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
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).
Facilitating an evidence-based culture at Unity Health Toronto - St. Michael’s Hospital
Unity Health Toronto - St. Michael’s Hospital, a Best Practice Spotlight Organization® (BPSO®) has embedded evidence-based practices into its culture and daily work processes as part of its corporate strategy.
Unity Health Toronto - St. Michael’s Hospital, a Best Practice Spotlight Organization® (BPSO®) in Toronto, Canada, has embedded evidence-based practices into its culture and daily work processes. Evidence-based practice is part of the hospital’s corporate strategy. It has invested resources to build a critical mass (over 30 per cent) of staff members who are best practice champions.
The hospital also provides multiple capacity-building opportunities, including a community of practice, boot camps, booster sessions and mentorship. The annual Nursing Week Gallery Walk, depicted in the image above, is just one way that St. Michael’s Hospital profiles the work of champions and others dedicated to using evidence to inform change initiatives.
SOURCE: Transforming Nursing Through Knowledge, 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.
Engaging Patient Family Advisors to advance guideline implementation at Scarborough Health Network
A case study about the integration of patient family advisors at Scarborough Health Network to enhance community engagement and health equity.
Scarborough Health Network (SHN) (Home - Scarborough Health Network (shn.ca) is an organization pursuing Best Practice Spotlight Organization® (BPSO®) designation in Scarborough, Ontario, Canada. Patient Family Advisors (PFAs) are a vital part of SHN’s philosophy of care, representing the diverse community SHN serves. A key element of the PFA role is sharing lived experiences with SHN staff and the Scarborough community.
SHN has demonstrated commitment to the role of PFAs within their organization by creating a new department for health equity, patient and community engagement (HEPCE). This department focuses on:
- recruiting, onboarding, managing, recognizing and retaining PFAs
- educating staff on best practices related to engaging with PFAs
During recruitment and onboarding, the HEPCE and current PFAs educate potential PFAs about the role’s scope and expectations. All PFAs are also provided with information on how to share their patient or caregiver story with their audience.
PFAs have played an important role in SHN’s BPSO committee. Indeed, one PFA has been integral to the process of recruiting and engaging champions at SHN throughout the COVID-19 pandemic’s health human resources (HHR) crisis. Their role has included participating in champions’ virtual drop-in sessions (2020-2021) and in-person roadshows (2022).
Champion roadshows are events during, which SHN practice leaders and PFAs promote the BPSO program, share best practice guidelines and recruit champions around the organization, without asking busy staff members to leave their units.
The PFA also supported the recruitment and engagement of champions by:
- collaborating with other champions and working group members to plan champions’ drop-in sessions and roadshows
- working alongside the team to plan safe spaces for staff and PFAs to share their stories
- sharing stories of positive experiences with staff members in relation to the impact of best practices (for example, RNAO’s Person and Family Centred-Care best practice guideline) on their experience
Staff members have reported being motivated to become best practice champions after attending a champion’s roadshow. SHN has also consistently gained champions during the HHR crisis and maintains at least 15 per cent of nursing staff as best practice champions.
The PFA’s role was vital to demonstrating the lasting impact of best practices. They have expressed feeling empowered by their role in BPSO work, expressing that the work helped them find their voice and become part of the movement to promote and implement best practices.
Overall, PFAs play an essential – and dual – role in supporting the implementation of best practices at SHN. In line with person- and family-centred care, PFAs assume an outward-facing role in shaping the implementation of best practices and SHN’s values. In addition, they also act in an inward-facing role to support the bolstering of champions.
To learn more about the PFA role at SHN, please visit the following link: Patient Family Advisors.
Shared with permission by Scarborough Health Network
Co-designing change through the active engagement of persons with lived experience - Holland Bloorview Kids Rehabilitation Hospital
Case study - Holland Bloorview
Holland Bloorview Kids Rehabilitation Hospital (Holland Bloorview) is a designated Best Practice Spotlight Organization® (BPSO®) in Toronto, 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.
These family leaders are families and caregivers who have received services at Holland Bloorview and have lived experiences of paediatric disability. Their roles include mentoring other families, acting as advisors to committees and working groups, and co-teaching workshops to students and other families.
One example of a successful implementation co-design within Holland Broadview is the ENFit™ Working Group. This interprofessional team works on the adoption of a new type of connection on products used for enteral feeding – or 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. This in turn decreases harm to children and youth who require enteral feeding.
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, the potential impacts on persons and families were emphasized. The working group engaged the family member by:
- co-creating the implementation plan
- involving them in a failure mode and effects analysis highlighting 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
Shared with permission from Holland Bloorview
