Implementing & Sustaining Practice Change:

The Best Practice Champion Philosophy

Nancy Bauer, HBA, HB. Admin, RN, ET

RNAO Champion Facilitator

Bev Faubert, BScN

RNAO LTC BP Coordinator

This Section of the Workshop will Answer these questions………

What are the benefits of RNAO Best Practice Champion Program?

What is the Champion role in implementing and sustaining practice change in the workplace?

Why is facilitation vital to uptake of Best Practice? Where you can find RNAO BP resources? How to become an RNAO BP Champion?

So, What are Best Practice Guidelines?

BPG History BPG History Ontario Ministry of Health and Long Term Care Report of

the Nursing Task Force, January 1999, “Good Nursing, Good Health : An Investment for the 21st Century”

Recommendation: Design/provide supports for Nurses to gain expertise in clinical areas & to be recognized for these skills

Recommendation: Assess/Evaluate how new approaches impact on client outcomes & the working environment for nurses

In November 1999 - RNAO was selected as lead

BPG Program GoalsImprove health care• Reduce the variation in care & stop care

that have little effect or cause harm• Transfer research evidence into practice• Promote nursing knowledge base• Assist with clinical decision making• Identify gaps in research• Reduce cost

35 BPG & 7 HWE Guidelines

6 In-Progress BPGs•Facilitating Client-Centred Learning•Self-Management Support in Chronic Illness•Bereavement Care (in partnership with VON)•Patient Safety: Alternatives to Restraints•End of Life Care During the Last Days and Hours•Safe Sleep for Infants

2 In-Progress HWE PGs •Practice Education in Nursing•Preventing & Managing Fatigue

Stroke Related RNAO BPG Topics

• Stroke• HTN• Smoking Cessation• Oral Hygiene• Delirium Depression &

Dementia• Pressure Ulcers• Pain• Falls• Continence

• Client Centred Care • Crisis Intervention• Establishing Therapeutic

Relationships• Supporting/Strengthening

Families through Expected & Unexpected Life Events

• Violence in The Workplace• Professionalism• Suicidal Ideation

What’s so great about RNAO BPGs?• Support current practice

• Provide practice direction

• Quick reference tools

• Educate clients and/or other healthcare professionals

• Gift to Nurses

So, What is so great about BPGs?

• Disseminate evidence

• Assist with knowledge transfer

• Promote the uptake of Best Practices

• Share resources

• Prevent “shelf-itis”

Why we need Best Practice Champions

The idea of a BP Champion was developed from the PARIHS Framework

Promoting Action on Research Implementation in Health Services

What is the RNAO What is the RNAO Nursing Best Practices Nursing Best Practices Champion Network?Champion Network?

A collective force that influences knowledge

transfer & BPG uptake. Provides a means for

the opportunity to connect with other BPC.

You do not need to be an RNAO member.

RNAO: Sustaining Practice Change Strategies

2. Best Practice Champions Network

3. Annual Summer Institutes Booster Sessions & HWE

4. Education Demonstration Project

5. eHealth & PDA Initiative

6. Biennial International BPG Conference

7. Advanced Clinical Practice Fellowships

8. Best Practice Spotlight Organizations

9. Champion Open House

10.LTC Best Practice Initiative

1. Best Practice “Champion” as change agent

SUSTAINABILITY Strategies

MOHLTC Best Practice LTC Initiative &

RNAO BP LTC Coordinators

Role of LTC BP Coordinator

• Seek, create & coordinate opportunities related to use of evidence based practices in LTC

• Establish regional networking forums such as Communities of Practice to support uptake of BP

• Continue providing access to best practice resources & support implementation

• Mentor staff in LTC• Link & integrate RAI MDS with Best Practice

Get Started

16

Raise Awareness•Share knowledge (e.g. newsletters, brochures, meetings, bulletin boards, memos, etc. )

•Coordinate forums for sharing lessons learned (e.g. story collection)

•Marketing strategies to execute the plan

Transfer of Knowledge

• Select staff to be Team Leads or champions & develop a multidisciplinary team for Guideline implementation

• Collaborate with initiatives, networks & organizations

• Make learning sessions fun…use games the include all staff, residents & families

RNAO SUSTAINABILITY Strategies

Integration and Evaluation

•Promote Collaboration and QI initiatives

•Integrate into existing framework

•Build standing agenda item

•Seek opportunities to evaluate the impact of best practices on resident care outcomes

•Celebrate your successes!

Contact Information for SW Region

Beverly Ann FaubertRNAO LTC Best Practice Coordinator

bfaubert@rnao.orgMobile: 519-401-8485

Guideline Implementation Toolkit

Why an Implementation Toolkit?

Because...... It is better than learning from experience.

“The problem with learning from experience is that you get the test before the lesson” (Alfred E. Neuman, nd. Mad Magazine).

Learning how to use the Toolkit puts the lesson before the test.

TOOLKIT FOR GUIDELINE IMPLEMENTATION 6 Step Process

1.Selecting a CPG (BPG or HWE)

2.Stakeholder Analysis

3.Environmental Scan

4. Implementation Strategy

5.Evaluating Success

6.Resources

Step 1: Identifying a PG

• Use the Implementation Toolkit to guide implementation of any Practice Guideline

• AGREE tool

AGREE Results & RNAO BPGsAGREE Scores for all guidelines

0.020.0

40.060.080.0

100.0120.0

WOCN 2

003

RNAO

AHCPR 1994

EPUAP 199

8

Singap

ore

2001

WHS

PVA 200

0

IOW

A 199

7

Guideline Code

Do

mai

n S

core

Purpose

Stakeholder

Rigour

Clarity

Applicability

Edit. Ind.

Step 2: Stakeholder ReviewStep 2: Stakeholder Review

What is a Stakeholder?What is a Stakeholder?An individualA groupAn organization

…with a vested interest in your decision to implement a Guideline.

“Stakeholders include individuals or groups who will be directly or indirectly effected by the implementation of a Guideline” (RNAO Toolkit, 2002).

Looking at “Vested Interest”Vested interest speaks to WIFM.There are 3 levels of Vested Interest.

1)Totally Clinical

2)Part Clinical & Part Personal

3)Totally Personal

What is a Stakeholder analysis?• Approach for generating information about stakeholders• To understand their behaviour, plans, relationships & interests• To determine influence, support &resources they can

contribute to your plans

Goal of Stakeholder Analysis:• To create solutions that work• To gain greater acceptance of your project• Plan for reluctance• Maximize support• To create solutions that work• To gain greater acceptance of your project

Stakeholder AnalysisStakeholder Analysis

Conducting a SH Conducting a SH Analysis early gives Analysis early gives you a chance to look at you a chance to look at objections to changeobjections to change

key stakeholder

nature of the vested interest stakeholder Influence & support (high, and low) management

strategies revise

Influence Support

Client Improved Quality of Life Watch grandchildren grow up

Nancy Improved client care Promotion & Recognition Accreditation coming Nice fit with current agenda

Clinical Instructor

Improved client care Mother died of a stroke

Physician Less time wasted on preventable illness and complications ↓ LOS Fewer phone calls in the

middle of the night

Take out the Stakeholder Assessment Worksheet: Stroke Example

Specific language to project or plan

Broad “Mother” Language

Note this is an undeliverable! This matrix is

usually for your eyes only!!

key stakeholder nature of the vested interest stakeholder Influence & support (high, and low)

management strategies revise

Stakeholder Assessment Worksheet (Toolkit)

Working with Stakeholders Based on Level of Influence & Support

I N F L U E N C E

Influence High Influence Low

SUPPORT

High support – High influencePositively affect dissemination.Need a great deal of attention and information to maintain their buy-in.

Strategies* to EngageKeep InformedHigh involvement, collaboration, partnershipsPreparing for Change Management

High support – Low influenceCan Positively affect project Need some attention to maintain buy-in

Strategies* to Engage Consensus – interact with early & oftenPreparing for Change ManagementEmpowering with professional status & Involve at some level - Work with to help you access information, points of view, gain access to high influence stakeholders

Low support – High influenceNeed great amount of attention to obtain / maintain neutrality/buy in.

Strategies* to EngageConsensusInvolve at some levelStress how developedAdapt plan to accommodate to major barriers

Low support – Low influenceLeast likely to influence disseminationHowever could have a negative impact so should be monitoredSome attention to obtain neutrality

Strategies* to EngageConsensusInvolve at some level

Broad “Mother” LanguageSpecific language to project

or plan such as:“Meet with Supervisor once a month for 5 minutes & update/report”.

Step 3: Environmental Readiness Step 3: Environmental Readiness • Structure• Workplace Or Organizational Culture• Communication Systems• Leadership Support• Knowledge, Skills And Attitudes Of The

Potential Target Group• Resources• Interdisciplinary Relationships

31

Other things to consider?• External & Community Partners

• External Funding Opportunities

• MOHLTC Initiatives

• Health Canada Initiatives

• eHealth Initiatives

• Quality Communication

Communication is a System Fraught with Error.............

Do you communicate clearly & completely

GROUP ACTIVITY: Effective Communication

• What are the communication avenues at your workplace? Do you have access to them all - Think in terms of Formal & Informal lines of communication

• What communication silos exist

• To whom do people listen

• Repetition Counts!!!

The 7 x 7 Rule, The Rule of 6 & The Rule of 7

• Where do colleagues collect & exchange ideas

Context & Communication

Various vehicles used in the change process…

– Newsletters– Email– Posters– F2F meetings– Sticky notes– Lunch & Learn– Social Media?

What’s so great about RNAO BPGs?

• Support current practice

• Provide practice direction

• Quick reference tools

• Educate clients and/or other healthcare professionals

• Gift to Nurses

Is there a gap between the two?

Consider Starting with a Gap Analysis

• Used for quick explanations of where we are....compared to where we want to be

• Helpful in a committee setting or as a summary to current practice

• However, a lot of work goes into understanding where & why the gaps in practice exist

• Dating gap analysis forms also allows for comparison of where the organization was & the progress that has been made

Consider Starting with a Gap Analysis:

“Gap Analysis at-a-Glance” is only a summary

What Goes into a Gap Analysis: Systems & workflow analysis, outcome root cause

analysis, chart audits, formal & informal staff interviews, meeting with interdisciplinary teams, discussion at practice committee level, surveys, policy review, related documentation review, staff skill-set analysis, equipment inventory...........

Phases of Organizational Change

• Determine need for change

• Awareness Raising for needed change

• Motivating towards change

• Engagement of stakeholders

• Planning & piloting change

• Operationalization

• Institutionalization

Where does a gap

analysis fall?

Where is the Sustainability?

Toolkit – Implementation Plan Toolkit – Implementation Plan Activity Target

dateMost responsible

personOutcomes/

deliverables

progress

1 Identification of project lead, champions and/or the group who will lead the identification and implementation of a CPG

a) Identify skill and role requirements

b) Communicate/recruit interested individual or group.

c) Secure participation of project lead.

d) Ensure project lead has clear mandate and resources required to start the planning process.

2 Identification of a CPG

a) Identify stakeholders who will participate in the identification, assessment and selection of a CPG.

b) Access the AGREE tool

c) Ensure understanding and knowledge about the use of the AGREE tool.

Stakeholder Identification, Analysis & Engagement Activities

Target date

Most responsible

Outcomes/

deliverables

Progress

Identify skill & role requirement of project Leaders

• SC BPG Lead: RNAO BP Champion with Stroke knowledge (ICU, rehab, CCC, LTC) & excellent computer skills

• SC Champions: RN, RPN & PSWs with an interest in Stroke, MI, Depression, Dementia Client Centred Care &/or Smoking Cessation

• SC Groups: SC BPG Steering Committee, Documentation Committee or Professional Practice Committee…. Or

Management - Implementation Action Plan – Toolkit

Broad general language

How to use – Plug in specifics to you

RNAO Champion Network Resources

• Monthly education teleconferences &/or video conferences

• e-Newsletter• Champion Open House Funding• BP Spotlight Organization• BPG Resources• BPCN Booster Education Sessions• Champion Facilitators • BPGs in web format for PDA users

Be afraid of standing still (Italian Proverb)

Never be afraid of going slowly.

Planning takes time but it is worth it.

2010 to 2011 - RNAO BPCN WorkshopsDATE

• September 22nd • September 24th • October 7th

• October 11th • October 13th • October 29thth • November 22nd • December 2nd • January 26th

LOCATION

London

London

Thunder Bay

Ottawa ............(French)

Kitchener

Richmond Hill

Guelph

By Videoconference

Markham

What is so great about RNAO Best Practice Champion Program??

BP Champions.....

• Link the Evidence to the Workplace

• Support Practice Change During Implementation

• Provide Sustainability

Personal Action Plan

RNAO Best Practice Champion - Personal Action Plan

Action or Strategy Desired Outcome Success Indicator

Key Resource Target Date

1 Speak to ……. Have direction & know what to do next

Draft Plan outlined

•Manager

1 week from today

2 Contact RNAO BP LTC Coordinator

Discuss possible involvement with stroke care gap analysis

Date for teleconference set

•Manager•Bev Faubert

3 weeks from today

3

4

5

Personal Action Plan....List THREE THINGS you can do as soon as you go back to school (Goals should be achievable in 3 weeks max)

Personal Action - Where to Begin …….1. RNAO Website & RNAO PGs (BPGs & HWE)

2. RNAO BPG Management of Hypertension Self Directed eLearning http://www.rnao.org/hypertension/index.asp

3. Attend a Best Practice Champion Workshop

4. Contact the RNAO LTC Best Practice Coordinator bfaubert@rnao.org

5. RNAO Champion Facilitator nbauer@rnao.org or nabauer948@yahoo.ca

6. Go to the RNAO PDA Initiative website BPG Stroke Assessment Across the Continuum

Nursing Management of Hypertension Self Assessment http://www.rnao.org/pda/hyp

E-learning• Therapeutic Relationships• Smoking Cessation• Vascular Access Device IV Therapy• Managing Hypertension• Pain Management • eHealth for Every Nurse

Self- Directed Learning• Continence• Falls Prevention• Pressure Ulcers• Venous Leg Ulcer• Pain Management

Pre-Packaged Education• Educational Workshop for RNs &

RPNs: Assessment & Management of Pressure Ulcers

• Continence/Constipation Workshop for RNs in Long-Term Care

• Diabetic Foot: Risk Assessment Education Program

• LTC Implementation Toolbox

Audio-Visual• Photos – positioning of older

patients in bed, chair• Oral Hygiene video

Don’t Reinvent the wheel. Use Available RNAO Implementation Tools

RNAO Best Practice Champion - Personal Action Plan

Initial Action or Strategy

Desired Outcome Success Indicator Key Resource Target Date

1 Speak to ……. Know what to do next

Draft Plan outlined • Manager• Practice Lead

1 week from today

2 Contact RNAO Best Practice LTC Coordinator

Discuss possible education opportunities

Date for teleconference set

• Manager• Bev Faubert

3 weeks from today

3 Watch “Tips & Tools” DVD

Be able to discuss the information with others

Show DVD to colleagues

• Manager• SWOSS Ed

Coord

2 weeks from today

4 Show Tips & Tools DVD to Manager

Have the DVD used in education & orientation

Date set for “Tips & Tools” Lunch & Learn sessions with SWOSS

• Manager• SWOSS Ed

Coord

3 weeks from today

5 Go to RNAO Website & look at BPCN Program

Attend a BP Champion Workshop this year

Speak to Manager & get approval to attend the Champion workshop

• Manager• Bev Faubert• Nancy Bauer

3 weeks from today

Personal Action Plan………..

This Section of the Workshop will Answer these questions………

What are the benefits of RNAO Best Practice Guidelines (BPG) Program?

Who are the “Facilitators/Connectors” role in implementing and sustaining practice change in the workplace?

Why is facilitation vital to uptake of Best Practice?

Where you can find BP resources?

How to become an RNAO BP Champion?

The smallest of actions is always better than the noblest of intentions

(Robin Sharma)

Work on your Action Plans for the rest of today...