Applying the two frameworks

The Leading Change Toolkit™ features two complementary frameworks:

the Social Movement Action (SMA) Framework* (Grinspun et al., 2020; Leading change through social movement); and
the Knowledge-to-Action (KTA) Framework* (Graham et al., 2006)

*For reference, figures of the two frameworks are included at the end of this section.

We recommend using both frameworks to support the uptake and sustainability of knowledge such as best practice guidelines (BPG). These two complementary frameworks, when combined, can effectively mobilize, accelerate and sustain change initiatives by applying the knowledge and skills from both.

To illustrate the advantages of applying both frameworks, we have created a scenario using the Person- and Family-Centred (PFCC) BPG (RNAO, 2015). Below, we provide a process description of this change initiative as it evolves from planning to sustainability, identifying the components of the two frameworks throughout.

Person- and Family-Centred Best Practice Guideline

Scenario

A health setting wants to enhance the care they are providing to persons, as the recipients of care, and their families. The goal is to achieve excellence in care by implementing the Person- and Family-Centred Care (PFCC) Best Practice Guideline (BPG).

A change team of person- and family-centred champions is formed to lead this change and engage staff. The change team decides to use both the SMA and KTA frameworks to accelerate their change initiative.

Planning for the change initiative

Planning for the change initiative	Framework components
A data analysis of recent patient survey results shows moderate to high levels of satisfaction regarding care planning and therapeutic relationships meaningful to patients. Discussions to start an evidence-informed change initiative begin. These discussions are based on: the data analysis of the survey results; an upcoming accreditation process; and a shared commitment staff, members of the senior leadership team and the family council to achieve excellence in care. Positive and high energy is noted for the change.	SMA Change is valued and necessary Receptivity to change An urgent need for action KTA Identify the problem
The new change team that has been formed includes staff who have become RNAO Best Practice Champions; they bring knowledge and skills on evidence uptake and sustainability processes. The champions include both point-of-care staff as informal leaders, and members of the senior leadership team as formal leaders. Collectively, the champions value person-centred care using a holistic approach. They are committed to supporting staff to achieve excellence in care through a collaborative and engaged process. The change team conducts a gap or opportunity analysis to determine the "know-do" gap, and selects the RNAO PFCC BPG to guide their change initiative.	SMA Intrinsic motivation Core leadership structures KTA Identify the problem: Determine the know-do gap; Identify, review, select knowledge
The change team plans on ways to adapt the knowledge of the PFCC BPG to the local context of the health setting. During the planning process, the change team considers including the support and influence of stakeholders and available resources. To promote staff engagement, framing is used to position the change as rooted in PFCC values and the shared goal of excellence in care. Members of the change team begin to take on leadership roles including developing a staff survey and running focus groups to assess barriers and facilitators to the planned practice changes based on the PFCC BPG recommendations. The survey results show potential knowledge barriers to making practice changes, as well as enablers which include support for person-centred values and evidence-informed decision-making. Based on this, the change team begins planning for individual and collective action. They identify and select strategies that will help them raise awareness and engage stakeholders in the practice change. One strategy: set up a series of education sessions. Building on this, the change team kickstarts the "All our best" social media campaign to help promote staff’s shared ownership for the change. This approach emphasizes the commitment to excellence in resident care; empowers staff as change leaders; and helps promote the upcoming education sessions.	SMA Framing Emerging leadership Collective identity Public visibility KTA Adapt knowledge to local context Assess barriers and facilitators to knowledge use Select, tailor and implement interventions

Planning for the

Framework components

A data analysis of recent patient survey results shows moderate to high levels of satisfaction regarding care planning and therapeutic relationships meaningful to patients. Discussions to start an evidence-informed change initiative begin. These discussions are based on: the data analysis of the survey results; an upcoming accreditation process; and a shared commitment staff, members of the senior leadership team and the family council to achieve excellence in care. Positive and high energy is noted for the change.

SMA

KTA

Identify the problem

The new change team that has been formed includes staff who have become RNAO Best Practice Champions; they bring knowledge and skills on evidence uptake and sustainability processes. The champions include both point-of-care staff as informal leaders, and members of the senior leadership team as formal leaders. Collectively, the champions value person-centred care using a holistic approach. They are committed to supporting staff to achieve excellence in care through a collaborative and engaged process. The change team conducts a gap or opportunity analysis to determine the "know-do" gap, and selects the RNAO PFCC BPG to guide their change initiative.

SMA

KTA

Identify the problem: Determine the know-do gap; Identify, review, select knowledge

The change team plans on ways to adapt the knowledge of the PFCC BPG to the local context of the health setting. During the planning process, the change team considers including the support and influence of stakeholders and available resources.

To promote staff engagement, framing is used to position the change as rooted in PFCC values and the shared goal of excellence in care. Members of the change team begin to take on leadership roles including developing a staff survey and running focus groups to assess barriers and facilitators to the planned practice changes based on the PFCC BPG recommendations.

The survey results show potential knowledge barriers to making practice changes, as well as enablers which include support for person-centred values and evidence-informed decision-making. Based on this, the change team begins planning for individual and collective action. They identify and select strategies that will help them raise awareness and engage stakeholders in the practice change. One strategy: set up a series of education sessions. Building on this, the change team kickstarts the "All our best" social media campaign to help promote staff’s shared ownership for the change. This approach emphasizes the commitment to excellence in resident care; empowers staff as change leaders; and helps promote the upcoming education sessions.

SMA

KTA

Creating practice change

Creating practice change	Framework components
The change team creates and runs a series of education sessions to support the practice changes, using the "All our best" slogan. Each session begins with sharing a resident story to continually align practice changes to PFCC values. Staff and senior leadership learn together, and also learn from members of the family council. They take time to practice new skills. They also meet in smaller working groups to review current documentation and policy to decide where revisions are needed. As part of the sessions, all attendees receive a champions t-shirt and pin. Group photos are taken and shared by email and on social media, with quotes from participants describing what "All our best" means to them.	SMA Individual and collective action Public Visibility Collective identity KTA Select, tailor, implement interventions
As the sessions continue and more staff become champions, momentum for the change grows.	SMA Momentum

Creating practice change

Framework components

The change team creates and runs a series of education sessions to support the practice changes, using the "All our best" slogan. Each session begins with sharing a resident story to continually align practice changes to PFCC values. Staff and senior leadership learn together, and also learn from members of the family council. They take time to practice new skills. They also meet in smaller working groups to review current documentation and policy to decide where revisions are needed. As part of the sessions, all attendees receive a champions t-shirt and pin. Group photos are taken and shared by email and on social media, with quotes from participants describing what "All our best" means to them.

SMA

KTA

Select, tailor, implement interventions

As the sessions continue and more staff become champions, for the change grows.

SMA

Momentum

Assessing the impact of the practice change

Assessing the impact of the practice change	Framework components
Following the education series, all participants complete a survey to determine the knowledge, attitudes and beliefs regarding the practice change. The survey shows positive feedback.	SMA Intrinsic motivation KTA Monitor knowledge
Three months later, audit and feedback data show that the practice changes are being implemented and that the newly revised policies are consistent with the practice changes and the PFCC BPG.	KTA Evaluate knowledge SMA Goals and outcomes are met
Staff champions attend webinars and conferences held by an external PFCC network as a means of learning from others and gaining new ideas and resources to support momentum. The champions also attend board of directors’ meetings and staff huddles to summarize the change initiative, highlight achievements and share key learnings.	SMA Networks Momentum

Assessing the impact of the practice change

Framework components

Following the education series, all participants complete a survey to determine the knowledge, attitudes and beliefs regarding the practice change. The survey shows positive feedback.

SMA

Intrinsic motivation

KTA

Monitor knowledge

Three months later, audit and feedback data show that the practice changes are being implemented and that the newly revised policies are consistent with the practice changes and the PFCC BPG.

KTA

Evaluate knowledge

SMA

Goals and outcomes are met

Staff champions attend webinars and conferences held by an external PFCC network as a means of learning from others and gaining new ideas and resources to support momentum. The champions also attend board of directors’ meetings and staff huddles to summarize the change initiative, highlight achievements and share key learnings.

SMA

Sustaining the practice change

Sustaining the practice change	Framework components
To sustain excellence in care, multiple implementation interventions continue including: semi-annual booster educational sessions for all staff an orientation session on PFCC for new hires and student placements updated messaging for the "All the best" campaign to stay relevant to current organizational priorities.	KTA Sustain knowledge use SMA Framing and reframing
As a result of engaging in the BPG implementation, members of the change team develop new leadership skills. These skills, which include applying social movement actions and the KTA Framework action cycle phases, increase their capacity to lead change using both "bottom-up" and traditional change approaches.	SMA Capacity in leading change is increased
Following a successful accreditation, a decision is made to spread the practice changes to other units within the health-care setting. Point-of-care champions initiate and lead plans to scale up the change.	SMA Change is scaled up, out, or deep Capacity in leading change is increased

Sustaining the practice change

Framework components

To sustain excellence in care, multiple implementation interventions continue including:

semi-annual booster educational sessions for all staff
an orientation session on PFCC for new hires and student placements
updated messaging for the "All the best" campaign to stay relevant to current organizational priorities.

KTA

Sustain knowledge use

SMA

Framing and reframing

As a result of engaging in the BPG implementation, members of the change team develop new leadership skills. These skills, which include applying social movement actions and the KTA Framework action cycle phases, increase their capacity to lead change using both "bottom-up" and traditional change approaches.

SMA

Capacity in leading change is increased

Following a successful accreditation, a decision is made to the practice changes to other units within the health-care setting. champions initiate and lead plans to scale up the change.

SMA

Applying the two frameworks

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