Visualizing the Perception of Legislative and Procedural Changes on Long-Term Care Homes in Ontario - Exploring the impacts of the COVID-19 Pandemic through the lens of LTC Employees
TimeThursday, April 152:00pm - 3:00pm EDT
The COVID-19 pandemic has changed a lot about how we view 'work design' within healthcare facilities. In Canada, this is particularly true for long-term care (LTC) homes (McGilton et al., 2020). Similar changes have also taken place in the United States to reduce mortality among nursing homes (Centers for Medicare & Medicaid Services, 2020). This research focuses on understanding how changes to work processes, procedures and legislation during the pandemic have affected long-term care workers, specifically those affected by legislation limiting long-term care employees to a single worksite (Government of Ontario, 2020). In terms of human factors/ergonomics (HF/E), this work focuses on the physical, cognitive, and emotional impacts of working in a rapidly changing workplace, which poses a high risk of infection for residents, staff, and families. The study collects broad data through a widely distributed survey, with depth coming through interviews that focus on creating a non-fiction narrative cooperatively with participants. This breadth and depth approach has seen use in healthcare settings and is considered an effective means of qualitative inquiry (Todres and Galvin, 2005). Constructs under investigation include worker perception of their compensation, perception of infection prevention and control (IPAC) measures, and the pandemic's emotional toll. In emphasizing the lived experience of workers within LTC, we aim to develop rich visualizations of the data we collect. These visualizations, combined with a narrative of this experience, aim to bring attention to this work sector while supporting evidence-based recommendations to rethink 'job design' within LTC.
Within the context of the COVID-19 global pandemic, health service environments both within and outside the hospital setting have become increasingly important from an HF/E and design perspective. The human-factors risks highlighted before the COVID-19 pandemic (Katz, Jane, & Ayes, 2019) are now in tragic focus. The risk for individuals living in long-term care homes experiencing outbreaks demonstrates the importance of examining HF/E considerations in these contexts. Our research focuses on long-term care workers in Ontario, Canada, with plans to expand this study to other provinces.
LTC employees in Ontario include personal support workers, registered nursing staff, allied health professionals (such as activity assistants, dietitians, and social workers), physicians, administrators, and facility support staff (Ontario Ministry of Long Term Care Long-Term Care Staffing Study Advisory Group, 2020).
An HF/E analysis of the working conditions within LTC homes was driven by curiosity regarding the impacts of work-related legislation and increased infection prevention and control (IPAC) protocols. A significant legislative change was the introduction of the Ontario Regulation 146/20: Limiting work to a Single Long-Term Care Home. This piece of legislation, colloquially known as the 'single site work order' (SSWO), outlined new rules for employees working in long-term care homes (Government of Ontario, 2020):
Beginning at 12:01 a.m. on Wednesday, April 22, 2020, an employee of a long-term care provider who performs work in a long-term care home operated or maintained by the long-term care provider shall not also perform work,
(a) in another long-term care home operated or maintained by the long-term care provider;
(b) as an employee of any other health service provider; or
(c) as an employee of a retirement home.
Our research focuses on understanding how this legislation and increased IPAC protocols have impacted LTC employees.
Analyzing the impact of changes to work design through healthcare employees' lens will provide insights into the lived experience of LTC employees. The research methodology emerged through an interdisciplinary approach to understanding complex situations. In this case, expertise in health services and epidemiology; design and human-factors principles; and journalistic interviewing, data visualization and narrative techniques are being explored to create a holistic approach to understanding and communicating lived experience.
To gather this information, we are deploying two data collection tools. The first is a province-wide survey targeted to LTC workers (n=300). The second tool is a narrative-based series of qualitative interviews where we will be asking LTC workers to discuss their daily experiences during the pandemic and how their work experience changed upon the introduction of the SSWO. These two techniques aim to support a 'depth with breadth' (Todres and Galvin, 2005) approach to knowledge gathering.
The survey touches upon five constructs of lived work experience that we anticipate have been affected by the COVID-19 pandemic:
1. Job Roles in the LTC System - We anticipate that different healthcare professions within LTC have been impacted differently by the SSWO and ensuing changes to their working tasks and roles within LTC. Questions probing at this construct provide participants with a closed list of LTC roles to select while allowing open-ended text responses to expand upon their roles and responsibilities.
2. Changing Financial Situation - We expect that the financial repercussions of the SSWO may have disproportionately impacted healthcare professionals who were working in multiple healthcare settings before COVID-19. Participants may share their monthly earnings in the time before and after the SSWO in an open-ended manner, with a set of closed 5-rank scales to measure their perception of compensation and financial health.
3. LTC Employment Motivation - Participants affected by the SSWO will have made a conscious decision to stay in their current LTC position. It may be worth trying to understand why. Probing this construct is done with a series of closed motivation categories (financial, professional, personal) with space for participants to share their longer form motivations.
4. Navigating COVID-19 IPAC - New IPAC measures were often rapidly changing at the beginning of the pandemic and in the early months and continue to evolve as we learn more. This construct aims to examine cognitive considerations around comprehension, learning, and memory or recall and leverage the knowledge of those who were dealing with these fluid situations daily to share their experiences.
5. Emotional Impact of COVID-19 - Developing a holistic picture of the lived experience requires understanding day-to-day physical and psychosocial considerations such as an LTC employee's emotional experience during the pandemic. To measure this construct, participants will indicate if they have been experiencing more or fewer groupings of moods, such as 'Tense, uneasy or worried' and 'Calm, contented or relaxed.' Descriptive and thematic coding of open-ended questions will also provide further insight into the emotional impact of working in LTC.
These five constructs and subsequent survey questions were developed and piloted through conversations with a personal support worker and registered nursing professional actively working in Ontario's LTC system.
The second stage of the study involves semi-structured interviews where we are recruiting respondents from the survey. The interview questions will provide some structure to the conversations. The participants' qualitative responses will allow for the generation of first-hand narratives of the COVID-19 experience for LTC workers.
The research team will analyze closed and numeric survey responses through the Tableau data-visualization software. Coding for open-ended questions will occur in descriptive and thematic stages on the Invivo qualitative platform. An essential aspect of this research is the emphasis on the communication of data with non-academic audiences. The team will be exploring various data-visualization techniques inspired by journalism to support this emphasis.
Sharing the narratives and findings with participants before their publication and dissemination will help validate synthesized data. The intention behind developing first-hand narratives from those working in the LTC system is to pair evidence-based findings with calls to action based on lived experience.
The results of this study will be received and partially analyzed in time for the conference proceedings. Partial references are given in this proposal due to limitations with word count. A full list of references will be provided in the presentation and conference paper.