Case studies
Social Movement Action Framework
Valuing the need for hospice and palliative care services
Advocacy for humane death and dying care practices led to the valuing and realization of hospice and palliative care services in South Australia.
Advocacy for humane death and dying care practices led to the valuing and realization of hospice and palliative care services in South Australia in the 1990s (Elsey, 1998). Early hospice and palliative care advocates pressed for comprehensive community services provided by knowledgeable, humane and compassionate care providers who understood and supported the need for an alternative to medical practices in this area.
Advocates also recognized the need for funding, legislation, support of relevant volunteer organizations, and capacity-building in health professionals to ensure effective delivery of hospice and palliative care services.
Using social media to increase public visibility and raise awareness
Social media is used by RNAO regularly to advocate for advancing the rights of Ontarians, including residents of long-term care homes. Read this case study that includes examples of effective social media campaigns advocating for the Nursing home Basic Care Guarantee.
RNAO uses social media campaigns to increase public visibility and raise awareness of issues. One example: RNAO’s call on the Ontario government to mandate recommendations set out in its Nursing Home Basic Care Guarantee. The campaign incorporated the hashtags #LTC #BasicCareGuarantee and #4Hours4Seniors to raise awareness of the staffing crisis in long-term care (LTC) and to encourage the public, health professionals, the government, LTC residents and their families to mobilize change.
As the campaign evolved, so did the visuals and the messaging. The three examples below show the stages of the campaign as it gained attention and momentum – from “good” through “better” to “best.”
RNAO developed an Action Alert (AA) to mobilize collective action to advocate for nursing home residents. The link to the AA, the graphic, the messaging and the hashtag #4Hours4Seniors were all shared on social media to urge others to sign and share the AA. People were also encouraged to use the hashtag to contribute to the dialogue about the LTC crisis.
The social media campaign aimed to support the goal set out in the AA – encourage as many people as possible to add their signatures to urge action from key political leaders.
This is a good example of a social media campaign, incorporating a graphic, supportive messaging, a call-to-action (the link to the AA) and a specific hashtag.
In this example, RNAO staff members are holding signs identifying why #4Hours4Seniors matters to them. The hashtag is used consistently and individual reasons for supporting the cause are illustrated.
This is a better example of a social media campaign – it brings a personal touch to the campaign and allows supporters to share why they want to join the conversation. It also brought life to the hashtag and to the purpose of the campaign.
Image
In this example, RNAO collaborated with F.J. Davey Home in Sudbury, Ontario, Canada to encourage residents to share their “why” for wanting #4Hours4Seniors. Building on the same idea as the “better” example given above, this example truly brought a face to the reason for the campaign in the first place. RNAO shared the photos and quotes from residents on its social media feeds (Instagram, Facebook and Twitter) alongside the hashtag #4Hours4Seniors.
For example, M. Doan, a senior living at the F.J. Davey Home, shared: “I am a very independent person, but my wife on the other hand isn’t and she means the world to me. With four hours of care, it doesn’t need to be rushed. And who wouldn’t want to see her beautiful smile for four hours!" (https://twitter.com/RNAO/status/1336781022780928000).
The photos are powerful as they show a real-life married couple living in a LTC home – two of the many residents RNAO advocated for through its AA and its ongoing call for a Nursing Home Basic Care Guarantee. The posters held by the couple express their personal values of dignity and comfort.
Using communication platforms to mobilize change for persons with diabetic foot ulcers
The collective actions of RNAO, Wound Care Canada and other supporters used public visibility strategies to advocate for diabetes-related foot ulcers care. Read more in this case study.
In 2014, RNAO, Wound Care Canada, and other supporters organized a coalition and advocated for diabetes-related foot ulcers care from the provincial government in Ontario, Canada. The coalition used evidence, political pressure to demand an integrated system of care with universal access to improve health outcomes, including reduced ulcers and amputations and reduced costs for pressure-alleviating devices. Members of the coalition participated in many activities, including:
- attending and participating in stakeholder meetings
- writing a media release and lead article in RNJ
- meeting with members of provincial parliament (MPPs) at RNAO’s annual Queen’s Park Day (Grinspun et al., 2018a)
The result of these advocacy efforts and changes in health outcomes are also described in an RNAO Evidence Booster measuring the impact of offloading devices for people living with diabetes and foot ulcers (https://rnao.ca/bpg/resources/evidence-booster-assessment-and-management-foot-ulcers-people-diabetes).
Knowledge-to-Action Framework
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).
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 the Person- and Family-Centred Care best practice guideline to local context at Sioux Lookout Meno Ya Win Health Centre
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. The service area is remote, isolated and encompasses 385,000 square kilometres, with a population that is 85 per cent First Nations. Learn more how this site adapted guidelines to their local context in this case study.
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
Engaging Persons with Lived Experiences
Holland Bloorview Kids Rehabilitation Hospital: Co-designing change through the active engagement of persons with lived experience
A case study from Holland Bloorview Kids Rehabilitation Hospital focused on engaging persons with lived experience in a change process.
Holland Bloorview Kids Rehabilitation Hospital (hereafter referred to as Holland Bloorview) is a designated Best Practice Spotlight Organization® (BPSO®) in Toronto, Ontario, 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. Family leaders are families and caregivers who have received services at Holland Bloorview, and have lived experiences of paediatric disability. Family leaders’ roles include being a mentor to other families, an advisor to committees and working groups, and faculty who co-teach workshops to students and other families.
Family Leader Roles at Holland Bloorview. Photo provided with permission by Holland Bloorview Kids Rehabilitation Hospital.
The ENFit™ Working Group is an example of a successful implementation co-design process within Holland Bloorview. The ENFit™ Working Group is an interprofessional team working on the adoption of a new type of connection on products used for enteral feeding [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, and thus decrease harm to children and youth who require enteral feeding.
Family Partnering with the EnFit Working Group. Photo provided with permission by Holland Bloorview Kids Rehabilitation Hospital.
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, great attention was given to the potential impacts on persons and families. The group engaged the family member by:
- co-creating the implementation plan
- involving them in a failure mode affects analysis, which highlighted 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.
