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.
Leveraging innovative quality monitoring - Humber River Hospital
Humber River Hospital is an acute care facility that has used continuous monitoring to determine the impact of BPG implementation and staff performance.
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/
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)
Engaging Persons with Lived Experiences
Engaging Patient Family Advisors to advance guideline implementation at Scarborough Health Network
A case study about the integration of patient family advisors at Scarborough Health Network to enhance community engagement and health equity.
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
Co-designing change through the active engagement of persons with lived experience - Holland Bloorview Kids Rehabilitation Hospital
Case study - Holland Bloorview
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
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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