Implementing & Sustaining Practice Change: The Best Practice Champion Philosophy

1. 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

2. 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?

3. So, What are Best Practice Guidelines?

4. 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

5. BPG Program Goals 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

6. 35 BPG & 7 HWE Guidelines • 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

7. 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

8. 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

9. So, What is so great about BPGs?

10. Disseminate evidence Assist with knowledge transfer Promote the uptake of Best Practices Share resources Prevent “shelf-itis” Why we need Best Practice Champions

11. The idea of a BP Champion was developed from the PARIHS Framework Promoting Action on Research Implementation inHealthServices

12. What is the RNAO Nursing Best Practices 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.

13. RNAO: Sustaining Practice Change Strategies • 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

14. SUSTAINABILITY Strategies MOHLTC Best Practice LTC Initiative & RNAO BP LTC Coordinators

15. 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

16. Get Started • 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

17. 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

18. 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!

19. Contact Information for SW RegionBeverly Ann FaubertRNAO LTC Best Practice Coordinatorbfaubert@rnao.orgMobile: 519-401-8485

20. Guideline Implementation Toolkit

21. 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.

22. TOOLKIT FOR GUIDELINE IMPLEMENTATION 6 Step Process Selecting a CPG (BPG or HWE) Stakeholder Analysis Environmental Scan Implementation Strategy Evaluating Success Resources

23. Step 1: Identifying a PG Use the Implementation Toolkit to guide implementation of any Practice Guideline AGREE tool

24. AGREE Results & RNAO BPGs

25. Step 2: Stakeholder ReviewWhat 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).

26. Looking at “Vested Interest” • Vested interest speaks to WIFM. • There are 3 levels of Vested Interest. • Totally Clinical • Part Clinical & Part Personal • Totally Personal

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

28. Take out the Stakeholder Assessment Worksheet: Stroke Example Broad “Mother” Language Note this is an undeliverable! This matrix is usually for your eyes only!! Specific language to project or plan

29. Stakeholder Assessment Worksheet (Toolkit)

30. 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”.

31. 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

32. Other things to consider? • External & Community Partners • External Funding Opportunities • MOHLTC Initiatives • Health Canada Initiatives • eHealth Initiatives • Quality Communication

33. Communication is a System Fraught with Error............. GROUP ACTIVITY: Effective Communication Do you communicate clearly & completely

34. Context & 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

35. Various vehicles used in the change process… • Newsletters • Email • Posters • F2F meetings • Sticky notes • Lunch & Learn • Social Media? Remember: Lunch & Learn today at 1130 in the Education Conference Room!

36. 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?

37. 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

38. 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...........

39. 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?

40. Toolkit – Implementation Plan

41. Management - Implementation Action Plan – Toolkit Broad general language How to use – Plug in specifics to you

42. 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

43. Planning takes time but it is worth it. Never be afraid of going slowly. Be afraid of standing still (Italian Proverb)

44. 2010 to 2011 - RNAO BPCN Workshops 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

45. 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

46. Personal Action Plan

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

48. Personal Action - Where to Begin ……. • 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 bfaubert@rnao.org • RNAO Champion Facilitator nbauer@rnao.org or nabauer948@yahoo.ca • 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

49. 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