Background
Literature review and knowledge gaps
Purpose
Conceptual framework
Methods
Study design
Study setting and BPG program
Data sources and characteristics
Organizational key informants (N = 14) | |
Current job title | n = 1 Director of Nursing |
n = 4 Assistant Directors of Nursing | |
n = 5 Nursing Practice Consultants | |
n = 3 Clinical Nurse Specialists | |
n = 1 Nurse Educator | |
Highest level of education (degree) | 12 Masters, 2 Doctoral |
Age (yrs) | 2 30s, 2 40s, 7 50s, 3 60s |
Average time in profession (yrs) | 31 (12–46) |
Average time in organization (yrs) | 19 (8–33) |
Average time in current job (yrs) | 6.4 (0.5–15) |
Average time of interview (mins) | 93 (75–120) |
Documents (N = > 350) | |
• Examples: program implementation plans, educational manuals, policy and procedures guides, meeting minutes, website publications, internal and external communications (i.e., letters, emails), presentations, administrative data summaries, reports, funding applications, job descriptions | |
Observations and Exchanges (N = > 40) | |
• Attendance at nursing department conferences, workshop days, and administrative meetings • Participation in informal interactions and meetings with a variety of health centre stakeholders (e.g., executive to frontline staff, patients/families, and volunteers) |
Data analyses
Strategies for study rigor
Ethical considerations
Results
Characteristics of program sustainability
Benefits
Institutionalization
Development
Factors that influenced program sustainability
Factors | Illustrative quotations | Influence on sustainability |
---|---|---|
Innovation-related factors
| ||
Relevance of the program | • “[The BPG program goals are] a continuing, evolving preoccupation within the organization.” (O09) • “[The program] is an important commitment that focused specifically on the work that nurses do.” (O13) • “The program addressed the issues in a bigger picture way. Not like a band-aid solution, but a longer-term solution.” (O04) | Positive |
Nature of the program | • “Now that we have more and more research… we really need to keep it up there. If we’re doing something, there has to be a reason why we’re doing it in a particular way…” (O05) • “It’s our responsibility as an academic nursing group to use evidence.” (O02) | Positive |
Context-related factors
| ||
Extra-organizational partnership | • “That we were a [RNAO] ‘Spotlight Organization’ (designation) sent a message that this is something big.” (O06) | Positive |
External pressure for performance | • “We now have some external benchmark data that we’ve never had before, that shows that we’re not as good as we thought we were. And so we can make more progress. That kind of pressure…” (O11) • “In Canada there’s going to be some more benchmarking, and hospitals comparing themselves… not only the [university health centre] group, but something bigger. So we know that we have to improve.” (O06) | Positive |
Financial resources | • “Financially, [the nursing department’s] hands are tied. … We don’t have a budget [for the program], but we still need to do that job. It becomes more and more difficult.” (O05) | Negative |
Interprofessional collaboration | • “Although we talk about it being interprofessional, it was a lot of around nursing.” (O12) • “Why aren’t some of the other disciplines–pharmacy, medicine, physiotherapy…–involved anymore? They were participating more at the beginning, or when we needed them…They’re no longer there at the table.” (O09) | Negative |
Nursing department culture | • “It’s the culture. The [nursing department] hasn’t really formed its own… I don’t know how successful we’ve been in taking up a sort of identity that we can be proud of.” (O10) • “We do not have that culture of zero tolerance (for substandard care). Think we’re ready to take that responsibility? Far from that.” (O04) | Negative |
Leadership-related factors
| ||
Co-directorship of the program | • “The working closely together between practice and research [leadership] was also a factor…” (O12) • “[The director of nursing] is trying to put this kind of structure of … best practice guidelines… and making it better for the patient… She’s imposing a structure that we never had.” (O01) • “[The research director] was at arm’s length… could ask good questions… non-territorial… a well-informed voice” with “willingness to path-find.” (O13) | Positive |
Commitment of several nursing leaders to the program | • “It’s the ongoing presence of a core team of really committed nursing leaders… who have been involved for a long, long time… People who really took it seriously.... relentless, pushing, never giving up.” (O02) • “The other thing that’s kept it going is the commitment of the leaders. I think if they weren’t so stubborn, and didn’t continue to pull people together, and didn’t continue to push [the program would not have been sustained].” (O11) | Positive |
Complementarity of leadership actions across the department | • “Everybody has to see it as important in their work, because it’s all like a chain. And if one [chain link] is weak … then obviously the rest could fall.” (O06) • “If you want to sustain change, you have to have leaders working at various levels of the organization. It’s textbook out of sustainability 101.” (O02) | Positive |
Process-related factor
| ||
Reflection-and-course-correction strategy | • “The idea of continually revisiting and almost reshaping [the BPG program] is the name of the game” (O10) • “We cannot sit on it and pretend because we’ve changed… it’s a done deal. It never ends…” (O04) | Positive |
Innovation-related factors
Context-related factors
Leadership-related factors
Process-related factors
How the program was sustained: key relationships between characteristics and factors
Interaction of commitment of leadership with benefits
Interaction of complementarity of leadership actions with both institutionalization and development
Leadership role | Examples of leadership actions |
---|---|
Program Co-Directors | • Prioritized program activities • Pushed for more BPG-related improvement • Sought creative sources for funding • Advanced an agenda of expectations related to BPGs • Reinforced a BPG-inspired framework for nursing practice • Nurtured a “climate of inquiry” within the department |
BPG Task Force Co-Leaders and Other Members | • Facilitated “re-implementation” of BPGs on units with lower levels of sustainability • Implemented more recommendations from each of the BPGs • Developed BPG-based patient teaching materials • Adapted BPG nursing tools to unique patient populations • Engaged other professionals to work on collaboration-related BPG practice challenges • Updated organizational policies and procedures based on BPGs |
Clinical Program Nursing Directors | • Included BPGs as a standing agenda item at program meetings • Relieved unit managers from dossiers that took time away from BPG-promoting work • Worked with unit managers to prioritize unit-based BPG practice monitoring • Discussed BPG-related performance data formally and informally with unit management teams • Reminded these teams to use measured BPG-related outcomes as “balancing indicators” during other unit changes • Included BPG-related unit performance as a criterion in unit managers’ individual evaluations or annual unit progress reporting • Participated in the annual health centre-wide prevalence survey |