Control and Eradication of MRSA Through Culture Change Leah Gitterman CHICA/BD MRSA Roadshow February 20, 2009.

Slides:



Advertisements
Similar presentations
Positive Deviance Initiative
Advertisements

Nancy Iversen, RN, BSN, CIC
MCIC Perioperative Initiative February 14, 2006 Operating Room Briefings.
Every Cloud has a Silver Lining Ms Maire Bermingham Assistant Director of Corporate Support Services Dr Naomi Baldwin Senior Infection Prevention and Control.
HELP US TO PREVENT INFECTIONS SPREADING cleanyourhands campaign 2008/09.
1 P o w e r The P o w e r of Positive Deviance Solutions before our very eyes The Premise: In every community there are certain individuals whose uncommon.
Positive Deviance: A Culture Change Management Approach to Reducing Health Care Acquired Infections Michael Gardam Ontario Agency for Health Protection.
Discovering Positive Deviance Organized by members of the PD in the Community Working group and supported by the Ontario Agency for Health Protection and.
The Positive Deviance Hearth Nutrition Model. 2 Basic Causes -Resources and control (human, economic and organizational) -Resources and control (human,
The Healthcare Commission and Patient Safety AvMA NPSA Patients for patients safety partnership event Richard Elson 18th March 2008.
Is Getting There Half the Fun?
UMMC Risky Business?. YES We work with YOU High Acuity Increasing Volume.
Public Engagement in a Multi-Stakeholder World Don Lenihan June 2008.
1 Leadership for Safety Web Workshop: Reality Rounding Essential Hospitals Engagement Network July 17, 2013.
Controlling MRSA Michael Gardam Director, Infection Prevention and Control University Health Network, Toronto National MRSA Intervention Lead
The art of reflection.
POSITIVE DEVIANCE / HEARTH Overview of the Strategy.
Epilogue Death and Dying.
1 Eliminating MRSA Infections Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change.
Questions from a patient or carer perspective
1 Using Cultural Change to Control Superbugs Michael Gardam Physician Director, CHICA Canada Medical Director, Infection Control University Health Network.
Publication MO NH January 2012 This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract.
Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal
Public Narrative Christina Krause July 24, How do we create change at scale? Source: Marshall Ganz Shared understanding leads to Action Narrative.
Benchmarking Benchmarking Dianne Bourque, RNC, CNOR Lam Facial Plastics Plano, TX September 19 th, 2007.
Positive Deviance as an approach to delivering sustainable change NHS Employers 17 th June 2014.
Copyright 2011 Right Care The Accountable Integrated Care System Sept 2011 Commissioning for Value.
Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational.
Positive Deviance Unleashing Creative Action at the Front Line History and Theory Katie Procter.
by Joint Commission International (JCI)
Step 6: Implementing Change. Implementing Change Our Roadmap.
TALKING TO THE PATIENT AND FAMILY!. While talking to the patient and their family… *Sit down and make eye contact with the patient and their family.
Managing the Unexpected …and keeping people safe at the same time Jason Rowley Group Health and Safety Director Carillion.
New Approach to Controlling Superbugs Virtual Learning Session 3 Data – Measuring Progress.
Medical Audit.
Quality Directions Australia Improving clinical risk management systems: Root Cause Analysis.
Supporting Quality Care
Battling bacterial evolution: The work of Carl Bergstrom
1 Dying and death HAIVN Havard Medical School AIDS Initiative in Vietnam.
Positive Deviance Approach For Behavior & Social Change Funded through the Ford Foundation Tufts University.
The P o w e r of Positive Deviance Solutions before our very eyes 1 The Premise: In every community there are certain individuals whose uncommon practices/behaviors.
Quality teaching and learning enabled by ICT
Designing and Facilitating Sustainable Change Initiatives Lisa Kimball Minneapolis April 13, 2012 MNODN 1 Plexus Institute
Instilling Clinical Leadership, Ownership and Accountability.
KGH 2009 Government supervisor Big, growing deficit High sick time Low morale High infection rates Dirty Bad relations with partners Community trust broken.
Innovation U N L E A S H E D with Positive Deviance Keith McCandless, Social Invention Group January 2007.
Collaboration. Definitions of Collaboration Collaboration is “a process through which parties who see different aspects of a problem can constructively.
Rapid cycle PI Danielle Scheurer, MD, MSCR Chief Quality Officer Medical University of South Carolina.
NHS – Enabling Change Improving processes and adding value 5th February 2015 Ian Quinnell Associate Director for Programme Management and Service Improvement.
The Spread of Pathogens Starter 1. Why are most antibiotics no longer effective against MRSA? 2. Describe the pattern in Graph 1 and 2 3. Explain why deaths.
Lesson Overview Lesson Overview What Is Science? Lesson Overview 1.1 What Is Science?
Discovery and Action Dialogue & Positive Deviance (DAD / PD) This approach emphasizes hands-on learning and focuses on actionable behaviors. PD subscribes.
Challenges to successful quality improvement HAIVN 2012.
Challenges to successful quality improvement HAIVN 2013.
Improvement Model and PDSA Cycles. Organ Donation The Service Improvement Model provides a framework to test, implement and sustain change ideas to overcome.
Healthcare Quality Improvement Dr. Nishan Sharma University of Calgary, Canada March
Healthcare Quality Improvement Dr. Nishan Sharma University of Calgary, Canada October
NOT TO BE USED UNTIL 12 NOON FRIDAY #Takingcharge in Greater Manchester Health and Social Care Devolution key messages.
Unit 9: Evaluating a Public Health Surveillance System #1-9-1.
Health Care, Education and Researchwww.billingsclinic.com MMA: Launching High Impact Health Care Teams Virginia Mohl, MD, PhD, DIO and Medical Director.
Effective Healthcare Communication: A Story in Three Parts Nagesh Rao, Ph.D. Director, MICA XVIII NATIONAL SEMINAR ON HOSPITAL & HEALTHCARE MANAGEMENT,
Insert name of presentation on Master Slide The Model for Improvement Wednesday 16 June 2010 Presenter: Dr Jonathon Gray.
Technology of healthcare  BY: seemeka Johnson. Technology of healthcare Doctors now know that genetics play a part in possibly passing on diseases from.
How to show your social value – reporting outcomes & impact
DR Seema Singhal MS, FACS, FICOG, FCLS, MNAMS Assistant Professor
Enhancing Agency and Reducing Risk: A Case for Positive Deviance
Improvement 101 Learning Series
Discovery and Action Dialogues
Introduction to Quality Improvement Methods
Leader’s Role in Process Improvement
Presentation transcript:

Control and Eradication of MRSA Through Culture Change Leah Gitterman CHICA/BD MRSA Roadshow February 20, 2009

Outline Hospital acquired infections are adverse events Why our current strategies don’t work all that well How to move forward Positive Deviance Human Factors

Consider… A family member is admitted to the ICU following a heart attack. She initially does well but then suddenly dies after inadvertently being given too high a dose of a beta blocker.

Consider… A family member is admitted to the ICU following a heart attack. She initially does well but then suddenly dies after developing septic shock from a hospital acquired MRSA infection.

Are these different? Both events resulted in death Both events were preventable

So why do we treatment them differently? Medication error would result in a root cause analysis being undertaken – Incident report filed – Human factors considerations – Concern of legal liability – Prevent the error from occurring again MRSA acquisition would likely end up as a statistic

If something is preventable, should it be considered a cost of doing business… …or should we try to prevent it from happening?

Examples of Trying Hand hygiene Improved hospital design Follow best practice for surgical procedures ARO control strategies Staff education Environmental cleaning Appropriate antibiotic use Appropriate medical device reprocessing Surveillance Vaccination

Changing gears…. You are an infection control practitioner. Your boss calls you in to express her disappointment that your hospital’s MRSA rate is the highest in the province. What is your response? a)I’ll try harder b)I need more staff to make this happen c)Why are you looking at me? I can’t fix this on my own.

In order to tackle hospital acquired infections, we need to change our healthcare culture…...and this cannot be done by infection prevention and control programs alone

The engines of culture change PUSH PULL Culture

SUPER BUGGED I went in for minor surgery and came out with a vicious infection. A story about contaminated hospitals, dirty doctors and the bacteria that are killing 8,000 Canadians a year By Stephanie Verge

Superbugs Suspected in Nurse ’ s Death Ontario’s Ministry of Labour is investigating whether the death of a London nurse last month was caused by a superbug caught at work Josh Wingrove, February 11, 2009

Why turn to a behaviour change approach? We already know what to do Previous successes have been resource intensive Pace of spread in healthcare organizations using “best practice” approach has been disappointing Broad scope

One successful strategy… Positive Deviance

The Premise Of Positive Deviance No matter how seemingly intractable a problem, in every community there are certain individuals whose uncommon practices/behaviours enable them to find better solutions to problems than their neighbours who have access to the same resources

Malnutrition in Vietnam Children In 1990 > 60% of children under 5 were severely malnourished. However, among a few families who were poorest of the poor, the kids were well nourished Observation of these nourished kids, showed that the parents and older siblings were collecting tiny shrimps Split rice portions up Higher prevalence of hand washing Other families in the village recognized that they could use similar practices and therefore the “deviant” practices became the norm.

Helpful Frames of Context Appreciating self-organization  Naturally occurring  Relies on self discovery  Can work for or against what “leader” wants to happen  Is messy Matching the right method to the right challenge

This is about… Creating sustainable change Transforming culture Changing personal human behaviours and habits

Positive Deviance Involves social and behavioural change Problem recognized by the community and the community wants to solve it Innovative behaviours are identified from within Self-discovery

Define: the problem and a successful outcome Determine: individuals who already exhibit behaviour Discover: uncommon practices/behaviours Design: and implement intervention enabling others to access and practice new behaviours

How does it work? Invite those who are interested. Everyone in the group must identify with others in the group Front-line staff is integral in the process IPAC does not have the answer. IPAC has the “what, but not the “how” Let them adopt solutions on their own Identify and analyze the deviants Track and publish results

Who is included? Who are your customers? ▫Get the right people around the table ▫Who isn’t here? ▫“nothing about me without me” Don’t answer questions nobody has asked yet-work on those that people have asked and want to find solutions for

Who is Included? The very people whose behaviour needs to change The community owns the project Everyone that touches the problem are invited to join in Often “unusual suspects” join and take unexpected leadership roles

Learn from the people Plan with the people Begin with what they have Build on what they know Of the best leaders When the task is accomplished The people all remark We have done it ourselves Lao-Tzu’s Tao Te Ching (6 th Century BCE)

What PD Tells us that is Different Solutions imported from external sources results in “social immune response” in the same way that our body triggers an immune defense response

What about Leadership?

PD Tools Kick offs Improvisation Sharing Stories Discovery and Action Dialogues Social Network Analysis

Discovery and Action Dialogue How do you know if your patient carries MRSA? What do you do to prevent spreading MRSA to other patients or staff? What prevents you from doing these things all the time? Is there anyone who has a way of doing things that helps them to overcome these barriers Do you have any ideas? What can we do now? Volunteers?

Social Networks Mapping the spread of contagion Integration – how well connected is the network Assists in finding opportunities to communicate

The Power of Storytelling

Data Collection is Integral to PD Ongoing measurement reinforces change when it is owned by the community

The six beta sites have all achieved significant hospital-wide reductions of MRSA ranging from 30% to 69%.

Challenges Requires comfort with uncertainty Ownership of data IPAC taking a step back Paradigm Shift for Practitioners Scaling up strategies Time ▫These discussions ARE patient care

Five Stages of Grief Denial Anger Bargaining Depression Acceptance

If we start looking for existing solutions, and include everyone, especially those who are not the usual suspects, the possibilities vastly exceed our wildest notions in their simplicity, scope and speed of implementation

Traditional versus PD Strategies Externally fuelled Top-down Deficit based-”what’s wrong” Begins with analysis of underlying problem Solution limited by perceived problem parameters Internally fuelled Down up, inside-out Asset based “what’s right” Begins with analysis of successful solutions Enlarged through discovery of actual parameters

Why Does it Work? Enables us to act today It is possible to find successful solutions today before underlying causes are addressed Enables the community to discover successful uncommon Only strategies that are accessible to all are kept-don’t need extra resources

What about other QI Initiatives Still relevant Can be done along with a PD strategy Complement one another

Type of Problem and Approach Clear “what” and “how” – classic model for improvement Needs discover, high uncertainty - PD

Human Factors The study of how people interact physically and psychologically with products, tools, procedures and processes Designing systems so that they are natural for people

Science finds Industry Applies Man Conforms Slogan from the 1933 Chicago World’s Fair

People Propose Science Studies Technology Conforms Don Norman, The Invisible Computer 2001

Human Factors in Healthcare Medical error Adverse events Hand Hygiene ▫CPSI funded study ▫To identify barriers and enablers to hand hygiene in different clinical environments ▫Toolkit develompment

Environment Modifications

Embrace New Strategies The solutions exist Go and ask the experts Simple actions generate grand results

It is easier to Act your way into a new way of Thinking, than Think your way into a new way of Acting

Any Questions?

References Pascale RT and Sternin J “Your companies secret change agents”. Harvard Business Review Marsh DR, Schroeder DG, Sternin J “The power of positive deviance”. British Medical Journal, vol. 329