Case studies
Social Movement Action Framework
Advancing the global Black Lives Matter movement to end systematic racism
The urgent need to end systemic racism gained international traction following the death of George Floyd. Learn more about how an urgent need for action fosters social movement action in this example.
The urgent need to end systemic racism gained international traction following the death of George Floyd. Support for the global Black Lives Matter movement increased, leading to national and international discussions on structural racism and demands to address long-standing problems of police brutality. Calls to action included defunding the police and a global movement for justice, freedom and liberation.
Applying focused strategies and training to achieve a timely change
Staff at the Birchmount and General site locations of Scarborough Health Network in Toronto, Ontario, Canada are committed to providing excellence in clinical practice. In addition to implementing best practice guidelines focused on clinical care, they have also address healthy workplace environment issues including focusing on anti-bullying. Learn more in this case study.
Staff at the Birchmount and General site locations of Scarborough Health Network (SHN) in Toronto, Ontario, Canada are committed to providing excellence in clinical care. At this Best Practice Spotlight Organization® (BPSO®) Best Practice Spotlight Organization (BPSO) – Scarborough Health Network (shn.ca), there was a strong interest and shared concern from staff and leadership teams on the prevention of bullying in the workplace.
In response, they chose to focus on anti-bullying as an area for improvement. To do so, they implemented the Preventing and Managing Violence in the Workplace Best Practice Guideline (RNAO, 2009). Collaborative efforts from the interprofessional team contributed to developing targeted strategies and training, leading to effective action.
Building capacity in change agents for health innovation and transformation
United Kingdom junior doctors increased their capacity as change agents after mobilizing and implementing the WHO surgical checklist.
Although positioned as the “future leaders of health-care transformation and innovation,” junior doctors (or interns) in the United Kingdom actually receive very little training in leadership competencies at medical schools to prepare for this role (Carson-Steven et al., 2013). Instead, they learn in clinical environments that are frequently unreceptive to change and innovation informed by best practices.
To overcome these barriers and emerge as leaders, a group of junior doctors chose to independently learn how to innovate and champion evidence-based practice by applying social movement approaches including mobilizing for change. By participating in programs, such as the Institute for Healthcare Improvement’s “Open Schools,” they built capacity in social movement thinking and actions and used their knowledge, skills, networks and experiential learning to drive change in their clinical practice.
The junior doctors applied social movement actions when they led a change initiative to implement the World Health Organization’s guidelines on the use of surgical safety checklists for patient safety. They co-created a supportive learning community to learn together and from one another and to overcome obstacles and resistance. As emerging leaders, they engaged in collective action, including organizing a “teach-in” to raise awareness about the urgent need for change and the implementation of best practices in surgical care as determined through evidence. And, each doctor committed to recruiting colleagues to strengthen the social movement and build momentum and a critical mass.
For more details, see The social movement drive: a role for junior doctors in healthcare reform - PubMed (nih.gov).
Knowledge-to-Action Framework
Sustaining the Assessment and Management of Pain Best Practice Guideline across a multi-site long-term care home
The Region of Peel, a Best Practice Spotlight Organization® (BPSO®), has sustained the implementation of the Assessment and Management of Pain best practice guideline (BPG) for almost a decade.
The Region of Peel, an RNAO Best Practice Spotlight Organization® (BPSO®) started implementing the RNAO Assessment and Management of Pain best practice guideline (BPG) in 2014 and has sustained its use since then. For example, in their 2019 BPSO annual report, they cited a continuous downward trend in the number of clients who reported a worsening of their pain. Pain experienced by the residents was better controlled, and the staff was found to assess, identify, and manage pain better by using the BPG.
Their keys to success include:
- building on what works (for example, existing practices and policies)
- empowering champions and growing their champion network
- involving residents and families
- gaining support from leaders and partners including RNAO, Peel of Region Leadership, Health Quality Ontario).
- collaborating with an interdisciplinary team
- conducting a formal sustainability evaluation
To learn more about The Region of Peel’s journey in sustaining the use of the Assessing and Managing Pain BPG, along with other BPGs, check out this webinar.
Overcoming barriers to evidence-based practice – Lessons learned from DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing
DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing are international BPSOs in Beijing, China. Staff at the sites identified barriers to the use of evidence in practice including heavy workloads, cultural differences and reluctant attitudes about using evidence to inform practice.
DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing are international BPSOs in Beijing, China. They identified barriers to the use of evidence in practice including heavy workloads, cultural differences and reluctant attitudes about using evidence to inform practice. The assessment and identification of barriers allowed change teams to develop effective strategies for implementation with the input of stakeholders.
For example, for the implementation of the RNAO best practice guideline Assessment and management of foot ulcers for people with diabetes, barriers included
- nursing shortages across China,
- a lack of training to support the development of knowledge and skills in evidence-based nursing practice,
- the costs of guideline implementation. and
- practice recommendations that exceeded local nursing scope.
SOURCE: Transforming Nursing Through Knowledge, 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.
