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New Approach to Controlling SuperbugsVirtual Learning Session 1

Discovering Positive DevianceMichael GardamLeah Gitterman

Agenda

• Intro to WebEx• Patient story• What is the “new approach”?

Interacting in WebEx

Apr 8, 2023 3

Be prepared to use:

• Pointer

• Raise your hand

Meet Our Team

Erika Bailey Michael Gardam Leah Gitterman Liz Rykert

Susan McDonald Paige Reason Katie Procter Jessica Ip – Project Coordinator

A story…

Why focus on a behaviour change approach?

• Current “top down” approaches have had limited success

• Traditional “best practice” approach has been disappointing

• We need to acknowledge that we are human!

Culture EatsStrategy

For Breakfast

Sharing best practices• Solutions imported from external sources

results in “social immune response”

NEW IDEA

NEW IDEA

The Premise Of Positive Deviance

No matter how bad things are, there are always people in the group that do a better job, despite having access to the same resources

3 quick examples

• Malnutrition• Smoking cessation• Medication reconciliation

If you tell people where to go, but not how to get there, you'll be amazed at the results.

General George S. Patton

PD and MRSA

• US pilot project• Implementation of PD followed by 20 month

follow up period• No attempt to decolonize patients• 26-62% reduction in MRSA clinical infections

SHEA 2009

Examples from Healthcare• Hook story• Transportation cards• Isolation signage• Nursing student Hand Hygiene video• Vancouver General: HH rates• Toronto East: cleaning equipment, antibiotic

stewardship

Quinte Health Visitor Board

Making the invisible visible at

Vancouver General

Improv at Toronto Western Hospital

This is about…• Creating sustainable change• Helping culture to shift• Indentifying existing practices • Developing new behaviours to overcome

barriersActing your way into a new way of thinking

100%

4%

9%

74%

Problems known to top managers

Problems known to middle managers

Problems known to supervisors

Problems known to front line managers

“Up, down and out”

TAKE

Talk amongst yourselves

Think about someone you know who you suspect might be a positive deviant…

What are they doing? What makes you recognize their behaviour as unusual or different?

Tell us your stories

The 6 D’s

1. Define: the problem and a successful outcome

2. Determine: if anybody exhibits the desired behaviour

3. Discover: uncommon practices/behaviours

4. Design: activities enabling others to access and practice new behaviours

5. Discern: effectiveness of activities or project through ongoing monitoring and evaluation

6. Disseminate

How does it work?• Invite those who are interested• Front-line staff must be there (the “Gurus”)• Create conditions for people to discover and adopt

their own solutions• Identify and analyze the positive behaviours• Create ways to spread peer to peer• Track and publish results

Who is included?Anybody who wants to be thereEverybody who touches the problem– Get the right people around the table– Who isn’t here?– “nothing about me without me”

4 Phases of Implementation

1. Getting Started2. Engaging the Organization 3. Fuelling Change4. Making Sense and Diffusing

Getting Started• You have to decide how to “kick off” this

process in your facility• Examples:

– UHN– US experience– CPSI study sites

Talk amongst yourselves

• What would this look like in your organization?

• How would you launch it?• Anybody you know who might be interested?

– Front line, middle management, senior management?

PD Tools• Kick offs • Improvisation• TRIZ• Sharing Stories• Discovery and Action Dialogues• Wise crowds• Social Network mapping• Ethnographic mapping

• stopsuperbugs.com– Google groups: discussion forum– Google maps

• positivedeviance.ca• positivedeviance.org• Twitter: @DrMichaelGardam• Facebook: stopsuperbugs• Faculty office hours• One-to-one coaching available

New website screen shot