Promoting a cultural shift and a system change to respond to agitated and excessive behaviours (REAB).

The Responding to Excessive & Agitated Behaviour (REAB) Program was designedas a system change model to create a healthy work culture and to promote quality, client-centered care. It is a unique program that has integrated best clinical practices with workplace safety policy and criteria promoting continuous assessment ofa facility's ability to meet the requirements of the REAB model. Funding was received from the BC Nursing Directorate. Key clinical and work health leaders in a large BC health authority were supportive of this initiative. Phase I began in 2004 with a review of the literature and environmental scans leading to the development of the REAB model. The model contains ten elements which if addressed promotes the best in clinical practice and working conditions. In Phase II benchmarking data were collected and the REAB process was trialed in fifteen facilities. The findings and the model were validated by a variety of representatives from practice and industry in a one day forum. Phase III was the development of a resource toolkit to guide the implementation process and contained supportive resources. Phase IV, now in progress, consists ofan orientation to the toolkit and access to a facilitator who assists agencies in identifying their own gaps in relation to the model, as wellas guides the implementation of a viable and sustainable plan for improvement. This paper reviews the evolution and the development of this project so that others may incorporate its methodology and resources into their own facility.