Case studies
Social Movement Action Framework
Engaging champions' narratives
This RNAO champions training program used storytelling, metaphors, collective artwork and personal narratives to frame the importance of person-and family-centred care. Learn more
This RNAO champions training program used storytelling, metaphors, collective artwork and personal narratives to frame the importance of person-and family-centred care.
Doodling to frame the issue of poverty
Doodles are a creative expression of framing to position an issue and build meaning. Learn morew in this case study.
Here is an example of a doodle used to frame the issue of poverty. The notion of people being "locked in" by circumstances outside their control is a powerful metaphor. This doodle shows some of the main factors that combine to restrict and restrain people, locking them into poverty. (Joseph Roundtree Foundation)
Transforming long-term care reform
The urgent need to transform long-term care (LTC) in Ontario gained broad support in 2020 during the COVID-19 pandemic. Read more in this case study.
The urgent need to transform long-term care (LTC) in Ontario gained broad support in 2020 during the COVID-19 pandemic. The pandemic exposed long-standing system failings. Examples of triggers included:
- an alarming mortality rate resulting from COVID-19 in LTC settings, representing a large majority of COVID-19-related deaths in Ontario
- a scathing report from the Canadian Armed Forces
- devastating stories from families who were separated from loved ones
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.
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 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
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.
