Case studies
Social Movement Action Framework
Strengthening health systems: The experience of the National Health Forum in El Salvador (2009 - 2018)
A nationwide social movement in El Salvador from 2009 to 2018 supported the achievement of the National Health Forum and exemplified goals and outcomes being met by activists. Read more in this case study.
The National Health Forum (NHF), a nationwide popular movement in El Salvador, played a central role in the development of the National Public Health System from 2009 to 2018 (León et al., 2020). It is part of a global movement that aims to build coalitions and networks. The People’s Health Movement (PHM) brought together grassroots health activists, civil society organizations and academic institutions from around the world to address the social, environmental, and economic determinants of health (Kapilashrami et al., 2016).
The NHF provides a strong example of community participation and exemplifies a social movement with fully achieved goals. Formally created in 2010, the NHF had three fundamental goals that were met via social movement actions:
- to build people’s power and strengthen the organizational fabric
- to stand against the idea that previous governments held of privatizing health care
- to stimulate and promote effective social participation in health
The NHF developed three community participation strategies that played a role in strengthening El Salvador’s national public health system. These strategies are: (1) building capacity among local community leaders to become effective decision-makers at all levels of the health-care system, (2) responding to and prioritizing the needs identified by the community for the sector-specific working groups, and (3) advocating for policies based on human rights.
“The NHF was born with high participation of different social movements, all united in the same direction. There were a series of problems, as they wanted to privatize health care […] The NHF was created when the health reform came into being. We, the NHF, are part of the reform” – NHF member
Advocating for change through the Alzheimer's Association
The Alzheimer's Association was started by activists committed to advancing Alzheimer's knowledge through research.
The Alzheimer’s Association (Alzheimer's Association | Alzheimer's Disease & Dementia Help) was founded in 1980 by a group of family care providers and individuals who supported the need for an organization dedicated to support the needs of caregivers facing Alzheimer’s and to advance knowledge through research. As early activists for the Alzheimer’s movement, they sought to break down the silence of Alzheimer’s and learn more about the disease, including prevention, treatment and a cure.
Through a people-led approach, the association reaches millions of people globally through a multi-pronged approach grounded in individual and collective action. Advocacy to give all persons living with Alzheimer’s access to the support services they need includes strategies such as launching awareness campaigns and grassroots campaigns to impact legislation.
With multiple chapters throughout North America and globally, the Alzheimer’s Association includes a network of advocates and allies. These include other Alzheimer’s organizations, universities engaged in research, corporations and pharmaceuticals. As an example of a civil society organization, the Alzheimer’s Association is a community-based non-profit organization that has protected and advocated for the needs and interests of persons and families living with Alzheimer’s for over 40 years.
Scaling up change to address hunger and food waste through The Campus Kitchens Project
The Campus Kitchens Project was an effective scaled up change initiative that addressed food insecurity. read more in this case study.
The Campus Kitchens Project (CKP) is an example of a successful scaled-up change initiative. Founded in 2001 as a branch of a community kitchen initiative that targeted food insecurity in Washington, D.C., United States, this non-profit is the first and largest student-led social movement taking on the crisis of food waste and hunger in the United States (Larson et al., 2017). More than 30,000 students in 63 universities, colleges and high schools are now repurposing unwanted or surplus food to provide meals to people who have food insecurity.
Working in leadership teams, student leaders and volunteers on campuses receive education, training and coaching over a period of several months to help empower people, families and communities on topics including:
- food insecurity
- improving social and nutritional health by increasing food knowledge and helping others developing cooking skills
The Campus Kitchen Project also establishes community partnerships with existing local organizations that provide services and food to individuals already challenged with food insecurity, such as senior housing facilities, youth outreach groups and churches. Local leadership teams also partner with dining services that operate large foodservice kitchens and dining halls and engage student groups and faculty advisors.
Student teams carry out different functions. While some teams focus on improving the way that homeless shelters prepare and deliver meals, other teams host communal dinners, partner with senior centers, or improve transportation to improve access to food.
“Instead of more branch offices or trying to provide all the services in-house, we find universities and students to partner with who already have the necessary resources on campus and want to do this kind of community impact work. Turning our nation’s institutions of higher education into hubs for replication and ongoing innovation could be the superhighway to scaling up for any nonprofit.” - Laura Toscano, Director, The Campus Kitchens Project
Knowledge-to-Action Framework
Adapting BPG recommendations to a public health context – Insights from Toronto Public Health
Toronto Public Health – a Best Practice Spotlight Organization® (BPSO®) - has adapted several RNAO best practice guidelines (BPGs) to align with a population health approach.
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).
Adapting BPG recommendations to a Chinese acute care context to reform care delivery– lessons learned from DongZhiMen Hospital
Care practices were revised using adapted evidence-based best practice guidelines in an acute care facility in Beijing, China.
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).
Facilitating an evidence-based culture at Unity Health Toronto - St. Michael’s Hospital
Unity Health Toronto - St. Michael’s Hospital, a Best Practice Spotlight Organization® (BPSO®) has embedded evidence-based practices into its culture and daily work processes as part of its corporate strategy.
Unity Health Toronto - St. Michael’s Hospital, a Best Practice Spotlight Organization® (BPSO®) in Toronto, Canada, has embedded evidence-based practices into its culture and daily work processes. Evidence-based practice is part of the hospital’s corporate strategy. It has invested resources to build a critical mass (over 30 per cent) of staff members who are best practice champions.
The hospital also provides multiple capacity-building opportunities, including a community of practice, boot camps, booster sessions and mentorship. The annual Nursing Week Gallery Walk, depicted in the image above, is just one way that St. Michael’s Hospital profiles the work of champions and others dedicated to using evidence to inform change initiatives.
SOURCE: Transforming Nursing Through Knowledge, 2018.
Engaging Persons with Lived Experiences
Integrating patient partners in change – Lessons learned from Kidney Health Australia
Kidnney Health Australia case study
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.
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Topics prioritized by content experts |
Topics prioritized by patient partners |
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