Trust Before Change:
Lessons from Building Psychological Safety in Long-Term Care
By Rosanra Yoon, Jelena Atanackovic, and Melissa Corrente | September, 2026
Building Psychological Safety in Long-Term Care Starts with Listening
Nearly 8 in 10 Long-Term Care (LTC) workers report worsening mental health, burnout, moral distress and post-traumatic stress. At the same time, Canada's aging population continues to increase demand on a workforce that has already experienced significant strain, particularly during and after the COVID-19 pandemic. Chronically under-resourced, the LTC sector and its workers’ are struggling with workplace related psychological stress, collective occupational trauma and grief that has been exacerbated by the disproportionate toll of the pandemic on LTC workers and the people and families they care for.
Supporting the psychological health and safety of LTC workers is no longer optional. It is essential to sustain a workforce that provides compassionate, high-quality care to residents and families every day.
Through a CIHR-funded project, our team partnered with five LTC homes across Ontario to strengthen psychological health and safety and foster more trauma-informed workplace cultures. Rather than introducing a one-size-fits-all solution, we worked alongside leaders, staff, and organizational champions to understand local needs and co-design support that were meaningful and practical within each setting.
Our project focused on four interconnected phases: engagement and assessment, co-design, implementation and evaluation, and sustainability planning. While each phase was important, one lesson quickly became clear: meaningful engagement is the foundation for everything that follows.
Taking the Time to Build Trust
The engagement phase included a needs assessment focused on trauma-informed approaches to worker psychological safety. We met with senior leaders, identified site champions, conducted virtual meetings, and visited LTC homes in person.
These conversations were about much more than gathering information. They were opportunities to build relationships, understand context, and learn directly from the people experiencing the realities of LTC work every day.
As researchers, we also served as knowledge brokers, translating evidence into practical and relevant tools that could support decision-making within each organization. At the same time, LTC teams shared invaluable insights that deepened our understanding of the unique challenges and strengths within their settings
Four Lessons That Emerged
As we worked across participating sites, four promising practices consistently emerged:
1. Identify and Support Natural Champions
Some of the most influential people in an organization are not always those with formal authority. Practice leads, administrators, directors, and other respected staff members often act as natural champions who understand both organizational priorities and frontline realities. These individuals helped bridge communication gaps, identify needs, and build momentum for change.
2. Listen to Pain Points Before Designing Solutions
Every LTC home had its own context, challenges, and priorities. Taking time to understand what staff were experiencing allowed us to tailor supports in ways that felt relevant and responsive. Listening first helped ensure that implementation efforts addressed real needs rather than assumed ones.
3. Meet Frontline Staff Where They Are
Frontline workers are often balancing heavy workloads and competing demands. Meaningful engagement required flexibility, patience, and a willingness to adapt our approach. Working through trusted site champions helped us connect with staff in ways that respected their time and realities.
4. Engagement Takes Time, and That's Okay
One of our biggest lessons was that engagement cannot be rushed.
The process took considerably longer than originally anticipated. Staffing changes, outbreaks, competing organizational priorities, regulatory requirements, scheduling challenges, and even facility construction affected timelines. While these realities created delays, they also reinforced an important insight: building trust and fostering readiness for change are essential parts of implementation, not barriers to it.
Too often, engagement is viewed as a preliminary step before the "real work" begins. Our experience suggests the opposite. Engagement is work. It creates the relationships, trust, and shared understanding needed for sustainable implementation and meaningful organizational change.
Looking Ahead
For researchers and implementation teams working in long-term care, our advice is simple: be patient, be responsive, and invest in relationships. Identify natural champions, listen deeply to local challenges, and work alongside staff to develop solutions that reflect their realities.
Psychological safety is not built through policies alone. It grows through trust, collaboration, and a genuine commitment to supporting the people who provide care every day.
To learn more about our work, visit our project page in the ESKM Hub section of the CHWN website, or join us at CHWC 2026 on December 3–4 in Ottawa.