Designing and Facilitating Sustainable Change Initiatives Lisa Kimball Minneapolis April 13, 2012 MNODN 1 Plexus Institute

2 Eliminating MRSA Infections Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change

20,000 die every year in the U.S. from MRSA infections… 20,000 …more than die from AIDS

Where do you find MRSA in Hospitals? Everywhere!

MRSA CAN be stopped! MRSA incidence rates – Billings Clinic Housewide – January 1999 – December st Jan, 2005 – 30 th June, % Reduction in HA MRSA infections Active surveillance began in ICU Jan 2007 May 2006 PD/MRSA project began 84% (4 people) (9 people) (14 people) (20 people) (33 people) (38 people) (34 people) (14 people) (6 people) 0.13 June - Dec

Preventing MRSA infections is primarily a complex social and behavioral challenge rather than a knowledge or technical problem. “ ”

All invited and included

Theatre In the Round A diverse audience, from many units across the clinic, assembles in the conference room… now an inpatient medical room. For the next 60 minutes, no one knows what to expect.

Engagement, engagement, engagement! …in an array of proven social change processes, featuring Positive Deviance, designed to engage everyone in: Discovering which of their practices can play a role in the transmission of MRSA Spreading effective practices, creating new practices and deciding what changes they need to make personally and together

Monitoring tools …for the staff to track their OWN performance with essential infection control practices on their unit Staff may choose to track the percentage of swabbing at admission, discharge or transfer and conduct periodic surveys on compliance with hand washing and standard isolation precautions (gloving and gowning)

Learning collaborative Every hospital implementing the Plexus MRSA Practice Change Bundle is connected with other facilities engaged in the same process and others who have already implemented it

Team Coaching

D&A Dialogues What do you know/think about ________? What do YOU do about ______________? What keeps you from doing that all the time? Who/Where have you seen overcome those barriers? What other ideas do you have about removing barriers? (or supporting desired behavior) What has to happen next to make that happen? Who will do what when next?

Dr. Jon Lloyd, Pittsburg VA They all pointed at the ICP staff When we asked the staff: Who is responsible for infection control? A year later everyone raised his hand “ ”

The Palmer Method

Jerry Zuckerman, MD, medical director of infection prevention and control, Albert Einstein Medical Center I’ve seen more change at Einstein in the last six months than in my 16 year career in infection control. “ ”

Results Healthcare associated MRSA infection rates for RWJF/Plexus pilot units from 2006 to 2008 declined 74%

Close to Zero MRSA incidence rates – PD MRSA Intervention Unit - ICU January 2004 – December (13 people infected) 2.72 (14 people infected) 2.76 (14 people infected) 0.38 (2 people infected) 0.20 (1 person infected) CY 2008 Jan-Dec Jan 1, 2006 – Jun % reduction in HA MRSA infections 2006 – % decrease 2007 – % decrease 2 others achieved reductions of 65-70%

While national rates of MRSA HAI’s go up, RWJ/Plexus PD beta site rates are going down. “ ” Dr. John Jernigan, CDC

How many $$$$ could you save by reducing MRSA infections? MRSA infections result in… Increased lengths of stay Opportunity costs Unreimbursed expenses Potential liability

Long term benefits Hospital Reputation Leadership Development Break Down Silos Liability/Risk ReductionReduction of MRSA BurdenProcess Skills Applicable to Other Issues

The work of Plexus Institute initiative using PD to fight MRSA in hospitals, was one of The New York Times Magazine featured ideas of the year for 2008

PD Focus on Practice Rather than Knowledge ACT “It’s easier to ACT your way into a new way of THINKING, than to THINK your way into a new way of ACTING”

PD Enables us to Act TODAY The presence of Positive Deviants demonstrates that it is possible to find successful solutions TODAY before all the underlying causes are addressed! Although most problems have complex, interlinked underlying causes...

Contrasting Approaches TRADITIONAL Externally Fueled (by “experts” or internal authority) Top-down, Outside-in Deficit Based “What’s wrong here?” Begins with analysis of underlying causes of PROBLEM Solution Space limited by perceived problem parameters Triggers Immune System “defense response ” Liberating Structures Internally Fueled (by “people like us”, same culture and resources) Down-up, Inside-out Asset Based “What’s right here?” Begins with analysis of demonstrably successful SOLUTIONS Solution Space enlarged through discovery of actual parameters Bypasses Immune System (solution shares same “DNA” as host)