Background: Evidence-based clinical care delivery begins with comprehensive assessments of patients' priority needs. A Canadian health sciences corporation conducted a quality improvement initiative to enhance clinical care delivery, beginning with one acute care site. A real-time staffing tool, the synergy tool, was used by direct care providers and leadership to design and implement patient-centered care delivery. The synergy tool is the patient characteristics component of the Synergy Model™, developed by an expert panel of nurses in the 1990s. Since then, the tool has been effectively used to assess a variety of patient populations on eight important characteristics, informing real-time staffing decisions. Methods: Plan-Do-Study Act cycles were managed by department-based project teams with assistance from business analytics and a quality/safety officer. Results: Initial findings demonstrate reductions in nurse missed breaks, improved workload management, and significant increases in staff engagement. Conclusions: The synergy tool is an easy-to-use tool that can be used to highlight priority care needs for individual patients or specific patient populations. The tool informs real-time staffing decisions, ensuring a better fit between patient needs and nurse staffing assignments. Although this initiative began with nurses, project work is expanding to include inter-professional teams.

The incidence and prevalence of cancer continues to rise throughout Canada. Approximately one in two Canadians are expected to develop cancer at some point in their lives (Canadian Cancer Society, 2021). As the complexity and acuity of individuals with cancer increases, there is increased necessity to define the ideal nurse-to-patient ratio and patient caseload for nurses in specialized oncology settings. Two senior nurse leaders, faced with the need to determine the most appropriate model to inform the nursing model of care within their respective care areas, collaborated and decided to implement the Synergy Model. The Synergy Model is a professional practice model developed by the American Association of Critical Care Nurses (AACN). In the Synergy Model, nursing care reflects the integration of nurses’ knowledge, skills, attitudes, competencies, and experience to meet the needs of patients and families (Curley, 2007). This model provides a framework for matching nursing resources based on patient care needs and has been adapted in various care settings. The model, however, has not been applied in a surgical oncology inpatient unit or in an oncology ambulatory care setting. Using a quality improvement methodology, the Synergy Model was piloted in these new areas and found to be effective. The Synergy Model can be utilized to determine the need for additional nursing resources with specialized oncology nurses and appropriate skill mix of intraprofessional nursing teams. It can also be used to assess adult oncology patients who present to the ambulatory systemic care suite for unscheduled care related to symptomatic concerns.

There has been an increased need for highly skilled nursing staff trained in hematopoietic stem cell transplant (HSCT) care driven by the increase in transplant eligible patients (CCO, 2017). There is a lack of literature pertaining to orientation to HSCT coordination, a highly specialized nursing role. Historically, orientation to HSCT coordination has been preceptor based without a formal orientation process. Objectives: For this pilot study, a learning pathway and educational tools were developed and evaluated to support a standardized and systematic approach to the staff education and to improve quality of care. Methods: Eight nurses new to HSCT coordination participated in this study and completed the follow-up evaluations. Nurses were assessed before the intervention to identify knowledge gaps for each sub-role of allogeneic and autologous stem cell coordination. Following the assessment, nurses received a tailored self-directed learning package mapped to a learning pathway and a competency evaluation tool. A competency-based “building-block” training approach was used in which a new skill was added only after a previous skill was mastered. Utilizing the Kirkpatrick (2006) model, nurses were evaluated pre- and postorientation to assess changes in both knowledge and in behaviour relating to transplant coordination. Results: Participants reacted favourably to these tools and reported a significantly higher level of knowledge and competency in the transplant coordination role following orientation. Further research on the use of a learning pathway to guide the orientation of nurses to the HSCT coordination role would complement this pilot study.

Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients’ care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients’ acuity and dependency needs. Data on patients’ priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients’ holistic care needs and leaders’ capacity to plan staffing assignments based on patients’ priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.