Case studies
Social Movement Action Framework
Building a global collective identity to advance knowledge uptake and sustainability - the RNAO Best Practice Spotlight Organization (BPSO) Program
RNAO's Best Practice Spotlight Organization (BPSO) program has integrated a collective identity of knowledge champions to advance evidence uptake and sustainability.
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The Best Practice Spotlight Organization® (BPSO®) Program (https://rnao.ca/bpg/bpso) has global reach and impact that is sustained by many factors, including the development of collective identity that promotes an evidence-based culture. The BPSO logo, as a tangible representation of a collective identity, is displayed in individual sites to indicate they are BPSO units. This visibility motivates and inspires nurses and other staff to use best practice guidelines (BPG) to support the health and well-being of staff, patients/persons and their families. Participation and membership in the international BPSO network further the ties and pride of BPSO and builds the collective identity (Grinspun & Bajnok, 2018).
Within organizations, individual BPSOs nurture Best Practice (BP) Champions (https://rnao.ca/bpg/get-involved/champions) who take on leadership roles to support the planning, implementation, evaluation and sustainability of BPGs. Nurses and other staff members develop a collective identity based on a culture of integrating evidence-based practice to achieve excellence in care. The visibility of BP Champions is seen when staff where BPSO-branded clothing items, and pins that are awarded at the completion of the Best Practice Champions’ training workshop (see the examples below of social media posts of BPSO-branded t-shirts and a pinning ceremony of new champions by RNAO CEO, Dr. Doris Grinspun) (Grinspun & Bajnok, 2018). |
Mobilizing community engagement to sustain a childhood obesity prevention initiative
Multiple communities mobilized to sustain a childhood obesity prevention program through targeted individual and collective action. Read more in this case study.
A community initiative called Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) provides an example of collective action in the context of public health.
In the SCOPE public health initiative, the community formed a coalition with local partners such as libraries and primary care offices to take collective action for the prevention of childhood obesity. Together, they participated in a range of collective action activities, including: presentations and events promoting healthy eating choices, stakeholder engagement, resource development and policy and practice change (Kennedy et al., 2019a).
Promoting healthy public policy through mobilized collective actions
Queen’s Park on the Road and Queen’s Park Day are two events in which RNAO members meet with members of provincial parliament (MPPs) from all of the political parties to promote healthy public policy and nursing services. through individual and collective actions. Learn more in this case study.
Through two annual initiatives – Queen’s Park on the Road and Queen’s Park Day – RNAO members meet with members of provincial parliament (MPPs) from all of the political parties to promote healthy public policy and nursing services. Through direct engagement and advocacy with MPPs, RNAO has mobilized collective action for policy initiatives addressing areas such as poverty reduction, the use of pesticides for cosmetic use, promoting refugee health and protecting the safety and security of residents in long-term care (Grinspun et al., 2018a).
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.
Identifying the problem at Cardioinfantil Foundation of Cardiology Institute (FCI-IC) to achieve excellence in care
Cardioinfantil Foundation of Cardiology Institute is an acute care facility with a goal of achieving excellence in care in the prioritized areas of fall prevention and wound care.
Cardioinfantil Foundation of Cardiology Institute (FCI-IC) is a 340-bed hospital in Bogotá, Colombia. Recognizing that the use of best practice guidelines (BPG) for nursing care was uncommon in Colombia, they joined RNAO’s Best Practice Spotlight Organization® (BPSO®) program with the goal of achieving excellence in care.
FCI-IC had 10 years of evaluation data that revealed problems in specific clinical areas such as fall prevention and wound care. They conducted a baseline diagnostic evaluation to identify the highest priority problems to tackle and to select the most appropriate guidelines and best practice recommendations. As part of this, they surveyed their key partners in the change to learn more about their use of assessment tools, the status of electronic medical records, routine clinical practices such as the use of bed rails, and prevalence data.
This assessment process led to them selecting three RNAO BPGs as knowledge tools: Prevention of Falls and Fall Injuries in the Older Adult, Risk Assessment and Prevention of Pressure Ulcers, and Assessment and Management of Foot Ulcers for People with Diabetes.
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.
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.
