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Positive Deviance Unleashing Creative Action at the Front Line History and Theory Katie Procter
Millions of people worldwide are suffering from infections acquired in hospitals and other healthcare settings.
Some Canadian Statistics • Each year in Canada, more than 220, 000 healthcare associated infections result in 8, 500 -12, 000 deaths, and the rates are rising. • One in nine hospital patients in Canada get a healthcare associated infection. • Infections are the fourth leading cause of death in Canada. • From Healthcare Acquired Infections – Canadian Union of Public Employees report 2009
MRSA • “Superbug” – common, deadly and relentless • Some successful eradication of MRSA in some Northern European countries and very isolated American institutions • Positive Deviance Initiative and Plexus Institute to explore using PD in healthcare facilities
August 2005 • PD Institute promoted the use of the PD approach to reduce MRSA in 40 hospitals around the world • PDI collaborated with Veterans Administration to work in 6 hospitals in the US • Used the MRSA bundle – hand hygiene, active surveillance, contact precautions and environmental cleaning
• Focus on practice rather than knowledge It’s easier to ACT your way into a new way of THINKING than to THINK your way into a new way of ACTING!!
Modified Focus Groups • Discovery and Action Dialogues • Improvisation • Theory of Inventive Problem-Solving (TIPS) or TRIZ in Russian
USA Trial Results Clinical results: 35% average drop in MRSA infection • The Billings Clinic incidence rate declined by 88% • Albert Einstein Medical Center infections dropped 35% so, • 57 people went back to their families, homes and lives. Expected organizational results • Hand hygiene and gowns & gloves use improved at all sites • Self-report data on performance & employee satisfaction improved Unexpected benefits • Improved nursing recruitment into tough units • Improved process for on-call scheduling 13
Billings Clinic - Healthcare-associated MRSA Infections Housewide Incidence Rates January 1999 – June 2008 Incidence Rate = # cases / patient days X 1, 000 Case is defined as healthcare-associated infection. 14
Healthcare-associated MRSA Infections ICU Incidence Rates January 2004 – June 2008 Incidence Rate = # cases / patient days X 1, 000 Case is defined as healthcare-associated infection.
Canadian Research Project • 6 beta sites to start – 2 in BC – Vancouver General and Kelowna General – 5 stayed for the long haul • All submitted data and came up with very creative ideas • Toronto East General very successful • Now projects dotted all across Canada
Canadian Research Project • In general, the rates of infection have come down across all sites in the preliminary data • Vancouver General Hospital was the only hospital that reported hand hygiene compliance – there was an increase from 35% to 83% and has settled back to about 75% • Faster response by staff to infection break out
To get started you need! • Complete top to bottom commitment • Management that agrees to just remove the boulders • A coach with skilled facilitation in leading the techniques • A strong PD core team made up of volunteer interdisciplines – 4 – 6 is ideal
Some kind of a kick off and regular meetings • Information to staff as to what you are doing • Some kind of kick-off • Regular core team/coach meetings – suggest once a week for 4 – 6 months then drop back to every 2 weeks/reassess • Regular core team/staff meetings as well – suggest once a week for 4 – 6 months then assess what you need based on the energy and work being done – tie these to:
Reporting of the data by the STAFF that makes sense to their process changes and how it makes sense to their needs.
Good facilitators have NO HOMEWORK – THE STAFF DO!
Some challenges • Complete shift for practitioners – from being the • • expert to being facilitator asking questions Need comfort with power sharing and letting go of control Strategies to scale up Time and human resources to have the conversations Need comfort with uncertainty You can’t predict all outcomes and consequences It’s a slower process
Unleashing is all about Engaging your PEOPLE, developing SKILLS, changing BEHAVIOR, INSPIRING & MOBILIZING them
This is about LOCAL change, NOT borrowing from other institutions
Unusual Suspects • This is about finding local people or pockets of positivity where the job gets done who have no more resources than anyone else then spread peer-to-peer • It might be someone who surprises you. Ask around!
You use it when you know that: You have a Wicked Important Problem that is Seemingly Unsolvable Progress is measureable, it just might be different Behavior needs to change NOT knowledge Skilled facilitation is available
When you want different outcomes • FROM • Problems • Best practices • Buy-in • Education • Shame and Blame • Knowledge • Big initiatives • Telling • Periscoped purpose • Prescription • Top down • Standard outcomes • TO • Solutions • Local emergence • Ownership • Learning • Celebrating local success • Behavior • Small changes • Asking • Shared purpose • Discovery • Unusual suspects • Joyful, shared meaning & extraordinary results
When you want different conversations a difference! • Nothing will make a difference! • We can make • We’re doing everything we can do! • We can do more! • We don’t have time! • We actually do have time! • We don’t have the resources! • We don’t need anymore resources! • You’ll never get them to change! • We CAN change! • Just tell us what to do! • We CAN do! • Don’t tell me what to do! • We can fix this problem! • We will always have this problem! • ETC ETC
http: //www. positivedeviance. org/pdf/Newsletter/October 2012 newsletter. pdf