Case studies
Social Movement Action Framework
Engaging an interprofessional change team to lead implementation: West Park Healthcare Centre
West Park Healthcare Centre applied a call to action to implement best practice guidelines with the support and guidance of their senior leadership and implementation teams. Learn more about the role of core leadership structures in this case study.
West Park Healthcare Centre, an RNAO BPSO, is a rehabilitation and complex care centre in Toronto, Canada. They applied a compelling call to action to implement these RNAO BPGs: Assessment and Management of Pain, Client Centred Care and Prevention of Falls and Fall Injuries in the Older Adult.
With support from senior leadership, interprofessional change teams – including nurse leaders, such as advanced practice nurses and nurse practitioners – were responsible for leading the implementation strategies, which included taking collective action. Implementation efforts focused on engaging in quality improvement measures, promoting the culture and values of evidence-based practice and aligning their implementation efforts to the organization’s culture and values.
As members of the implementation teams, the nurse leaders were influencers who aimed to build collaborative and committed relationships amongst the interprofessional team and create a work environment that empowered staff to take evidence-based action. The team embraced diverse perspectives and knowledge to allow for adaptations to the local context.
Engaging collective strength in action at Central West Specialized Developmental Services
The change team at Central West Specialized Developmental Services (CWSDS) has built a strong core leadership structure to support their implementation efforts by including both formal and informal leaders.
Central West Specialized Developmental Services (CWSDS) is a pre-designate Best Practice Spotlight Organization® (BPSO®.) During the BPSO pre-designation process, the CWSDS change team has built a strong core leadership structure to support the implementation of best practices, by including both formal and informal leaders.
The CWSDS change team relied on the following strategies to build a strong core leadership structure:
CWSDS’s RNAO-BPSO organizational structure. Figure provided with permission by CWSDS.
- embedding the RNAO BPSO pre-designation process within the organization’s strategic plan.
- emphasizing the interprofessional nature of the initiative by encouraging professionals from all disciplines to become involved.
- engaging an interprofessional team of stakeholders within the organization with the change, including direct support professionals, managers, food services, human resources staff, and members of the communication and information technology teams.
- encouraging stakeholders to become trained RNAO Best Practice Champions and to participate in RNAO events.
- making sure all stakeholders were informed and involved in the change initiative (by, for example, providing updates during managerial meetings and including stakeholders in completing gap analyses.)
- supporting Best Practice Champions in leading best practice guideline (BPG) implementation alongside the BPSO Steering Committee.
As a result of the change team’s work to build a core leadership structure, they were able to tailor the implementation of BPGs toward daily clinical problems relevant to their direct support professionals. This increased recognition of and support for their change initiative.
To learn more about CWSDS’s BPG implementation journey, watch their 38-minute webinar: Collective Strength in Action: How to Promote and Implement Best Practice Guidelines.
Engaging a network to strengthen alliances for an Indigenous school diabetes prevention project
An Indigenous diabetes prevention school project used a network to support community partner's capacity building and collaboration. Read more in this case study.
In Quebec, Canada, community groups and researchers participated in a network using social movement approaches for the Kahnawake Schools Diabetes Prevention Project. In the early phase of the social movement, the network supported capacity building and collaboration of the community members. As the movement evolved, the network strengthened alliances among the community members and their shared decision-making. It also supported the program’s expansion to more children. At the conclusion of the project, the network supported the emerging leadership of the community partners (Tremblay et al., 2018).
Knowledge-to-Action Framework
Implementing effective interventions for drug and alcohol use using Screening, Brief Intervention and Referral to Treatment (SBIRT)
Evidence-based interventions to support the development of a screening, brief intervention and referral to treatment (SBIRT) for persons who use drugs and alcohol.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is endorsed by the Substance Abuse and Mental Health Services Administration as an effective intervention for drug and alcohol use. SBIRT has been implemented in multiple health-care settings including acute care.
Implementation leaders were asked to identify barriers, facilitators, as well as implementation strategies that would be most helpful. From this review, implementation leaders perceived that providing ongoing consultation to clinicians for using SBIRT, distributing educational materials to clinicians, and conducting audits and providing feedback were the most helpful.
All implementation leaders voiced the value of available training resources, and peer support as they moved through the implementation process.
Implementation leaders felt more confident leading change in the future due to the knowledge and skills they developed during SBIRT implementation. They also learned the importance of leveraging support from other interprofessional team members, such as social workers and clinical educators.
Read more about it here. Learn more about SBIRT here. Or, review our best practice guideline, Engaging Clients Who Use Substances.
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 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).
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.
