Case studies
Social Movement Action Framework
The Alabama Comprehensive Cancer Control Coalition
A coalition of community partners who took action and created change for cancer prevention and promotion.
In Alabama, United States, a public health community coalition targeting breast and cervical cancer prevention engaged in grassroots advocacy to influence policy and legislation for smoke-free spaces (Wynn et al., 2011).
This coalition was made up of local stakeholders, including an interdisciplinary committee of government officials, faith-based organizations, academics, researchers and volunteers. Their collective efforts were effective in part because the people involved were receptive to change.
There was a strong impetus for change caused by these concurrent factors:
- data showing an unequal burden of cancers among Black Americans due in part to higher rates of tobacco use and second-hand smoke exposure.
- recognition that the risk of cancers could be lowered by: implementing evidence-informed strategies; increasing public awareness and advocacy; and promoting healthy public policy.
- the coalition’s commitment to creating social change by improving the health and well-being of the community to achieve positive health outcomes.
- public support for the establishment of legislated smoke-free areas, evident from the results of local and national Gallup polls.
- an understanding of the powerful impact of social movement actions to create change.
This receptivity to change led the coalition to engage in social movement actions. They became empowered by learning strategies to lead change; they realized the power of their collective voices and mobilized actions. They felt their actions were timely and needed due to the data indicating rising cancer levels amongst Black Americans. They were committed to taking action to address and rectify health inequities.
Advocating for supervised injection services to save lives
RNAO advocates for making harm reduction services available for people who use substances as a means of saving lives. To this end, individual and collective actions has resulted in continued access to supervised injection services. Read more in this case study.
RNAO supports making harm reduction services available for people who use substances as a means of saving lives, reducing stigma and building healthy communities. As part of this work, RNAO advocates for using evidence to inform policy in the area of supervised injection services.
When the only supervised injection services site in Canada faced threats of closure by the federal government, RNAO mobilized by engaging members’ support, the media and the public. As part of a coalition, RNAO and others advocated for and participated in a hearing before the Supreme Court of Canada.
As a result of the evidence on the benefits of harm reduction and public interventions advocating for the continued access to supervised injection services, the court ruled that the site should remain open. The victory led to the groundwork for additional supervised injection services to open in other provinces across Canada, including Ontario (Grinspun et al., 2018a).
Championing clinical excellence through intrinsic motivation at Vall d'Hebron Barcelona Hospital Campus
Vall d’Hebron Barcelona Hospital Campus championed clinical excellence through nurses' and other staff's leadership and intrinsic motivation.
In Barcelona, Spain, Vall d’Hebron Barcelona Hospital Campus, a Best Practice Spotlight Organization®(BPSO®) Nursing care | Vall d'Hebron Barcelona Hospital Campus (vallhebron.com), nurses and other staff became RNAO Best Practice Champions in several clinical areas including breastfeeding, ostomy and wound care. A ceremony was held to recognize the champions’ leadership and their commitment to using evidence-based guidelines to achieve excellence in clinical practice. Their intrinsic motivation is evidenced by their dedication to providing best practices and optimizing their patients’ health and well-being. For more information, watch the video BPSO Program: Excellence in Cares of Infirmary - YouTube
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.
