Featured Resource: The Leading Change Toolkit
By Dr. Doris Grinspun [1] CEO & Co-Chair Expert panel, Leading Change Toolkit, Registered Nurses’ Association of Ontario (RNAO),
Katherine Wallace [1] Senior Manager, Implementation Science, Project Lead & Toolkit Developer, Toolkit Development Team, RNAO,
Susan McNeill [1] Associate Director, Guideline Implementation and Knowledge Transfer & Former Project Lead, Toolkit Development Team, RNAO,
Shelly-Anne Li [2] Former Toolkit Developer, Toolkit Development Team, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
Oliwia Klej [1] Project Coordinator, Implementation Science & Web Editor, Toolkit Developer Team, RNAO
Dr. Janet Squires [3] Professor, School of Nursing and Senior Scientist & Co-Chair, Expert panel, Leading Change Toolkit, University of Ottawa; Ontario Hospital Research Institute (OHRI)
Healthcare Excellence Canada [4] & the Leading Change Toolkit Expert Panel [5]
Are you leading a change initiative and hoping to make lasting improvements? Implementation toolkits support end-users such as change agents and members of change teams to mobilize knowledge uptake and sustainability. Earlier this autumn, the Registered Nurses’ Association of Ontario (RNAO) released a comprehensive overhaul of its foundational implementation resource in collaboration with Healthcare Excellence Canada.
The Leading Change Toolkit™ is now available online free of charge (Leading Change Toolkit™ | RNAO.ca). It is revolutionary in its approach as it combines two complementary implementation frameworks to mobilize change:
the novel Social Movement Action (SMA) framework (Grinspun et al., 2020); and
the widely-used Knowledge-to-Action (KTA) framework (Graham et al., 2006).
What is the SMA framework?
We developed the SMA framework to support and promote knowledge uptake and sustainability in health-care settings. We used the results of a concept analysis, relying on a method developed by theorists Walker and Avant (2005). The framework is structured according to a three-point timeline:
1. preconditions (what must happen to inspire social movement action?);
2. key characteristics (what conditions are needed for social movement action to happen?); and
3. outcomes (what may result from a specific social movement action?)
The SMA framework identifies 16 elements needed to achieve change for a shared concern or strongly desired change that is catalyzed by an urgent need for action. Social movement action harnesses intentional individual and collective action and reflects the engaged participants’ shared purpose, values and emerging collective identity. It promotes a grassroots, people-led approach to change.
Grinspun, D., Wallace, K., Li, S.A., McNeill, S., & Squires, J. (2020, Spring). Leading change through social movement. Registered Nurse Journal.
What is the KTA framework?
The KTA framework is a systematic and structured process model that combines more than 30 change models. Many implementers use the KTA framework; the RNAO featured it in both the current and previous editions (2012) of RNAO’s toolkits. In our new third edition, we include updated evidence on the KTA framework, based on a systematic search of peer-reviewed literature.
Graham, I., Logan, J., Harrison, M.B., Straus, S.E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: time for a map? Journal of continuing education in the health professions, 26(1), 13-24). Used with permission.
We have also included new summaries of 33 valid and pragmatic tools such as surveys and questionnaires that support the assessment of key components of the framework. Each tool has been mapped to the relevant action cycle phases to enhance understanding of a change process in a local context.
How can these frameworks be used together to mobilize change?
The Leading Change Toolkit includes linkages of one framework to the other to support applying the knowledge and skills of both approaches. For example, to expand understanding and increase strategies, change teams who are determining the know/do gap using the KTA framework (Determining the knowledge-to-practice gap (know-do gap) | RNAO.ca) can also implement the SMA framework’s three preconditions of change (Preconditions | RNAO.ca).
The result is mobilized knowledge that can be accelerated and sustained through an innovative and novel approach to implementation – one that integrates social movement activity with a traditional change model.
Background on Leading Change Toolkit development
RNAO has produced toolkits since 2005 to support the implementation of our current 49 best practice guidelines (BPG) (https://rnao.ca/bpg/guidelines). Our toolkits and BPGs focus on clinical care and healthy work environments for nurses and other members of the multidisciplinary team. These resources have supported change teams in the successful uptake of knowledge over the years. We aim to share new learnings and evidence through the latest iteration of our implementation resource, the Leading Change Toolkit.
[1]Registered Nurses’ Association of Ontario; [2]Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; [3]University of Ottawa and Ontario Hospital Research Institute; [4]Leading Change Toolkit co-sponsors team members (Acknowledgements | RNAO.ca); [5]Leading Change Toolkit Expert Panel members (Expert Panel | RNAO.ca)
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