Scarborough Health Network (SHN) (Home - Scarborough Health Network (shn.ca) is an organization pursuing Best Practice Spotlight Organization® (BPSO®) designation in Scarborough, Ontario, Canada. Patient Family Advisors (PFAs) are a vital part of SHN’s philosophy of care, representing the diverse community SHN serves. A key element of the PFA role is sharing lived experiences with SHN staff and the Scarborough community.

SHN has demonstrated commitment to the role of PFAs within their organization by creating a new department for health equity, patient and community engagement (HEPCE). This department focuses on:

• recruiting, onboarding, managing, recognizing and retaining PFAs
• educating staff on best practices related to engaging with PFAs

During recruitment and onboarding, the HEPCE and current PFAs educate potential PFAs about the role’s scope and expectations. All PFAs are also provided with information on how to share their patient or caregiver story with their audience.  

PFAs have played an important role in SHN’s BPSO committee. Indeed, one PFA has been integral to the process of recruiting and engaging champions at SHN throughout the COVID-19 pandemic’s health human resources (HHR) crisis. Their role has included participating in champions’ virtual drop-in sessions (2020-2021) and in-person roadshows (2022).

Champion roadshows are events during, which SHN practice leaders and PFAs promote the BPSO program, share best practice guidelines and recruit champions around the organization, without asking busy staff members to leave their units.

The PFA also supported the recruitment and engagement of champions by:

• collaborating with other champions and working group members to plan champions’ drop-in sessions and roadshows
• working alongside the team to plan safe spaces for staff and PFAs to share their stories
• sharing stories of positive experiences with staff members in relation to the impact of best practices (for example, RNAO’s Person and Family Centred-Care best practice guideline) on their experience

Staff members have reported being motivated to become best practice champions after attending a champion’s roadshow. SHN has also consistently gained champions during the HHR crisis and maintains at least 15 per cent of nursing staff as best practice champions.

The PFA’s role was vital to demonstrating the lasting impact of best practices. They have expressed feeling empowered by their role in BPSO work, expressing that the work helped them find their voice and become part of the movement to promote and implement best practices.  

Overall, PFAs play an essential – and dual – role in supporting the implementation of best practices at SHN. In line with person- and family-centred care, PFAs assume an outward-facing role in shaping the implementation of best practices and SHN’s values. In addition, they also act in an inward-facing role to support the bolstering of champions.

To learn more about the PFA role at SHN, please visit the following link: Patient Family Advisors.

Shared with permission by Scarborough Health Network

Holland Bloorview Kids Rehabilitation Hospital (Holland Bloorview) is a designated Best Practice Spotlight Organization® (BPSO®) in Toronto, Canada.  Holland Bloorview has an award-winning Family Leadership Program (FLP), through which family leaders partner with the organization and the Bloorview Research Institute to co-design, shape and improve services, programs and policies.

These family leaders are families and caregivers who have received services at Holland Bloorview and have lived experiences of paediatric disability. Their roles include mentoring other families, acting as advisors to committees and working groups, and co-teaching workshops to students and other families.

One example of a successful implementation co-design within Holland Broadview is the ENFit™ Working Group. This interprofessional team works on the adoption of a new type of connection on products used for enteral feeding – or feeding directly through the stomach or intestine via a tube. By introducing the ENFit™ system, a best practice safety standard, the working group plans to reduce the risk of disconnecting the feeding tube from other medical tubes. This in turn decreases harm to children and youth who require enteral feeding.

The working group invited a family member and leader whose son had received services at Holland Bloorview. This family member had significant lived experience with enteral feeding management, enteral medication administration, and other complexities associated with enteral products. During the meetings, the potential impacts on persons and families were emphasized. The working group engaged the family member by:

• co-creating the implementation plan
• involving them in a failure mode and effects analysis highlighting the impact of the feeding tube supplies on transitions to home, school and other care settings
• working with the family member to advocate for safe transitions within the provincial pediatric system, which led to the development of the Ontario Pediatric ENFit™ Group

To learn more about Holland Bloorview’s experience in partnering with families in a co-design process, watch their 38-minute webinar: The Power of Family Partnerships

Shared with permission from Holland Bloorview

In early 2018, Kidney Health Australia (KHA) developed a guideline for managing percutaneous renal biopsies for individuals with chronic kidney disease (Scholes-Robertson et al., 2019). KHA included 40 persons from across Australia with lived experience of chronic kidney disease and their caregivers – “patient partners”. KHA asked patient partners to prioritize which topics were most important to them during a percutaneous renal biopsy.

Patient partners valued: minimizing discomfort and disruption, protecting their kidneys, enabling self-management, and making sure that support for families and caregivers would be available. They indicated that all of this would help alleviate anxiety and avoid undue stress. Their voices were heard, and KHA effectively incorporated these suggestions in guideline development.

Notably, there were marked differences between the priorities identified by the content experts on the guideline development working group, versus what the patient partners perceived to be important to their health and wellbeing, as shown in the table below.   

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is endorsed by the Substance Abuse and Mental Health Services Administration as an effective intervention for drug and alcohol use. SBIRT has been implemented in multiple health-care settings including acute care. 

Implementation leaders were asked to identify barriers, facilitators, as well as implementation strategies that would be most helpful. From this review, implementation leaders perceived that providing ongoing consultation to clinicians for using SBIRT, distributing educational materials to clinicians, and conducting audits and providing feedback were the most helpful.

All implementation leaders voiced the value of available training resources, and peer support as they moved through the implementation process.

Implementation leaders felt more confident leading change in the future due to the knowledge and skills they developed during SBIRT implementation. They also learned the importance of leveraging support from other interprofessional team members, such as social workers and clinical educators.      

Read more about it here. Learn more about SBIRT here. Or, review our best practice guideline, Engaging Clients Who Use Substances. 

A major acute-care hospital in Toronto, Ontario, Humber River Hospital (now Humber River Health) has used continuous monitoring to determine the impact of their BPG implementation and staff performance.

These tiles, displayed on large screen monitors in a Command Centre (pictured above), are integrated into the daily delivery of care to support physicians, nurses, and other clinical staff. Each row within the tile represents a patient, followed by where they are located. By clicking on a patient, staff can see more information regarding the clinical criteria that put them on the tile.

With every patient, there is an expected time in which the issue should be resolved based on a service level set by the hospital. If the system detects that the process is taking longer than expected, the icon will escalate to amber and then to red, indicating a higher level of alert.

Tiles also include several quality monitoring indicators based on RNAO's best practice guidelines (BPG) related to fall risk intervention, wound and skin management, pain management and delirium management. By centralizing data in the Command Centre, the monitoring indicators empower clinicians so that they can intervene in a timely manner to ensure that best practices are followed. 

Read more about this innovative quality monitoring approach here: https://www.hrh.ca/2020/08/04/cc-risk-of-harm/ 

Cardioinfantil Foundation of Cardiology Institute (FCI-IC) is a 340-bed hospital in Bogotá, Colombia. Recognizing that the use of best practice guidelines (BPG) for nursing care was uncommon in Colombia, they joined RNAO’s Best Practice Spotlight Organization® (BPSO®) program with the goal of achieving excellence in care.

FCI-IC had 10 years of evaluation data that revealed problems in specific clinical areas such as fall prevention and wound care. They conducted a baseline diagnostic evaluation to identify the highest priority problems to tackle and to select the most appropriate guidelines and best practice recommendations. As part of this, they surveyed their key partners in the change to learn more about their use of assessment tools, the status of electronic medical records, routine clinical practices such as the use of bed rails, and prevalence data.

This assessment process led to them selecting three RNAO BPGs as knowledge tools: Prevention of Falls and Fall Injuries in the Older Adult, Risk Assessment and Prevention of Pressure Ulcers, and Assessment and Management of Foot Ulcers for People with Diabetes.

Tilbury Manor, a 75-resident long-term care home in Tilbury chose to focus on provincially-mandated “required programs” (fall prevention, skin and wound care, continence care, bowel management and pain management) when seeking to improve resident care.

They conducted a gap analysis to compare their current practices with the best practices outlined in related RNAO best practice guidelines. Their analysis included an assessment of clinical practices, policies and documentation systems. The results of the gap analysis helped them create specific action plans.

Tilbury Manor then formed project teams led by nurses and supported by a team of champions. These teams proceeded to educate staff, implement new clinical practices, conduct care reviews and conduct audits.

Multiple positive outcomes were reported as a result of implementing these best practices including reductions in reports of pain, less use of restraints, and less falls, pressure ulcers and urinary tract infections.

Sioux Lookout Meno Ya Win Health Centre (SLMHC) is a pre-designate Best Practice Spotlight Organization® (BPSO®) in Sioux Lookout, a town in Northwestern Ontario. SLMHC is a hub for inpatient and outpatient hospital services, providing services to including Sioux Lookout and 28 northern communities. The service area is remote, isolated and encompasses 385,000 square kilometres, with a population that is 85 per cent First Nations.

As part of its pre-designation process, the SLMHC change team implemented the Person- and Family- Centred Care (PFCC) best practice guideline (BPG). During implementation, the SLMHC change team worked to adapt the PFCC BPG to the local context of their organization in order to best serve the needs of the population in the surrounding areas as well as in other remote communities.

The SLMCH local context posed unique challenges. Among these:

• Standard guidance on privacy did not always apply to members of the First Nations communities served. Some members wished to have their health information shared with their chief and community.
• Some people must travel as far as 400 or 500 kilometers to return home after discharge from SLMHC. Thus, it was essential to arrange appropriate care transitions and make sure people being discharged would not lose personal belongings.

The SLMHC change team adapted the PFCC BPG to the local context by:

SLMHC Patient Oriented Discharge Summary. Shared with permission.   

• placing names on the doors of the hospital rooms of some individuals, so their community members could stop by and visit.
• creating a Patient Oriented Discharge Summary (PODS) that included the following options to indicate the person’s preferences regarding sharing their health information:

• I agree to my health information being shared with________
• I do not agree with my health information being disclosed to people in my community (for example, band or council) 
• creating a detailed staff checklist within the PODS to ensure safe care transitions (by, for example, faxing the completed form to an external Indigenous Transition Navigator, or listing personal items collected from the room).

• working with an Indigenous Transitions Facilitator, whose roles include conducting follow-up phone calls with the person, patient rounding, and coordinating safe transitions.

After successfully creating a tailored PODS that meets the need of the population they serve, SLMHC has been able to better support person- and family-centred care principles within the organization.

Shared with permission by Sioux Lookout Meno Ya Win Health Centre

Toronto Public Health – a Best Practice Spotlight Organization® (BPSO®) in Toronto, Canada – has implemented several RNAO best practice guidelines (BPGs), including Woman Abuse: Screening, Identification and Initial Response (2005) and Preventing and Addressing Abuse and Neglect of Older Adults (2014). Because some practice recommendations in these guidelines focus on the individual person or patient level, they didn’t always align with Toronto Public Health’s population health approach.

To adapt recommendations to the public health context, the change team completed a literature review to explore definitions and adapt strategies to align with the model of care delivery and health promotion philosophy.

Another approach that was taken by Toronto Public Health: piloting BPG recommendations within one small program team. The team would then evaluate the implementation until successful, consistent with the Plan-Do-Study-Act approach). Once successful, the intervention was scaled up within the organization to other programs and teams (Timmings et al., 2018).

DongZhiMen Hospital – a BPSO in Beijing China – was motivated to reform care delivery through the use of RNAO BPGs. While best practice recommendations provided general guidance, DongZhimen Hospital identified the need to translate these statements into detailed instructions and parameters tailored to their specific hospital context.

To adapt statements to their context, they translated the guideline into Chinese. A multidisciplinary team then worked through the initial steps of the Knowledge-to-Action Framework. This involved:

• reviewing carefully the evidence to thoroughly understand the intent of the recommendations
• conducting a comprehensive gap analysis
• interviewing staff members and others to identify facilitators and barriers to the use of the BPG.

Using this information, the team was able to create specific, clinical nursing practice standards derived from the recommendations and relevant to their context (Hailing and Runxi, 2018).