The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) is a Community of Practice focused on Best Practice Implementation (BPI). The goal of the network is to adopt and utilize the best available practices in Spinal Cord Injury care to improve outcomes in the areas of pressure ulcer, pain management, and bladder management using evidence-informed implementation science.A best practice (BP) is a method or technique that has consistently shown results superior to those achieved by other means, and is considered a benchmark. In the case of the SCI KMN, they are evidence based practices or recommendations that improve health outcomes related to Spinal Cord Injury.
The SCI KMN is anchored by 6 rehabilitation hospitalsin 3 provinces across Canada. Participating rehabilitation centres include: IRDPQ in Quebec City, IRGLM in Montreal, Lyndhurst Centre in Toronto, Parkwood Hospital in London, Glenrose Rehabilitation Centre in Edmonton and Foothills Medical Centre in Calgary.The network receives financial and additional in-kind support from The Alberta Paraplegic Foundation, Ontario Neurotrauma Foundation and Rick Hansen Institute.
The SCI KMN’s organizational structure consists of central executive and scientific operations to oversee the coordinated network activities of 6 rehabilitation hospitals collaborating in sustainable and scalable implementation of best practices in spinal cord injury care.Without this central backbone, the network would deteriorate into a loosely connected group of individual sites, hindering the potential for collaboration and knowledge exchange towards standardized best practice implementation.
Early in the development of the network, the SCI KMN partnered with the National Implementation Research Network (NIRN).NIRN not only has organized the conceptual frameworks for implementation but has also developed evidence-based practical tools. As with most frameworks, the NIRN concepts and tools are underpinned by the philosophical acknowledgement that implementation is not static. Pictured: The NIRN Stages of Implementation
The NIRN implementation science frameworks and tools serve as an aid to many groups in complex adaptive environments, such as healthcare. With that in mind, NIRN has allowed organizations to adapt their toolsfor contextual use with one major caveat: documentation of changes should be shared for mutual learning. Being the first national implementation science initiative in SCI care, the SCI KMN is paving new ground and has met challenges that have required a unique set of adapted frameworks and tools.The SCI KMN underwent an extensive site/stakeholder selection & engagement stage prior to initiating the NIRN Stages of Implementation. We determined that this process was necessary to effectively implement best practices and decided to develop an additional stage of implementation (pre-implementation) to accurately reflect the stages of implementation that we felt were necessary in SCI rehabilitation and related healthcare domains.
NIRN has developed a self-assessment tool that utilizes a 3-point scale and is important for guiding the implementation process and quality improvement cycles. The SCI KMN is trialing the expansion to 5-point likert scale that provides a higher level of granularity for the purposes of an ongoing, formative evaluation of implementation at each site. In addition to this, we are also evaluating quantitative behavior change measures among individuals at each site. We hope that these adaptations will better measure the effectiveness of organizational change as a result of implementation science - in hopes of achievingmore thorough evaluation of activities as well as quality improvement.
As our network continues to grow and gather a wealth of knowledge and experience, we believe it is our implicit duty to provide other healthcare workers with guidance and instruction important for the development of effective implementation strategies. In addition to the experience of our veteran members, the SCI KMN is developing a comprehensive walkthrough in the form of an Adapted Implementation Guide.The guide will provide provide opportunities to disseminate current SCI KMN implementation strategies and give an overview of our journey as a network to date
This guide provides a systematic approach to understanding how to use implementation science to put research into clinical practice. In addition, the intention is that users of the guide will be able to implement best practices at an accelerated rate and develop effective KM strategies to continue implementing with high fidelity.
As individuals, sites and other related groups join the network, they will need to play ‘catch-up’. These individuals also may not have the luxury of implementation science experts - which the SCI KMN has been fortunate to have - to guide them through the stages of implementation.
Speaking the Same Language: Creating a User Guide to Streamline Knowledge Mobilization
Speaking the Same LanguageCreating a User Guide to Streamline Knowledge MobilizationReinhart-McMillan W1, Koning C2, Mumme L2 and The SCI KMN1Ontario Neurotrauma Foundation, 2Glenrose Rehabilitation Hospital
Section Section Name Slide No.1.Background of the Project &Adapted ImplementationProcesses32.Need for an AdaptedImplementation Guide73. Present and Future Content 124. System-Level Outcomes 15Talk Contents
Working together to uniformly adopt bestpractices to improve secondary outcomes of SCI.
• Adopted the Science of ImplementationThe 4 Stages of Implementation as Developed by the National ImplementationResearch Network
1. Site and Stakeholder Selection ProcessSCI KMN Adaptations ( ) toAccount for:
2. Formative Evaluation for Ongoing QualityImprovement2) Site Self-AssessmentNot In Place Fully In Place• Quantitative Behavior Change Measures• 5-Point Likert Scale3) Data Collectionand Analysis4) Quality Improvement1) Stage-Based BestPractice Implementation
AdaptedImplementationGuideTo provide new membersand other interested partieswith guidance andinstruction …AdaptedImplementationGuidePersonalizedMentorshipfrom Peerswith BPIExperienceStructuredEducationand TrainingCurriculumTraining Tools
So… Why a Guide?The most valuable training will be first-handmentorship from ‘groomed’ SCI KMN memberswith implementation science at their site.However a guide will provide additional benefits…
Why a Guide?3) Accelerated best practice implementationFirst-handexperiencesComprehensiveand SystematizedLearning ResourceEfficient BestPracticeImplementation
Adapted ImplementationFrameworks and ToolsSCI KMNAdaptedImplementationProcessA Need toAdapt TheseFrameworks, Tools andApproachesImplementationScienceFrameworks &ApproachesAdopted by theSCI KMN• ImplementationScience Overview• Overview ofImplementationScience Frameworks &Approaches Utilized bythe SCI KMN• NIRN ImplementationScience Framework• UtilizingImplementationScience Frameworks –Walkthrough• Building anImplementation TeamSection Overview
Our Journey• Detailed overview of SCI KMN journeyacross each stage of implementation.‘Call Out’s’ from clinical leaderscompliment this content and provide practicalsolutions for first time implementers“• SCI KMN Pre-Exploration Stage -Network Activities• SCI KMN ExplorationStage - NetworkActivities• SCI KMN InstallationStage - NetworkActivities• SCI KMN InitialImplementation Stage- Network Activities• SCI KMN FullImplementation Stage- Network ActivitiesSection Overview
On the Horizon• Further integrateclinical exampleswith theory• Color themesand ‘quick links’for fast access• ‘Key Learnings’for each section• Vetting through theSCI KMNimplementation teams
System-Level OutcomesAND…• Standardization – growing, geographicallydisparate network still ‘Speaking the SameLanguage’• Continue sustainable best practice implementationwith high fidelity.
System-Level OutcomesWorking towards…More Well-informed Practitioners + Efficient Systems + Relevant Policiesto achieve Optimal Patient Outcomes for Less $A.K.AMORE BANG FOR YOUR BUCK
Stay Tuned….For More Information:Westley Reinhart-McMillan SCI KMNProject Coordinator and AdaptedImplementation Guide Developerwestley@onf.orgWhen will the first release becomeavailable?• Fall 2013How will it be disseminated?• Initially hard and electronic copies will bedistributed but web-based formataccessible across all platforms .