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New Approach to Controlling SuperbugsVirtual Learning Session 1
Discovering Positive Deviance
Meet Our Team
Erika Bailey Michael Gardam Leah Gitterman Liz Rykert
Susan McDonald Paige Reason Katie Procter Jessica Ip
Mohammad Salhia
Linda Morgan
Marc Van der Woerd
The Premise Of Positive Deviance
No matter how seemingly intractable a problem, in every community there are individuals whose uncommon practices/behaviours enable them to find better solutions to problems than their neighbours who have access to the same resources.
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!
Sharing best practices
• Solutions imported from external sources results in “social immune response” in the same way that our body triggers an immune defense response
NEW IDEA
NEW IDEA
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• 1 site had an 80% drop in MRSA infections
SHEA 2009
Examples from Healthcare
• Hook story• Transportation cards• Nursing student Hand Hygiene videohttp://www.youtube.com/watch?v=rBBSF0GHziQ• 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
The power of storytelling
• One death is a tragedy; one million is a statistic.
• Stories can capture the complexity of the situation.
This is about…
• Creating sustainable change• Helping culture to shift• Identifying existing and/or uncommon
practices • Developing new behaviours to overcome
barriersActing your way into a new way of thinking
Who have the knowledge?
≈
100%
4%
9%
74%
Problems known to top managers
Problems known to middle managers
Problems known to supervisors
Problems known to front line managers
The Awareness Iceberg
100%
74%
9%
4%
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
Positive Deviance-the 6 D’s
1. Define: the problem and what a successful outcome looks like
2. Determine: if there are any individuals who already exibit 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 deviants• Create ways to spread peer to peer• Track and publish results
Who is included?Everybody 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 Started (Months 1-2)
2. Engaging the Organization (Month 3)
3. Fuelling Change (Months 4-12)
4. Making Sense and Diffusing (Month 12+)
Getting Started
• You have to decide how to “kick off” this process in your facility
• Examples:– UHN– US experience– CPSI study sites
Take 15 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?
3 clicks to join a
breakout session
Tell us your stories
Minimum Specifications
• Actively seek involvement beyond usual suspects
• Adapt and build as unit(s) develops momentum
• Track progress and feed back to community• Follow existing science/evidence based
practice
Minimum Specifications
• Use inquiry based processes “DAD’s”• Feed back and rapidly act on suggestions or
communicate why they cant be acted upon• Create conditions to enable others to share
practices• Allow for a periodic “booster” shot• Cultivate ownership
PD Tools
• Kick offs • Improvisation• Sharing Stories• Discovery and Action Dialogues• Social Network Analysis• Ethnographic mapping
Resources
• www.stopsuperbugs.com• Faculty office hours: every Monday from 1-2pm• www.positivedeviance.ca• www.positivedeviance.org• The Power of Positive Deviance• Inviting everyone: Healing Healthcare through
Positive Deviance
www.stopsuperbugs.com