Priming the Governance System for Climate Change Adaptation: The Application of a Social Ecological Inventory (SEI) to Engage Actors in Niagara, Canada

Adaptive systems of governance are increasingly gaining attention in respect to complex and uncertain social-ecological systems. Adaptive co-management is one strategy to make adaptive governance operational and holds promise with respect to community climate change adaptation as it facilitates participation and learning across scales and fosters adaptive capacity and resilience. Developing tools which hasten the realization of such approaches are growing in importance. This paper describes explores the Social Ecological Inventory (SEI) as a tool to 'prime' a regional climate change adaptation network. The SEI tool draws upon the social-ecological systems approach in which social and ecological systems are considered linked. SEIs bridge the gap between conventional stakeholder analysis and biological inventories and take place through a six phase process. A case study describes the results of applying an SEI to prime an adaptive governance network for climate change adaptation in the Niagara Region of Canada. Lessons learned from the case study are discussed and highlight how the SEI catalyzed the adaptive co-management process in the case. Future avenues for SEIs in relation to climate change adaptation emerge from this exploratory work and offer opportunities to inform research and adaptation planning.

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.