Case studies
Social Movement Action Framework
Applying focused strategies and training to achieve a timely change
Staff at the Birchmount and General site locations of Scarborough Health Network in Toronto, Ontario, Canada are committed to providing excellence in clinical practice. In addition to implementing best practice guidelines focused on clinical care, they have also address healthy workplace environment issues including focusing on anti-bullying. Learn more in this case study.
Staff at the Birchmount and General site locations of Scarborough Health Network (SHN) in Toronto, Ontario, Canada are committed to providing excellence in clinical care. At this Best Practice Spotlight Organization® (BPSO®) Best Practice Spotlight Organization (BPSO) – Scarborough Health Network (shn.ca), there was a strong interest and shared concern from staff and leadership teams on the prevention of bullying in the workplace.
In response, they chose to focus on anti-bullying as an area for improvement. To do so, they implemented the Preventing and Managing Violence in the Workplace Best Practice Guideline (RNAO, 2009). Collaborative efforts from the interprofessional team contributed to developing targeted strategies and training, leading to effective action.
Advancing the global Black Lives Matter movement to end systematic racism
The urgent need to end systemic racism gained international traction following the death of George Floyd. Learn more about how an urgent need for action fosters social movement action in this example.
The urgent need to end systemic racism gained international traction following the death of George Floyd. Support for the global Black Lives Matter movement increased, leading to national and international discussions on structural racism and demands to address long-standing problems of police brutality. Calls to action included defunding the police and a global movement for justice, freedom and liberation.
Transforming long-term care reform
The urgent need to transform long-term care (LTC) in Ontario gained broad support in 2020 during the COVID-19 pandemic. Read more in this case study.
The urgent need to transform long-term care (LTC) in Ontario gained broad support in 2020 during the COVID-19 pandemic. The pandemic exposed long-standing system failings. Examples of triggers included:
- an alarming mortality rate resulting from COVID-19 in LTC settings, representing a large majority of COVID-19-related deaths in Ontario
- a scathing report from the Canadian Armed Forces
- devastating stories from families who were separated from loved ones
Knowledge-to-Action Framework
Conducting gap analyses to successfully implement new clinical practices at Tilbury Manor
Tilbury Manor, a long-term care home, chose to focus on provincially-mandated “required programs” when seeking to improve resident care using a gap analysis.
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.
Evaluating the impact of implementing the Person- and Family-Centred Care Best Practice Guideline at Spectrum Health Care
Spectrum Health Care, a Best Practice Spotlight Organization® (BPSO®) and home health organization, evaluated care outcomes after implementing the Person- and Family-Centred best practice guideline (BPG).
Spectrum Health Care (Spectrum), an RNAO Best Practice Spotlight Organization® (BPSO®), is a home health organization with more than 200 nursing staff across three locations in the province of Ontario, Canada.
Spectrum chose to implement the 2015 Person- and Family-Centred Care (PFCC) Best Practice Guideline (BPG) to enhance person- and family-centred care and to reduce complaints regarding care. Members of the senior leadership team at Spectrum Health Care led implementation together with Spectrum’s Patient and Family Advisory Council.
To support the practice change, Spectrum used the following implementation interventions:
- Conducting a gap analysis to determine the knowledge/practice gap;
- Holding education sessions for staff on person- and family-centred care best practices;
- Revising their care processes to include review of care plans with the person and/or members of their family
- Surveying staff members on their attitudes about person- and family-centred care via surveys
- Developing staff education on communication strategies to support the assessment of a person’s care needs and care plans.
After implementing these interventions, Spectrum assessed the number of complaints received from persons receiving care per 1,000 care visits and compared that to their baseline.
They found a decrease of 42 per cent of complaints from persons received over an 18-month time period at one of the sites that was implementing the PFCC BPG at Spectrum Health Care.
At another site, an 80 per cent reduction in complaints was found following the staff education intervention.
Data analyses overall indicated that the implementation of the PFCC BPG was highly successful in reducing persons' complaints regarding care.
Read more about Spectrum Health care’s results of implementing the PFCC BPG here: Slide 2 (rnao.ca)
Sustaining the Assessment and Management of Pain Best Practice Guideline across a multi-site long-term care home
The Region of Peel, a Best Practice Spotlight Organization® (BPSO®), has sustained the implementation of the Assessment and Management of Pain best practice guideline (BPG) for almost a decade.
The Region of Peel, an RNAO Best Practice Spotlight Organization® (BPSO®) started implementing the RNAO Assessment and Management of Pain best practice guideline (BPG) in 2014 and has sustained its use since then. For example, in their 2019 BPSO annual report, they cited a continuous downward trend in the number of clients who reported a worsening of their pain. Pain experienced by the residents was better controlled, and the staff was found to assess, identify, and manage pain better by using the BPG.
Their keys to success include:
- building on what works (for example, existing practices and policies)
- empowering champions and growing their champion network
- involving residents and families
- gaining support from leaders and partners including RNAO, Peel of Region Leadership, Health Quality Ontario).
- collaborating with an interdisciplinary team
- conducting a formal sustainability evaluation
To learn more about The Region of Peel’s journey in sustaining the use of the Assessing and Managing Pain BPG, along with other BPGs, check out this webinar.
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.
