Case studies

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

RNAO’s Best Practice Spotlight Organization® (BPSO®) program itself was scaled up, scaled out and scaled deep – on the national level – when RNAO and the Canadian Patient Safety Institute (CPSI) entered into a formal partnership on a pan-Canadian falls prevention initiative campaign in 2007, with a focus on long-term care (LTC) (McConnell et al., 2018).

This collaboration involved the implementation of best practices, capacity building at the micro and meso levels with individuals and organizations, and engagement with national partners. The work was informed by the first and second editions of RNAO’s best practice guideline (BPG) Prevention of Falls and Fall Injuries in the Older Adult and CPSI’s program Safer Healthcare Now! on falls prevention as a critical patient safety issue Reducing Falls and Injuries from Falls.

The National Collaborative on Falls Prevention in Long-Term Care, launched in 2008–2009, included staff from 32 LTC homes and an interprofessional expert panel. The goals of the collaborative:

1. to reduce the rate of falls in older adults by educating and training staff and patients about fall prevention
2. develop a forum for improvement teams
3. participate in a methodology on quality improvement initiatives using the Model for Improvement (Langley et al., 2009).

The collaboration was highly successful – process indicators showed decreased rates of falls in the LTC homes following implementation. However, it was determined that more time and support would be needed to scale the fall prevention initiative out and deep to in order to embed and sustain the practice changes. 

In 2010–2011, the collaborative expanded to a national campaign where the program was delivered virtually to more than 45 organizations from diverse health sectors using web-based technology. This enabled greater access to the program with impressive outcomes, and showed that technology could be used as a tool to scale the program up and out.

This was followed up by creation and delivery of a fall prevention learning series in 2011–2012 to strengthen the uptake and sustainability of best practices. The training integrated implementation science, change theory and quality improvement methodology. As with the other collaboration components, the outcomes of the learning series demonstrated improvements in practice changes and reductions in falls causing injury, and organizational policies to support and sustain the change. The continued use of evaluation to determine outcomes and impact as part of quality improvement and using ongoing audit and feedback demonstrated a change that was scaled deep. 

The collaboration helped embed principles of social action movement by its focus on a credible and important shared concern – preventing falls – where urgent change was needed. Momentum was used to support the continued engagement of fall prevention champions across sectors. Networks were used to share resources and expand collaborations across communities.          ​​​​​​

The Best Practice Guideline (BPG) Program has supported the leadership and influence of thousands of Registered Nurses’ Association of Ontario (RNAO) Best Practice (BP) Champions as change agents engaged in the implementation of evidence-based practice changes.

For example, at Clínica las Condes (CLC), a Latin American Best Practice Spotlight Organization® (BPSO®) in Santiago, Chile, BP Champions are committed volunteers consisting mostly of nurses and other health professionals. Their leadership is evident in the multiple activities they lead, including:

• reviewing guidelines and organizational policies
• motivating colleagues
• presenting guideline recommendations at clinical services meetings twice a year
• ensuring adherence to practice changes in their clinical units

(Serna Restrepo et al., 2018)