Shining a light on factors that lead to psychological harm in long-term care and proposed solutions to mitigate risk.
In November of 2023, the Ontario Centres for Learning, Research and Innovation at the Schlegel-UW Research Institute for the Aging and the Public Services Health and Safety Association (PSHSA) conducted a root cause analysis (RCA) workshop to understand causal factors and identify solutions for psychological harm to workers in long-term care in Ontario.
The scope of the RCA was defined by the following risk statement:
Working in long-term care can be psychologically demanding. Leaders and worker team members experience events and situations in the workplace that may result in psychological harm.
Long-Term Care Root Cause Analysis
Primary Causal Factors for psychological harm
- Workload management
- Protection from moral distress
- Organizational Culture
- Psychological demands
- Clear leadership and expectations
- Psychological protection
Secondary Causal Factors for psychological harm
- Staffing: short staffed
- Recruitment and retention
- Lack of funding
- Ratio of staff to residents
- Physical and cognitive abilities of staff
- Resident complexity of care
- Job demands outweigh worker competencies
- Communication
- Psychological Health and Safety not integrated into work
- Turnover
For a comprehensive look at primary, secondary and tertiary causal factors, view our fishbone diagram here.
Key areas of focus to prevent psychological harm to workers in long term care
Using secondary causal factors to guide discussions, 144 solutions were identified to prevent psychological harm in long-term care.
Download a sortable list with all solutions here.
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System-level processes and/or resources: Revise provincial processes and/or resources with a focus on funding models, collaborative partnerships, assessment tools and indices.
Education and training: Standardize inclusion of situational, experience-based content in formal education programs, and formalize workplace training opportunities related to both clinical skills and mental health.
Workplace resources: Ensure that equipment, technology, and materials, are available and accessible in the LTC Home and the built environment is designed to support worker mental health.
Work arrangements and compensation: Provide flexible work hours, scheduling, and total compensation packages to meet individual and operational needs.
Staff engagement/involvement: Solicit frequent and meaningful staff input and participation.
Resident care: Identify, understand, and provide holistic resident care using a collaborative, participatory approach.
Career progression and growth: Support workers at career entry, mid-career, and late career by creating career roadmaps, position-specific development plans and mentorship programs.
Role clarity, work assignment and responsibilities: Identify, document, and communicate the unique roles and responsibilities of LTC stakeholders that lead to quality resident care and staff wellbeing.
Job demands: Use evidence-based tools to identify job demands and design work to reduce cognitive, physical, and psychological load.
Workplace policies and procedures: Develop and implement formal policies and procedures for workplace psychological health and safety.
Community interaction: Enhance public facing communication and community programs and partnerships to increase visibility and decrease stigma.
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Additional Resources
CSA Z1003-13
A voluntary standard that specifies requirements for a documented and systematic approach to develop and sustain a psychologically healthy & safe workplace.
