to them. [00:48:00] Not very different from undergraduate students, although that sense of shock is not there anymore because they've done it for a few years by the time they get to me.
[00:48:09] But, um. Again, concerns about staffing concerns about workload, but what I find with masters students, because, you know, I'm privileged because I actually teach a leadership courses is learning from them. What a big difference their relationship. With the leader with their manager with their supervisor, actually.
[00:48:32] What a big difference that makes on their ability to be able to survive well. In a complex environment, so invest my recommendation for my second recommendation for, um, nurse leaders and managers out there would be invest in your relationship with your staff. It's going to pay off. This is so important what you're sharing.
[00:48:54] Now. You're kind of singing from my song sheet a little bit because 1 of the things that I notice in my work is that there's a [00:49:00] clear disparity between. Managers and leaders who create that relational equity as a foundation for their operation compared to managers and leaders who are just trying to get tasks done.
[00:49:12] And it's so, you know, in fairness to those that are really driven by that sort of task management perspective, oftentimes those managers and leaders are dealing with their own anxiety or their own sort of angst about getting things done. And there's a transition there and to leave sort of hierarchical approaches or command and control approaches and do something that's more relationally based.
[00:49:39] But how am I going to get everything done is kind of the first objection that I hear all the time, but I was just thinking about an interpersonal or interprofessional paper. I read transforming team culture, a case study in critical care, and I'll post that in the in the show notes, too. But it talks about doctors, nurses and coming together to do care.
[00:49:59] And [00:50:00] how relationship with the foundation of the operational efficiencies and what actually happened was that people got to know each other in a different way, they psychologically felt psychologically safe, and they talked about what they really needed and wanted, and that became the grease on the wheels, so to speak, for what happened afterwards.
[00:50:21] And the studies clearly saying, um, This is what we need to focus on. And so it makes me curious as you're teaching leadership to master's nursing students, um, and you hear what I just shared and you, and you think about sort of that relationship being the foundation, what are some things that you could share with managers and leaders that are really struggling to do that?
[00:50:43] It's not that they're not capable. It's maybe that they've been doing it a certain way, a long time, and so now they're being asked to do something different. Um, I know for myself, I had to make that transition and what I felt like at that time was afraid. I'm afraid I'm not going to get everything [00:51:00] done if I do a different approach like this, um, you know, and embed myself on the unit with my staff and my team, man, how am I going to get everything else?
[00:51:11] I've got to get done all the emails, all the things. And now I know now on the other side of it, what happens is, is that you actually do get things done in a much different way, but I'm curious, what would you tell those folks that are struggling with that sort of internal angst? Yeah, I, I think that's a very good question because I'd like to first start by saying.
[00:51:35] And acknowledging that, yes, as a leader, as a manager, you obviously have commitments to your organization. You have timelines, you have, you know, budgets, you need deliverables. I mean, that's certainly very important as part of your commitment to the organization, but it's not enough. It's you need more than that to be able to [00:52:00] actually, um, I guess, um, deliver your commitments to the organizations because we know when those, um, staff.
[00:52:11] Managerial relationships when they're absent that eventually at the end of the day, it's the organization that's going to suffer. You know, those people are at a higher risk of burnout. They're at a higher risk of leaving the organization and more likely to call and say so. It goes a long way to invest in your relationships with your staff, and it doesn't have to, it doesn't always take that long to be very honest.
[00:52:41] I agree with you, Trace, and that I think it's the issue might be other than workload, you know, lack of time resources because that's always always a problem. Is us getting into a habit of doing things a certain way, but it doesn't [00:53:00] have to be that way. Right? It doesn't take it doesn't need to take a very long time.
[00:53:04] It could be simple things is like, maybe getting just spending a few minutes to get to know your individual staff person, right? Maybe in some of the discussions or team meetings that you have. It doesn't always have to be in services. Maybe spend it, spend the time to get to know each other personally and learn about each other's values and life story to essentially try to build and create those relationships.
[00:53:37] Don't be afraid to acknowledge good work and say, thank you, right, personally, um, you know, have an open door policy, um, create opportunities for, for your staff person to be involved in, in the decisions that you make, um, and, and not just get their inputs and feedback and do nothing with it. Actually. [00:54:00] You know, you use the information, use the feedback to inform the decisions that you make.
[00:54:06] And if there are situations where the feedback cannot be incorporated or integrated into the decision, be transparent about it. You know, um, keep, keep your staff, keep your employees in the loop regarding the decisions that you make, the rationale behind them, and essentially all of this with, with an eye to.
[00:54:30] Make the staff person feel like they're involved, that they're important to you, that they're making a big difference. Yeah, thank you so much for that. And as I, I really appreciate the work you've done with the synergy tool as well, because I think that anything we can do that takes operational processes and incorporates that safe space of relationship as well, so that we're engaged and everybody's contributing, um, has [00:55:00] such a powerful effect.
[00:55:01] So I really am holding the intention with you that that is And a way of working that will become prevalent in Canadian health care. So thank you for your work and thank you so much for being here. I could just keep talking to you for another hour, but I think we better wrap it up now. So how can people get in touch with you?
[00:55:19] Um, my contact information is available online. If you search for my name, uh, UBC school of nursing, it usually shows up. Um, and I'm happy to hear from anybody who might be interested in Synergy Tool or any other work that I've done. Around quality safety or health system research. So awesome. Thank you.
[00:55:39] Thank you again for being here. And as it was great to talk to you. Excellent. Thank you so much for having me. Thank you so much for listening to the show. And if you have any comments or questions, please reach out to me on LinkedIn. I look forward to seeing you next time, either online or in one of our programs.
[00:55:55] And until then, remember to be a safe space. [00:56:00] Thank you again for getting to the end of this podcast. And if you enjoyed this and you found that there was value in it for you, my invitation is for you to subscribe for future episodes that come out weekly on Tuesdays. Thank you again, and I'm looking forward to being with you next time.
[00:56:17] Now remember to be a safe space.
