The Haematology/Hematopoietic Stem Cell Transplant (HSCT) Program at the Juravinski Hospital and Cancer Centre identified a unique opportunity to enhance patient care and the work environment by piloting the Synergy Model (Curly, 2007); a professional practice framework that involves assessing patient acuity to plan assignments based on “fit” between patient needs and staff competency.  Published research suggests the Models’ patient-centered philosophy optimizes patient outcomes, enhances collaboration and teamwork with the goal of providing better care, provides a unified language for discussing care and measuring patient acuity, helps teams make objective decisions about staffing assignments, and helps administrators establish staffing levels for effective patient care and workload management. The Model has been shown to be beneficial in various health care settings, but has yet to be applied with a haematology/HSCT patient population.

A pilot project was undertaken from November 2013 – March 2014 to examine the adaptability, applicability, and effectiveness of the Synergy Model in a Canadian inpatient haematology/HSCT setting.  A previously developed toolkit published by the British Columbia Nurse’s Union was used as a guide to build a haematology/HSCT patient acuity tool to measure patient complexity, stability, predictability, and participation in care. An inter-rater reliability analysis of the tool revealed high internal consistency (4 items, α > 0.7) and moderate agreement (Kappa= 0.68, p <.05). A nurse competency assessment was developed using the Canadian Nurses Association Oncology practice standards.  Processes were created for scoring patient acuity, planning patient assignments, and for decision making about staffing levels.

The results of the pilot revealed that the Model can be adapted and applied to a Canadian haematology/HSCT inpatient unit to positively impact the quality of the work environment, patient safety, and resource utilization. For example:
-94% of RNs felt the Synergy scores accurately reflected patient acuity.
-the scoring process is workable and scores were used 100% of the time to create nursing assignments.

Overall, nurses felt the Synergy Model achieves a better fit between nurse competency and patient needs. 87% of nurses felt their skills were matched with patient acuity using the Synergy Model, compared to 48% pre-Synergy implementation. Improvements were also noted in nurses’ perception of the level of support for novice nurses, their involvement in nursing assignments, the workload associated with their assignment, and several staff satisfaction and staff engagement indicators. There was also a reduction in patient safety occurrences and a decrease in overtime.

The Synergy Model can be adapted and applied to an acute inpatient setting to achieve a better “fit” between nurse’s skills and the patient’s needs. It provides a common, standardized language that helps the team communicate more effectively about patient acuity as well as an objective process for planning nursing assignments. The Model increases clinical autonomy and engagement as nurses are involved in decisions that impact patient care, the quality of the work environment and resource utilization. The flexible nature of the Model is well suited to a haematology patient population because it enables health care administrators to make more informed, effective, real time decisions about resource utilization and allocation in response to changes in patient acuity.  The Synergy Model is an enabler that creates the conditions needed to support our hospital’s vision of the Best Care for all.

Contact Person:

Title: Clinical Manager, C4 Hematology/HSCT Inpatient Unit

Contact information: georgg@hhsc.ca

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