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 RNAO was selected as lead

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

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 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.

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 Faubert RNAO LTC Best Practice Coordinator Mobile:

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 BPGs

Step 2: Stakeholder Review What 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” 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 Analysis Conducting a SH Analysis early gives you a chance to look at objections to change

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!!

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 SUPPORTSUPPORT High support – High influence  Positively affect dissemination.  Need a great deal of attention and information to maintain their buy-in. Strategies* to Engage  Keep Informed  High involvement, collaboration, partnerships  Preparing for Change Management High support – Low influence  Can Positively affect project  Need some attention to maintain buy-in Strategies* to Engage  Consensus – interact with early & often  Preparing for Change Management  Empowering 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 influence  Need great amount of attention to obtain / maintain neutrality/buy in. Strategies* to Engage  Consensus  Involve at some level  Stress how developed  Adapt plan to accommodate to major barriers Low support – Low influence  Least likely to influence dissemination  However could have a negative impact so should be monitored  Some attention to obtain neutrality Strategies* to Engage  Consensus  Involve at some level 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 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 – –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 ActivityTarget date Most responsible person Outcomes/ deliverables progress 1Identification 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. 2Identification 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 RNAO BPCN Workshops DATE September 22 nd September 24 th October 7 th October 11 th October 13 th thOctober 29 th November 22 nd December 2 nd January 26 th LOCATION 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 StrategyDesired OutcomeSuccess Indicator Key ResourceTarget 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 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 Attend a Best Practice Champion Workshop 4.Contact the RNAO LTC Best Practice Coordinator 5.RNAO Champion Facilitator or 6.Go to the RNAO PDA Initiative website  BPG Stroke Assessment Across the Continuum  Nursing Management of Hypertension Self Assessment

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 OutcomeSuccess IndicatorKey ResourceTarget 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...