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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……….

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Implementing sustaining practice change the best practice champion philosophy

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
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?



Bpg history
BPG History questions………

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 goals
BPG Program Goals questions………

Improve 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 questions………

  • 2 In-Progress HWE PGs

  • Practice Education in Nursing

  • Preventing & Managing Fatigue

  • 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


Stroke related rnao bpg topics
Stroke Related RNAO BPG Topics questions………

  • 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
What’s so great about RNAO BPGs? questions………

  • Support current practice

  • Provide practice direction

  • Quick reference tools

  • Educate clients and/or other healthcare professionals

  • Gift to Nurses



Disseminate evidence questions………

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 inHealthServices


What is the RNAO Nursing Best Practices Champion Network? Framework

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
RNAO: Sustaining Practice Change Strategies Framework

  • Best Practice Champions Network

  • Annual Summer Institutes Booster Sessions & HWE

  • Education Demonstration Project

  • eHealth & PDA Initiative

Best Practice “Champion” as change agent

  • Biennial International BPG Conference

  • Advanced Clinical Practice Fellowships

  • Best Practice Spotlight Organizations

  • Champion Open House

  • LTC Best Practice Initiative


Sustainability strategies
SUSTAINABILITY Strategies Framework

MOHLTC Best Practice LTC Initiative &

RNAO BP LTC Coordinators


Role of ltc bp coordinator
Role of LTC BP Coordinator Framework

  • 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 Framework

  • 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

16


Transfer of knowledge
Transfer of Knowledge Framework

  • 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
RNAO SUSTAINABILITY Strategies Framework

  • 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 FrameworkBeverly Ann FaubertRNAO LTC Best Practice [email protected]: 519-401-8485


Guideline implementation toolkit

Guideline FrameworkImplementation Toolkit


Why an implementation toolkit
Why an Implementation Toolkit? Framework

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 Framework

6 Step Process

Selecting a CPG (BPG or HWE)

Stakeholder Analysis

Environmental Scan

Implementation Strategy

Evaluating Success

Resources


Step 1 identifying a pg
Step 1: Identifying a PG Framework

Use the Implementation Toolkit to guide implementation of any Practice Guideline

AGREE tool



Step 2 stakeholder review what is a stakeholder
Step 2: Stakeholder Review FrameworkWhat is a Stakeholder?

An individual

A group

An 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
Looking at “Vested Interest” Framework

  • Vested interest speaks to WIFM.

  • There are 3 levels of Vested Interest.

  • Totally Clinical

  • Part Clinical & Part Personal

  • Totally Personal


Stakeholder analysis

What is a Stakeholder analysis? Framework

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 Analysis

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


Take out the Stakeholder Assessment Worksheet: FrameworkStroke Example

Broad “Mother” Language

Note this is an undeliverable! This matrix is usually for your eyes only!!

Specific language to project or plan



Working with Stakeholders Based on Level of Influence & Support

Broad “Mother” Language

Specific 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 Support

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
Other things to consider? Support

  • External & Community Partners

  • External Funding Opportunities

  • MOHLTC Initiatives

  • Health Canada Initiatives

  • eHealth Initiatives

  • Quality Communication


Communication is a system fraught with error
Communication is a System Fraught with Error............. Support

GROUP ACTIVITY: Effective Communication

Do you communicate clearly & completely


Context & Communication Support

  • 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


Various vehicles used in the change process… Support

  • Newsletters

  • Email

  • Posters

  • F2F meetings

  • Sticky notes

  • Lunch & Learn

  • Social Media?

Remember: Lunch & Learn today at 1130 in the Education Conference Room!


What s so great about rnao bpgs1
What’s so great about RNAO BPGs? Support

  • 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
Consider Starting with a Gap Analysis Support

  • 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 analysis1
Consider Starting with a Gap Analysis Support:

“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
Phases of Organizational Change Support

  • 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?



Management - Implementation Action Plan – SupportToolkit

Broad general language

How to use – Plug in specifics to you


Rnao champion network resources
RNAO Champion SupportNetwork 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


Never be afraid of going slowly

Planning takes time but it is worth it. Support

Never be afraid of going slowly.

Be afraid of standing still (Italian Proverb)


2010 to 2011 rnao bpcn workshops
2010 to 2011 - RNAO BPCN Workshops Support

Date

LOCATION

London

London

Thunder Bay

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

Kitchener

Richmond Hill

Guelph

By Videoconference

Markham

  • September 22nd

  • September 24th

  • October 7th

  • October 11th

  • October 13th

  • October 29th

  • November 22nd

  • December 2nd

  • January 26th


What is so great about rnao best practice champion program
What is so great about RNAO Best Practice Champion Program?? Support

BP Champions.....

  • Link the Evidence to the Workplace

  • Support Practice Change During Implementation

  • Provide Sustainability



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


Personal action where to begin
Personal Action - Where to Begin ……. Support

  • RNAO Website & RNAO PGs (BPGs & HWE)

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

  • Attend a Best Practice Champion Workshop

  • Contact the RNAO LTC Best Practice Coordinator [email protected]

  • RNAO Champion Facilitator [email protected] or [email protected]

  • 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


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

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

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


Personal action plan1
Personal Action Plan……….. Implementation Tools


This section of the workshop will answer these questions1
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...


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