Spotlight on Practice: Achieving Excellence in Service, Accountability, and Professional Leadership

Sunday, 27 July 2014

Rani Hajela Srivastava, RN, MScN, PhD
Jane Paterson, MSW, RSW
Gabriella Golea, RN, BScN, MN, CPMHN (C)
Margaret Gehrs, RN, BSc (HK), BScN, MScN, CPMHN (C)
Professional Practice, Centre for Addiction and Mental Health, Toronto, ON, Canada

While much has been written about the implementation of Nursing best practice guidelines within hospitals, there is a dearth of evidence on how to support such implementation within a mental health and addictions environment, and in an integrated interprofessional manner.  This presentation will describe how one large mental health and addictions academic teaching hospital endeavored to promote best practice guidelines (BPG’s) as part of a new strategic direction and practice plan. It will highlight how the unique aspects of organizational culture were considered during the selection, development, implementation, and evaluation of BPG’s in a mental health and addictions health care environment. The implementation was broadly guided by an organizational change framework that consists of six core strategies that the organization had initially used in an organizational initiative focused on the reduction of restraints and seclusion (National Executive Training Institute, 2003). The six core strategies are: (1) leadership, (2) using data to inform practice, (3) workforce development, (4) tools and resources, (5) debriefs and learning from experience, and (6) full inclusion of clients and families . This overarching framework was used an overall guiding strategy and augmented by additional supporting frameworks from the literature including the PARIHS Framework (see Rycroft-Malone, 2004), Complex Systems Perspective (see Suter et al, 2011), and the Organizational Memory Framework (see Virani et al, 2009). Change management processes addressed the unique skills mix of interprofessional care providers and integration with other initiatives and the strategic priorities of the organization. 

 Although designed and led by professional practice leadership, the formal initiative was designed as a 3 year journey that focused at all levels the organization with respect to leadership, engagement, and accountability. The engagement included the quality committee of the hospital board, senior management, advanced practice nurses and clinicians, educators, and an inteprofessional group of champions in direct care.   Six clinical and two healthy work environment best practice guidelines were chosen for implementation. We are two years into the three year journey and have experienced many expected and unexpected challenges and successes.   The presentation will highlight the phases of the the journey and critical success factors at each stage.  A key factor to the overall success has been the adoption of a continuous learning stance and intentional integration of the BPG implementation to other organizational initiatives and goals.