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  • 1. New Approach to Controlling SuperbugsVirtual Learning Session 1Discovering Positive Deviance

2. Meet Our Team
Michael Gardam
Erika Bailey
Leah Gitterman
Liz Rykert
Mohammad Salhia
Linda Morgan
Marc Van der Woerd
Paige Reason
Jessica Ip
Susan McDonald
Katie Procter
3. 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.
4. 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!
5. 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
6. 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
7. Examples from Healthcare
Hook story
Transportation cards
Nursing student Hand Hygiene video
Vancouver General: HH rates
Toronto East: cleaning equipment, antibiotic stewardship
8. Quinte Health Visitor Board
Making the invisible visible at
Vancouver General
Improv at Toronto Western Hospital
9. The power of storytelling
One death is a tragedy; one million is a statistic.
Stories can capture the complexity ofthe situation.
10. This is about
Creating sustainable change
Helping culture to shift
Identifying existing and/or uncommon practices
Developing new behaviours to overcome barriers
Acting your way into a new way of thinking
11. Who have the knowledge?

12. 4%
Problems known to top managers
Problems known to middle managers
Problems known to supervisors
Problems known to front line managers
The Awareness Iceberg
13. 100%
14. 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?
15. Tell us your stories
16. Positive Deviance-the 6 Ds
Define: the problem and what a successful outcome looks like
Determine: if there are any individuals who already exibit desired behaviour
Discover: uncommon practices/behaviours
Design: activities enabling others to access and practice new behaviours
Discern: effectiveness of activities or project through ongoing monitoring and evaluation
17. 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
18. Who is included?
Everybody who touches the problem
Get the right people around the table
Who isnt here?
nothing about me without me
19. 4 Phases of Implementation
Getting Started (Months 1-2)
Engaging the Organization (Month 3)
Fuelling Change (Months 4-12)
4. Making Sense and Diffusing (Month 12+)
20. Getting Started
You have to decide how to kick off this process in your facility
US experience
CPSI study sites
21. 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?
22. 3 clicks to join a
breakout session
23. Tell us your stories
24. 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
25. Minimum Specifications
Use inquiry based processes DADs
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
26. PD Tools
Kick offs
Sharing Stories
Discovery and Action Dialogues
Social Network Analysis
Ethnographic mapping
27. Resources
Faculty office hours: every Monday from 1-2pm
The Power of Positive Deviance
Inviting everyone: Healing Healthcare through Positive Deviance


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