Case studies
Social Movement Action Framework
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).
Advancing knowledge uptake and sustainability through RNAO's Best Practice Champions Network®
The Best Practice Champions Network® has been engaging change agents for over two decades to facilitate connection, a sense of belonging and a place to continue the implementation of best practice guidelines.
Launched in 2002, the RNAO Best Practice Champions Network® supports the active engagement of volunteer peer Best Practice Champions in knowledge exchange amongst one another, and between them and RNAO. Through this international network, more than 100,000 champions access tools and strategies such as workshops, webinars and online modules (Grinspun, 2018).
Knowledge-to-Action Framework
Applying the Knowledge-to-Action Framework to reduce wound infections at Perley Health
A case study on reducing wound infections at Perley Health in Ottawa, Ontario to advance best practices using the Knowledge-to-Action framework.
Perley Health is a designate Long-Term Care Best Practice Spotlight Organization® (BPSO®) which demonstrates a strong commitment to providing evidence-based care. During the pandemic, the team identified skin and wound infection as a clinical concern among their residents. Consistent with the literature, residents at Perley Health experiencing comorbid medical conditions such as frailty, diabetes, and arterial and venous insufficiency were at increased risk for chronic wound infections [1]. Chronic wounds are a prime environment for bacteria, including biofilm, making wound infection a common problem [2] [3]. Managing biofilm, which can affect wound healing by creating chronic inflammation or infection [3], becomes crucial as up to 80 per cent of infections are caused by this type of bacteria [4] [5].
To adopt and integrate best practices, the team at Perley Health decided to implement the Assessment and Management of Pressure Injuries for the Interprofessional Team best practice guideline (BPG). To support a systematic approach to change, four of the action cycle phases of the Knowledge-to-Action Framework, from the Leading Change Toolkit [6] are highlighted below.
Identify the problem
Perley Health’s wound care protocol was audited and the following gaps were identified based on current evidence:
- Aseptic wound cleansing technic could be improved, as nonsterile gauze was used for wound cleansing.
- Wound cleaning solution was not effective to manage microbial load in chronic wounds
- Baseline wound infection data were collected on the number of infected wounds within the organization each month over three years and is ongoing
Adapt to local context
The project was supported by key formal and informal leaders within the organization including the Nurse Specialized in Wounds, Ostomy and continence (NSWOC), the Director of Clinical Practice, a team of wound care champions, the IPAC team and material management. Staff was motivated to improve resident outcomes by lowering infection rates which facilitated the project but many continued to use old supplies so as to not waste material. Providing the rationale for the change and associated best practices improved knowledge uptake, as did removing old supplies to cut down on confusion. Barriers the team encountered included staff turnover and educating new team members.
Select, tailor, implement interventions
The interventions listed below were selected, tailored and implemented based on the evidence that was adapted to the local context. They were purposely chosen to support the clinical teams’ needs on busy units and to creatively overcome staffing challenges. Interventions included:
- use of a wound cleanser containing an antimicrobial
- use of sterile equipment for wound care, including sterile gauze
- creation of a wound-cleansing protocol was created to reflect best practice
- updating and approval of a policy by the Risk Assessment and Prevention of Pressure Ulcers team in collaboration with the director of clinical practice
Perley Health also created and delivered education in two formats designed to be accessible to front-line staff:
- Just-in-Time education was provided on every unit, on every shift, to registered staff by the NSWOC on all shift sets, over a one-month period. Wound care champions were available on each shift to aid in learning and answer additional questions to support the team’s needs.
- A continuing education online learning module was created and uploaded onto Perley Health’s Surge learning platform. Training is included in new hire onboarding and mandatory for yearly education.
Image
An RPN demonstrating how to cleanse a wound using wound cleanser at Perley Health
Evaluate outcomes
Evaluation indicators were selected to determine the impact of the implementation interventions when compared to baseline data, including the rate of wound and skin infections per 1,000 days. A 50 per cent reduction in wound infections was identified following the implementation of the identified change strategies and education above.
This graph represents four years of data collection on wound infections at Perley Health. Three years of baseline data and one year of post-implementation data are highlighted in red.
References
- Azevedo, M., Lisboa, C., & Rodrigues, A. (2020). Chronic wounds and novel therapeutic approaches. British Journal of Community Nursing, 25 (12), S26-s32.
- Landis, S.J. (2008). Chronic Wound Infection and Antimicrobial Use. Advances in Skin & Wound Care, 21 (11), p 531-540.
- Registered Nurses’ Association of Ontario (2016). Clinical best practice guidelines: Assessment and management of pressure injuries for the interprofessional team (3rd ed.). Registered Nurses’ Association of Ontario: Toronto, ON.
- Jamal, M., Ahmad, W., Andleeb, S., Jalil, F., Imran, M., Nawaz. M., Hussain, T., Ali, M., Rafiq, M., & Kamil, M.A. (2018). Bacterial biofilm and associated infections. J Chin Med Assoc. 81(1): 7-11.
- Murphy, C., Atkin, L., Swanson, T., Tachi, M., Tan, Y.K., De Ceniga, M.V., Weir, D., Wolcott, R., Ĉernohorská, J., Ciprandi, G., Dissemond, J., James, G.A., Hurlow, J., Lázaro MartÍnez, J.L., Mrozikiewicz-Rakowska, B., & Wilson, P. (2020). Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care, (Sup3b):S1-S26.
- Registered Nurses’ Association of Ontario (2022). Leading change toolkit: Knowledge-to-action framework. https://rnao.ca/leading-change-toolkit Registered Nurses’ Association of Ontario: Toronto, ON.
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.
Leveraging innovative quality monitoring - Humber River Hospital
Humber River Hospital is an acute care facility that has used continuous monitoring to determine the impact of BPG implementation and staff performance.
A major acute-care hospital in Toronto, Ontario, Humber River Hospital (now Humber River Health) has used continuous monitoring to determine the impact of their BPG implementation and staff performance.
These tiles, displayed on large screen monitors in a Command Centre (pictured above), are integrated into the daily delivery of care to support physicians, nurses, and other clinical staff. Each row within the tile represents a patient, followed by where they are located. By clicking on a patient, staff can see more information regarding the clinical criteria that put them on the tile.
With every patient, there is an expected time in which the issue should be resolved based on a service level set by the hospital. If the system detects that the process is taking longer than expected, the icon will escalate to amber and then to red, indicating a higher level of alert.
Tiles also include several quality monitoring indicators based on RNAO's best practice guidelines (BPG) related to fall risk intervention, wound and skin management, pain management and delirium management. By centralizing data in the Command Centre, the monitoring indicators empower clinicians so that they can intervene in a timely manner to ensure that best practices are followed.
Read more about this innovative quality monitoring approach here: https://www.hrh.ca/2020/08/04/cc-risk-of-harm/
Engaging Persons with Lived Experiences
Integrating patient partners in change – Lessons learned from Kidney Health Australia
Kidnney Health Australia case study
In early 2018, Kidney Health Australia (KHA) developed a guideline for managing percutaneous renal biopsies for individuals with chronic kidney disease (Scholes-Robertson et al., 2019). KHA included 40 persons from across Australia with lived experience of chronic kidney disease and their caregivers – “patient partners”. KHA asked patient partners to prioritize which topics were most important to them during a percutaneous renal biopsy.
Patient partners valued: minimizing discomfort and disruption, protecting their kidneys, enabling self-management, and making sure that support for families and caregivers would be available. They indicated that all of this would help alleviate anxiety and avoid undue stress. Their voices were heard, and KHA effectively incorporated these suggestions in guideline development.
Notably, there were marked differences between the priorities identified by the content experts on the guideline development working group, versus what the patient partners perceived to be important to their health and wellbeing, as shown in the table below.
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Topics prioritized by content experts |
Topics prioritized by patient partners |
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