Abstract for: Obstacles to High-Quality and Holistic Care: Dynamic Analysis of Job Turnover in Nursing Home Workers

Canada had one of the highest COVID-19 death rates worldwide in individuals living in nursing homes (NHs). Since the pandemic, a variety of actions have been proposed to address the long-standing and systemic NH staffing challenges. The understanding is that improving the conditions of work will improve the conditions of care. The focus of this study is understanding the feedback processes that result in high turnover of NH workers. We use three data sources to develop a fully specified model of organizational factors that impact turnover: (1) historical home-specific data available only from NH providers (e.g., human resources and clinical information systems); (2) NH worker experiences extracted from group model building workshops; (3) publicly reported NH data and those from organizational behaviour and SD literature (e.g., foundational SD models focused on the dynamics of service delivery and quality). Our study extends the literature by modeling NH worker turnover as an endogenous outcome of interacting organizational, workforce, and care delivery dynamics rather than as a parameter or exogenous constraint. A strength of this study is incorporating important intangible system elements and explicitly representing the mechanisms through which these elements influence turnover.