At the annual Best Practice Spotlight Organization® (BPSO®) Symposium in Toronto this fall, RNAO CEO Dr. Doris Grinspun, founder of the internationally renowned program, addressed a room of more than 200 in-person attendees and hundreds more online. It all “started with a proposal from a young nurse with dreams in her head,” she said of the Best Practice Guidelines (BPG) Program that has since grown into a social movement of science, with more than 1,500 BPSOs implementing RNAO’s best practice guidelines around the world (search our interactive map for more information). 

She recalls how her first conversations about BPGs happened while she was doing work with the Pan American Health Organization as director of nursing at Toronto’s Mount Sinai Hospital through the early 1990s. Grinspun’s vision came to fruition when she joined RNAO as its executive director in 1996 and pushed to change nursing for the better. “(It’s now) a powerful movement we’ve shaped together…for nurses, other health professionals and the public.” 

RNAO’s BPSO program has become the gold standard for a purposeful, social movement of science that relies on a conscious and intentional approach to growth that involves knowing when to accelerate change and when to slow down and let it happen organically (referred to by Grinspun as purposeful evolution in RNAO’s 2018 book about the program, Transforming Nursing Through Knowledge). This approach is one of the reasons why diverse care providers and political leaders of all stripes have supported RNAO’s BPG and BPSO programs since 1998 and 2003, respectively. 

The 1990s was a time of widespread disruption in Ontario’s health system as a result of restructuring and nursing layoffs. And it was during this uncertainty that RNAO took on a leading role with support from the Ontario government to reinvigorate the profession and ensure nurses had the knowledge and skills they needed to provide care in an increasingly complex environment.

Following a robust proposal by Grinspun, multi-year funding was announced and allocated to RNAO in 1998 for the development, pilot implementation, evaluation and dissemination of BPGs. The funding and partnership with the provincial government has continued for over two decades, regardless of the party in power. This speaks to the value, importance and impact of the program. Indeed, while this year marks the 20th anniversary of BPSOs, next year will mark 25 years since the BPG program was launched.

Champions support BPG implementation

As part of the network, nurses became champions by participating in one-day, in-person workshops, later supplemented with a self-directed eLearning program and an eventual virtual learning series during the pandemic. The curriculum prepares champions with numerous tools and strategies to promote and support the implementation of BPGs in their organizations.

“By networking, sharing experiences and building strong ties between organizations, these champions are influencing change at the point of care,” Grinspun told RNJ when news of the growing program was first published in 2005. Fast-forward two decades to the fall of 2023 and the launch of a revitalized champions program. The Champions Blended Learning Series is a training course that gives champions strategies for driving change and mobilizing action in their workplaces or academic settings. Read more about the exciting new curriculum and what inspires champions in our feature, Leading by example.

“Doris built a powerful vision,” McGuinty recalled in a recent conversation about his relationship with RNAO when he was premier. The now vice chair of the board at the University of Ottawa Heart Institute remembers his many conversations with Grinspun in the early 2000s. The BPG program "...was built on data, monitoring and evaluation, and scientific rigor. I was immediately drawn to it,” he says, adding it was also transformative, and had the potential to be world-class and Ontario-driven. 

With ongoing funding and support at the provincial level, expansion continued and healthy work environment BPGs were created to focus on things like nursing leadership, professionalism, collaboration and diversity in nursing. With this ongoing growth and success, it became clear that a strategy was needed to further implement BPGs into nursing practice through a sustained, organizational culture shift to evidence-based practice.

BPSOs implement BPGs 

“That’s when BPSOs really came into being,” says Dr. Tazim Virani, director of the BPG program from 1998 to 2007. With a desire to build knowledge transfer into this important work at an organizational level, RNAO signed agreements with the first cohort of BPSOs in 2003. 

It was a learning curve for RNAO and the inaugural seven health-care organizations that took part in the program. “We looked at how they were experiencing their success in implementing and sustaining their guidelines, and the kind of help they felt they needed,” Virani recalls. “They were trailblazers in creating an organizational culture that embraced evidence-based practice.” As more and more organizations signed agreements, the value of this new evolution of the program became clear.

An international network, supported by RNAO and its most seasoned BPSOs in multiple countries was Grinspun’s vision. And the BPSO Host model was established to allow international organizations to develop a relationship with RNAO while building the BPSO network in their own jurisdictions and supporting organizations in their communities to become BPSOs. Host organizations are given the tools and resources to facilitate this outreach in their respective countries, while also ensuring program fidelity and deliverables, explains Grinspun. For more information about Spain and other early adopters (including Australia, Chile and China), read our in-depth feature, A thriving global collective.

International expansion speaks to what nurses around the world were really looking for: a stronger identity as nurses and respected members of the health team, Bajnok says. “It helped nurses describe their practice, make changes to deliver evidence-based care, gave them a sense of confidence, and helped them network with nurses around the world. In fact, as in Canada, it shone a spotlight on the work and impact of nursing in health care.”

BPSOs in different sectors, specialties and communities

By 2009, RNAO began including academic institutions in the BPSO program. Today, “fifteen universities and colleges in different parts of the world have joined the program, and many more are joining in 2024,” says Susan McNeill, RNAO’s associate director of guideline implementation and knowledge transfer. An academic consortium (see sidebar for more on consortiums) meets regularly to build-up consistency and share success stories about implementation of BPGs into nursing curriculum. 

This breakthrough in the program paved the way for RNAO Clinical Pathways™ in 2022. Find out more in our comprehensive feature, Using evidence to enhance resident care, about the expansion to long-term care and the clinical pathways initiative.

In 2019, funding to further expand the program to Indigenous organizations and Ontario Health Teams (OHT) was secured by Grinspun. “BPSO OHTs can now partner with RNAO to implement guidelines using a model that includes all disciplines and sectors across the care continuum,” says Kristen Campbell, an RNAO implementation science manager (read about one OHT’s journey in our feature, Success stories and inspiration at annual symposium). 

Similarly, the Indigenous-focused BPSO program allows organizations to work with RNAO to implement BPGs that support the health and wellness of Indigenous people. Grace Suva, program manager, describes the focused work with Indigenous champions as a “game changer,” particularly in relation to the Leading Change Toolkit, a resource launched in 2021 to expand on and supplement the “Toolkit” created in 2002 for champions to implement BPGs. 

For Indigenous organizations, the process of change involves a true reflection on the Indigenous world view, and the updated toolkit “will resonate with current and future Indigenous-focused BPSOs and future champions,” Suva says. Read more about Indigenous-focused BPSOs in our feature, Weaving together Indigenous and western care practices.

Determining impact and evaluating outcomes

Throughout the BPSO program’s growth across sectors and countries over the last two decades, a focus on its impact and outcomes has always been top-of-mind. In August 2012, Grinspun and Dr. Monique Lloyd, then associate director of guideline development, research and evaluation, launched Nursing Quality Indicators for Reporting and Evaluation® (NQuIRE®), an international data system consisting of a database, an online data-entry system, multiple data dictionaries and collection/reporting processes that gather quality indicator data submitted by BPSOs. 

Evidence Boosters are published documents that include infographics that demonstrate the impact BPGs are having in organizations and institutions. Read about how this data provides a direct link between BPGs and better health outcomes in this issue’s in-depth feature about some of the impressive outcomes in public health, acute care, home and community care, long-term care, and academic institutions.

Scaling up, out and deep: The future of BPSOs

Today, with more than 1,500 BPSOs worldwide implementing BPGs in different settings and sectors, McGuinty and Witmer are impressed with the progress the program has seen over the last 20 years. “(BPGs) are becoming almost universally recognized as an essential component in the delivery of quality care,” McGuinty says. “More and more places are saying why would we not do that.” Encouraging all health professional to think more systematically, Witmer adds: “I think BPGs have played a significant role throughout the entire world.” 

“Going forward, we must always keep front and centre the people and communities we as nurses serve,” Grinspun says. “The ultimate goal is for the public – individually and collectively – to receive the best possible care every time they come into contact with care professionals, and RNAO BPGs and the BPSO social movement of science are key to achieving this. The public must always remain the real winners of this magnificent transformational effort.”