Case studies

A group of volunteers, staff and physicians from St. Joseph’s Healthcare Hamilton, an acute care facility in Hamilton, Ontario, Canada engaged in a social movement to address environmental issues, such as carbon emissions (Herechuk et al., 2010). The change agents formed a team of grassroots activists called the Environmental Vision and Action. They were intrinsically motivated as environmental stewards to make sure changes were made that aligned with environmental determinants of health. Through the support of the hospital’s senior leadership team, the hospital went “green” with environmentally-driven organizational changes, including the creation of a model for environmental excellence. For more details, see Achieving environmental excellence through a multidisciplinary grassroots movement - ScienceDirect 

Behavioural Supports Ontario (BSO) is a pre-designate Best Practice Spotlight Organization® (BPSO®) serving long-term care (LTC) homes in Hamilton, Haldimand-Norfolk, Brantford, Burlington and Niagara Regions. BSO aims to enhance care and services for older adults with dementia, complex neurological conditions and mental health challenges who present with responsive behaviours through comprehensive assessment and the development of strategies to optimize care for the resident. 

The Hamilton Niagara Haldimand Brant (HNHB) BSO team supports 86 LTC homes with more than 11,200 beds combined. Using transformational leadership and applying key characteristics from the Social Movement Action (SMA) Framework, the organization successfully shifted the culture of the organization to one that supports and sustains high quality and best practices by engaging and motivating staff.  Integral to the process was a strong core leadership team of interprofessional staff, intrinsic motivation and momentum.

The organization used RNAO’s BPSO model and gap (opportunity) analysis tools to identify and evaluate areas of improvement in process and practice in three fields of work during the implementation of three RNAO best practice guidelines (BPG) – Person and Family Centered Care, Identification and Assessment of Pain and the Management of Delirium, Dementia and Depression. The impact on personalized care and satisfaction with care are described in Figures 1 and 2.  

Figure 1: Percentage of residents and families participating in developing their personalized plan of care (assessments completed during referrals) 

Evaluation impact: There was a 50.3 per cent increase in residents’ and families’ participation in developing personalized care plans.  Data remained consistently above the HNHB average since January 2021.

Figure 2: Number of residents and families satisfied with their involvement in care and treatment planning

Evaluation impact: There was an 80 per cent increase in residents’ and families’ satisfaction with their involvement in the care and treatment plan at the five implementation sites. Survey results from the five implementation sites demonstrated that residents and families responded “always” and “usually” when asked if they were satisfied with their involvement in the care and treatment planning.

In addition to these outcomes, HNHB BSO has identified the following improvements via quantitative data: 

• increased number of screenings and assessments for pain completed
• improved consistency in the screening and assessments of delirium, dementia and depression for all clients
• improvement of more than 80 per cent in the number of residents and families satisfied with their involvement in care and treatment planning

Lessons learned

While implementing the BPGs, HNHB BSO discovered several effective strategies, including the following: 

• Engaging staff to agree on a common resident-centered goal by developing a “BSO High Five” program. This program recognizes front-line workers who have demonstrated a person-and family-centered approach to care and have motivated other staff to implement and sustain best practices.
• Applying transformational leadership that focused on staff and stakeholder involvement and engaging them throughout the assessment, planning, implementation and evaluation phases of BPG implementation.
• Developing a best practice steering committee that includes formal and informal leaders, staff, and stakeholders. Persons with lived experience are also engaged in the committee to ensure the incorporation of a global perspective into the planning process from the start.
• Ensuring best practices are on all meeting agendas to sustain momentum toward BPG implementation.
• Conducting process and education gap analyses to address areas of improvement as part of a quality improvement project. 
• Valuing staff-driven changes and improving synchronization between the project managers and the team to ensure cohesion, a common identity and a shared vision.
• Understanding the importance of going slow and growing the changes to ensure the alignment amongst all staff. This was crucial to the planning and evaluation phases and allowed for the realignment of strategies and approaches, if necessary, during the implementation of projects. 

Shared with permission from Hamilton Niagara Haldimand Brant (HNHB) Behavioural Supports Ontario (BSO)

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