Case studies
Social Movement Action Framework
Increasing visibility to advance the rights of Deaf children
A community coalition in Los Angeles, California took collective action to advocate for the rights of Deaf children in accessing child abuse prevention and treatment services. he coalition took multiple steps to increase visibility, spread awareness and gain support. Read more in this case study.
A community coalition in Los Angeles, California took collective action to advocate for the rights of Deaf children in accessing child abuse prevention and treatment services. The coalition took multiple steps to increase visibility, spread awareness and gain support. Some examples:
- one of the member organizations wrote an article published in a magazine for the Deaf community advocating for the protection of Deaf children.
- A presentation by coalition members was made at a local synagogue that included members of the Deaf community.
- A local social event included a focus on the collective actions of the coalition and how attendees could financially support their efforts.
These activities drew further attention to the collective action being taken and the urgency for change (Embry and Grossman, 2006).
Sustaining a health system change with momentum
To create system level changes in health-care in the United Kingdom, momentum was fostered to achieve goals. Read more in this case study.
The Health as a Social Movement project for the National Health Services (NHS) developed the Programme Theory of Change to create system-level changes in health care in the United Kingdom.
The project used this theoretical model to provide impetus for change by defining goals for the change. These goals included connecting individuals, groups and organizations acting as change agents with the health system to mobilize local action for health.
Momentum played a pivotal role in achieving system change and transformation. Indicators of momentum included:
- an increase in social connectedness of individuals, groups and/or organizations
- higher levels of control, resourcefulness and resilience in the community
- an increase in change agents’ confidence and influence over the health system
The sustained momentum arising from the individual and collective action aimed to support a preventable and sustainable health system, characterized as having:
- improvements in local services
- an integration of determinants of health into service provision
- higher levels of health and well-being (Arnold et al., 2018).
Maintaining momentum to achieve excellence - Unity Health Toronto: St. Michael's Hospital
To keep the momentum as a Best Practice Spotlight Organization® (BPSO®), Unity Health Toronto: St. Michael’s Hospital engaged their Professional Practice team as change leaders. Read more in this case study.
To keep the momentum as a Best Practice Spotlight Organization® (BPSO®) implementing, evaluating and sustaining RNAO best practice guidelines (BPGs), Unity Health Toronto: St. Michael’s Hospital, https://rnao.ca/bpg/bpso/st-michaels-hospital, an acute care facility in Toronto, Ontario, Canada engaged their Professional Practice team as change leaders. Strategies the Professional Practice team have used to maintain momentum include:
- profiling the activities, leadership and achievements of their champions and other change agents
- using newsletters, posters and pins to promote BPSO and increase its visibility
- participating in poster galleries and nursing rounds
- publishing multiple articles in scholarly and professional journals to highlight key accomplishments and deliverables
- creating and using an intranet site to update staff on BPSO activities (Ferris, Jeffs, Krock, & Skiffington, 2018).
Knowledge-to-Action Framework
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.
Overcoming barriers to evidence-based practice – Lessons learned from DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing
DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing are international BPSOs in Beijing, China. Staff at the sites identified barriers to the use of evidence in practice including heavy workloads, cultural differences and reluctant attitudes about using evidence to inform practice.
DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing are international BPSOs in Beijing, China. They identified barriers to the use of evidence in practice including heavy workloads, cultural differences and reluctant attitudes about using evidence to inform practice. The assessment and identification of barriers allowed change teams to develop effective strategies for implementation with the input of stakeholders.
For example, for the implementation of the RNAO best practice guideline Assessment and management of foot ulcers for people with diabetes, barriers included
- nursing shortages across China,
- a lack of training to support the development of knowledge and skills in evidence-based nursing practice,
- the costs of guideline implementation. and
- practice recommendations that exceeded local nursing scope.
SOURCE: Transforming Nursing Through Knowledge, 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
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.
