Draft Toronto Stroke Networks Education and Knowledge Translation (KT) Plan Acute Care & Rehabilitation 2013 ‐ 2015 Program Goal:To ensure that the appropriate Education and KT resources and processes are in place to support successful implementation of the Best Practice recommendations identified within the Toronto Stroke Networks work plan. Program Objectives:The TSNs Education and KT initiative will: 1. Identify, develop and implement evidence informed education and KT strategies to facilitate appropriate implementation and sustained use of the prioritized Stroke Flow best practice recommendations. 2. Support (through advising, coaching and mentoring)TSNs organizations to access the education and KT strategies and implement the prioritized stroke flow best practice recommendations over the next 24 months. 3. Develop and mobilize a community of stroke health care professionals within the 17 TSNs organizations to facilitate appropriate implementation and sustained use of best practices. 4. Integrate principles of interprofessional collaboration within the education, KT strategies and supports. 5. Incorporate a plan for evaluating the impact /value of the education, KT strategies and supports for successful implementation and as a basis for continuous quality improvement. 1 Key Assumptions: 1. Evidence‐based Education and KT strategies will facilitate implementation of best practices, positive change and improved patient outcomes. 2. Organizational commitment is essential to foster a learning community and enable successful implementation of stroke care best practices. 3. Building strong foundations of stroke care will contribute to continuous improvement towards excellence. 4. The development and utilization of the Toronto Stroke Networks Virtual Community of Practice (TSNsVCoP) will contribute to a learning community, accessibility,knowledge exchange, and sustainability of best practices and a community of dedicated HCPs within the complex stroke care environment. 5. Physician engagement while recognized as crucial to outcomes of the TSNs work plan is addressed within the structure and linkage with the University of Toronto Stroke Program (UTSP). The TSNs Education and KT implementation strategy was developed following the Graham Knowledge‐to‐
Action (KTA) Cycle and consists of three phases: Phase One: Two part consultation process with organizations providing stroke care within the TSNs.An electronic process assessment survey was distributed to facilitate organizational self‐assessment of the implementation of select processes promoting best practices for stroke. This was followed by a face‐to‐face consultation with the interprofessional team to further clarify organizational strengths, needs, and priorities. 2 Phase Two:Development and implementation of the KT plan.A Cross‐system implementation committee comprised of champions from each organization will play a key role in supporting the iterative, evidence‐
based processes of the KT strategy. The mobilization of cross‐system collaboration will enable successful implementation, sustainability and continuous improvement of stroke care best practices while ensuring consistent care practices across the continuum of care. Phase 3: Progress monitoring, evaluation and further planning. An advisory panel of KT experts, stroke leadership and academics will be consulted on the selection of approaches and strategies to support the KT implementation plan and guide in the development of the evaluation framework. 3 Education & KT Programs / Strategies Learning Objectives Deliverables Evaluation Goal: to enable increased knowledge in stroke core foundations and use of key strategies and skills for enhanced patient outcomes Building Stroke Core Foundations This program is dedicated to the enhancement of knowledge, skills and management strategies in best practice stroke care foundations for health care providers and teams within acute and rehabilitation stroke units. Best practice curriculum has been developed with evidence‐based KT education approaches to support varied learning needs, enable successful learning and sustained integration of best practices into clinical practice. Interprofessional Collaboration is a key element to the program. IPC will ensure application of learning to IP stroke teams fostering team development and approaches to care. This will also provide networking support for clinicians. 4 Education & KT Programs / Strategies Unique elements of the Core Stroke Care Foundations Program include: Training on the VCoP for virtual access to resources, ongoing knowledge exchange, and collaborative support from a clinical or interprofessional perspective. Co‐creation of foundational posters to build engagement, collaboration, and to facilitate team and individual competency for selected best practices: • Mobilization / Positioning / Handling • Post‐Stroke Complications / management / Neurological assessment • Cognition / Perception/Vision • Swallowing / Dysphagia /Communication Small Group Learning:Development of implementation guide to support establishing interactive, IP small group 5 Learning Objectives After participating in the Stroke Core Foundational program, HCPs will: Demonstrate skill in utilizing the VCoP to access people and material resources; participate in clinical and interprofessional knowledge exchange / collaboration and professional development activities. Demonstrate a consistent city‐wide team approach and Deliverables Evaluation Key deliverables include: 1) Orientation and training on the new Virtual Community of Practice (acute and rehab) 2) Provision of virtual clinical facilitators to serve as IP stroke champions on the VCoP 3) Clinical project on the VCoP: “Foundational Posters” (Acute and Rehab) a. to develop and prepare TSNs stroke foundational posters pertinent to OT, PT, SLP, Social Work, Dietitian and nursing team practice needs b. IP education half day conference to launch foundational posters and serve as VCoP meet and greet c. Utilization of foundational posters for mini educational and orientation sessions on stroke care units. 4) Development of a formalized and consistent orientation to acute stroke care units for nursing, allied TSNs VCoP evaluation
(Separate document) Developmental Evaluation approach (straw dog)‐ Wenger’s promoting and assessing value creation in CoPs. Cycles include: 1. Activities/interactions 2. Knowledge capital 3. Applied value (Change in Practice) 4. Realized value: performance improvement 5. Reframing value Outcomes: Start with numbers participating (quantitative.. and goal to build on participants and Education & KT Programs / Strategies based learning sessions for above best practices at local level. These facilitated sessions will be designed to integrate current or recent case experiences, best practices, and reflection on practice to enable learning and practice change. Focus will be on foundational knowledge and IPC. Structure to be developed by RECs with input from Advisory and Cross System BP Implementation Committees. 6 Learning Objectives Deliverables Evaluation health, CAs and rehab assistants. understanding of core foundational stroke skills and knowledge 5) Facilitation of structured team development and education activities on stroke unit to include: Increase knowledge in a. Allied health / nursing led – clinical and IP roles and IP stroke core foundational perspectives to training, at local level, facilitate team utilizing foundational posters awareness, shared ( e.g. small group learning development and sessions, ‘lunch and learns’, approach to improving or ‘huddles’) stroke care b. Skill based development to include: Dysphagia & nutrition; early mobilization, positioning, transfers, mobility; depression screening, and treatment (where appropriate); prevention & management of post stroke complications; cognition; perception, and management of patients with increased stroke severity and co‐morbidities Opportunity for practice and feedback on new skills at bedside c. Identification of mentors for coaching support (online or bedside) post‐workshop number of groups participating in…) Value assessment of VCoP for IP collaboration… and then for increasing knowledge and implementation of BPs) Pre‐post questionnaire Tracking numbers of foundational sessions/ huddles format developed/ in‐services… set requirements for numbers and topics… Pre‐post questionnaires VCoP evaluation of value creation stories COMPASS evaluation results Education & KT Programs / Strategies Delivery of skill based workshops with opportunity to practice and obtain feedback and maintenance of competence at a local level. Topics include: CMSA NIHSS / CNS Identified outcome measures E‐learning: Exploration, development and expansion on e‐learning opportunities. Virtual and on‐site peer mentorship (coaching) at the bedside to facilitate learning and adoption of best practices. Collaboratively developing team‐based action plans for all stroke units, utilizing IP COMPASS, to build interprofessional collaboration and enhanced team functioning Development of a comprehensive orientation program for health care providers new to stroke units including a 7 Learning Objectives Demonstrate competency in application of discipline specific outcome measure tools Deliverables Evaluation d. Interprofessional approach to facilitate learning utilizing informal joint assessments for the purpose of : • in‐time knowledge building • mutual skill development and • awareness of IP / team roles 6) City Wide Specialized training on Best Practice Recommended specific outcome measure tools: • CMSA • GRASP • CAHAI 7) Incentive program to improve motivation and maintain changes. 8) IPE/IPC Team and environment readiness assessment – IP COMPASS 9) On‐line education and/or self‐learning packages will be initiated on: • Anatomy and physiology of stroke (Hemispheres) • In‐patient code stroke protocol (where available) Education & KT Programs / Strategies Learning Objectives Evaluation focus on lifelong learning and continuous • quality improvement towards excellence. Support for local teams to enable continuous quality improvement, sustained positive change, and excellence in stroke care. Focus on foundations and adaptation to local environments with iterative progression towards more advanced stroke topics and excellence in stroke care. Goal: To facilitate standardized stroke flow processes across the system AlphaFIM implementation After participating in Alpha FIM Instrument training: Training will include a combination of workshops, In‐services, and 1:1 • OT’s & PTs will instruction on tools such as AlphaFIM, demonstrate skill in and E‐Stroke referral. Level of instruction correctly utilizing will vary by profession depending on the Instrument to their role in completing assessment and assess stroke referral forms. patients • Acute stroke IP 8 Deliverables NIHSS 10) Deliver comprehensive orientation program for health providers new to stroke units. 11) Specialized Training on the Alpha FIM – for appropriate Pre‐post questionnaires professions AlphaFIM completed 12) IP led AlphaFIM training to Education & KT Programs / Strategies This program is dedicated to developing a team approach and team responsibility to encourage timely access to designated stroke services and rehabilitation E‐Stroke Referral Implementation 9 Learning Objectives •
team members will demonstrate an understanding of the Alpha FIM numerical values in terms of the patient’s functional status IP team members will be able to state their role in contributing to the completion of AlphaFIM assessments within a three day window. Deliverables Evaluation facilitate team approach, understanding and relevance to meeting Best Practice guideline. After participating in e‐
Stroke Referral training: Participants will develop a team understanding and approach to completion of E‐Stroke referral within 3 day window (80%) 13) Training on E‐Stroke referral 14) IP‐led team approach training for completion of e‐stroke referral Education & KT Programs / Strategies Cross‐system Collaborative Learning Initiatives Three initiatives are outlined below: 1) Transition Improvement for Continuity of Care (TICC) Designed to improve the life experience for people with stroke (PWS) and their families/caregivers and to create a sustainable, interconnected system of seamless and consistent care processes. Specific interrelated projects underpinned by principles of relational strength and optimistic care, and supported by a TICC learning community include: • Stroke Passport: a patient‐ mediated communication and navigation tool • Knowing Each Other’s Work: a set of learning initiatives designed to foster learning and meaningful collaboration among 10 Learning Objectives Deliverables Evaluation •
•
TICC evaluation is a 15) Education and on‐
separate document goingcollaborative support for successful implementation and adaptation of TICC projects at pilot sites (acute and rehab) Passport Knowing Each Other’s Work (KEOW) Education & KT Programs / Strategies •
health care providers cross‐ system i.e. Essential Professional Conversations for Seamless Care; Stroke Care Observerships). Peers Fostering Hope: A peer approach designed to provide emotional support, knowledge exchange, hope, empowerment, improved recovery and quality of life for the person with stroke. Learning Objectives 11 Evaluation •
Peer Support •
Please see accompanying TICC posters 2) Toronto Stroke Networks Virtual Community of Practice (TSNs VCoP) Designed with and for Health Care Providers working in stroke care. The TSNs VCoP will meet four stakeholder identified outcomes of : 1. To have better knowledge exchange via peer‐to‐peer support 2. To improve the dissemination and adoption of stroke best practices 3. To build a more efficient way to find relevant people or material Deliverables Training identified in earlier aspect of Education and KT implementation plan TSNs VCoP evaluation is a separate document as outlined above. Education & KT Programs / Strategies Learning Objectives 12 Evaluation resources and finally… 4. To facilitate and encourage interprofessional collaboration between the TSNs members. The TSNs VCoP utilizes Membership and Groups Profiles, a Resource Repository and Discussion Forum to meet the desired outcomes. *Please see accompanying TSN VCoP Poster 3) Cross‐system KT and Implementation Committee for Best Practices Represents a face‐to‐face opportunity for cross‐system leaders ( acute and rehab) to connect (quarterly+) , share knowledge and lessons learned and collaborate to support adaptation of best practices locally while striving for city‐
wide consistency, and lead change within their respective organizations. The Graham Knowledge to Action Framework (as well as other potential Frameworks) to serve as a guide to enable successful implementation of Stroke Care Best Practices. Deliverables 16) Establish Cross‐system Education and KT Implementation Committee for Best Practices • Meet quarterly (or more as required) • Acute and rehab representation • Encourage link with local implementation committee • Provides cross system collaboration on education and KT implementation and process related needs to support Best Practice Implementation Education & KT Programs / Strategies Development of effective small group learning, cross system orientation and iterative progression of continuous quality improvement (CQI) would be brought to the Cross system KT and Implementation committee for local adaptation and implementation. 13 Learning Objectives Deliverables Evaluation