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