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Implementation of virtual P.I.E.C.E.S™ for resident care planning with family to build and sustain team collaboration and resilience for the workforce in LTC during COVID-19 and future outbreaks

Project status
Denise Connelly
Institution web page
Host institution
Western University
Team members
Denise Connelly, Nancy Snobelen, Anna Garnett, Lillian Hung, Melissa Hay, Marie-Lee Yous, Harrison Gao, Ruthie Zhuang, Shannon Snelgrove, Jacqueline Ripley, Cherie Furlan-Craievich, Melissa Babcock, Pam Hamilton, Maureen O’Connell, Cathy Sturdy-Smith, Jerry Roseblade, Vicki King, Mark Wighton, Heather Martin.
Funding information (if funded)
This project was funded by the Canadian Institutes of Health Research.
Project Summary

In this project, Registered Practical Nurses (RPNs) together with residents and their families, other health professionals, and managers of care will implement the PIECES™ Canada framework using virtual technology. PIECES is a care planning framework to guide person-centred team-based care planning for residents of LTC. A cross-sectional study design employing explanatory mixed methods will gather information from key stakeholders – including RPNs, family care partners and cognitively-able residents – using online surveys, focus groups, and individual interviews. Working together in partnership, an interdisciplinary team of researchers from Western University, University of British Columbia, Copper Terrace and Vision’74 LTC homes in SW Ontario, the Registered Practical Nurses Association of Ontario (WeRPN), PIECES Canada, Canadian Gerontological Nurses Association and SPOR-OSSU aim: to improve family and resident experience as essential care partners; build resilience in RPNs as team leaders to support the workforce in LTC; improve LTC staff and leader preparedness to mitigate impacts of future COVID-19 outbreak; accelerate available high-quality, real-time, actionable research evidence; and develop a plan to adapt, sustain, and scale the proposed intervention across LTC homes.

Project Partners Websites:

Canadian Foundation for Healthcare Improvement

PIECES™ Canada

WeRPN – Registered Practical Nurses Association of Ontario

Outputs / Expected Outputs
  • Improvement in resident health outcomes – effective PIECES-guided team-based care planning will target effective non-pharmacological solutions for managing responsive behaviours exhibited by older adults living in LTC homes, the frequency of which has been exacerbated by social isolation and COVID-19 health and safety protocols.
  • Improvement in family experience as essential care partnersprovide solutions for improved communication between the LTC home and family care partners during future COVID-19/flu outbreak restrictions.
  • Invaluable insights and compelling evidence about enablers and challenges to implementation and sustainability of the virtual PIECES intervention – data inherent for sustainability and scaling up with other LTC home partners.
  • Patient engagement and team building knowledge and skills – to solidify shared goals of trusting relationships and meaningful engagement of care partners and residents, team collaboration and better resident health outcomes
  • Building resilience in RPNs as team leaders to support the workforce in LTC – recognizing RPN knowledge and skills and supporting RPNs as team leaders to champion virtual integrated care planning to mobilize the whole team including residents and family care partners. Staff RPNs will feel empowered, supported through team collaboration, more competent and confident in person-centered care with enhanced knowledge and skills to manage work responsibilities in crises, and heightened personal, professional and workplace resilience.
  • Improved efficiency and effectiveness of team-based care coordination, communication, and shared values. PIECES is an effective tool for fostering positive continuous improvement by focusing on strengths, enhanced team collaboration, and sustaining care practices for LTC residents
  • Improving LTC staff and leader preparedness to mitigate impacts of future COVID-19 outbreak. Virtual PIECES huddles will provide valued engagement of family care partners, residents, and staff in a structure to withstand future outbreak restrictions and mitigate isolation for residents.
  • Acceleration of available high-quality, real-time, actionable research evidence. The collaborative partnerships among residents, family care partners, frontline staff, decision makers, academics, research trainees, and professional leaders will build research capacity, share lessons learned, package data for knowledge dissemination, fine-tune the new virtual huddle intervention, inform practice and a knowledge dissemination strategy, during and beyond the pandemic to develop a rapid learning health system.
  • Plan for adapting, sustaining, and scaling the proposed intervention. On-site project champions from each partner LTC home will lead and inform implementation of the virtual integrated care planning intervention in their LTC home. Coaches from PIECES Canada will meet virtually, as mentors, for RPN staff in each LTC home throughout the ongoing implementation process. The LTC homes, will share about the utility and effectiveness of virtual PIECES. with relevant knowledge users within and external to their corporations.  Positive partnerships and stakeholder engagement will build research capacity within the LTC homes and facilitate interdisciplinary collaborations among this research team and LTC homes in LTC+.
  • Effective implementation of new evidence-informed practices – guided by the Consolidated Framework for Implementation Research (CFIR) framework, the LTC homes will build capacity for effective implementation, sustainability and spread of new knowledge, skills and judgment that will positively impact the care of their residents and families.
  • Progress to date
    • Pre-intervention quantitative survey data has been collected.
    • RPN participants at each partner LTC home have been trained on the PIECES program. Each LTC home has developed a new adapted care planning process, and frontline care staff have been educated on new processes. The intervention is now being trialed on several cases at each LTC home.
    • Qualitative interview and focus group questions being developed with feedback from older adult resident and family care partner research team members.
    • Scoping review protocol on virtual team-based care planning with older adults has been accepted and published online in BMJ Open. The full scoping review is now underway. A second scoping review investigating the use of tools to measure patient engagement in research in LTC settings is also underway.
    • Representative from the research team meets regularly with other LTC+ research teams in the Communities of Practice relating to Presence of Family, People in the Workforce, and COVID and non-COVID care.
    • Presentations of study rationale and methodology, as well as preliminary progress, have been presented at the Canadian Association on Gerontology conference and the Institute for Healthcare Improvement Scientific Symposium.

Scoping Review Protocol published in BMJ Open:

Virtual team-based care planning with older persons in formal care settings: a scoping review protocol

IHI Scientific Symposium Featured Poster Abstract published in BMJ Open Quality (please see Publications and Other Outputs section below for a pdf of the poster).

Implementing virtual care planning with resident/family: A Canadian COVID long-term care experience

Project website


IHI Scientific Symposium Featured Poster Abstract


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Implementation of virtual P.I.E.C.E.S™ for resident care planning with family to build and sustain team collaboration and resilience for the workforce in LTC during COVID-19 and future outbreaks