C. Difficile Prevention Partnership Collaborative: Bringing Together Hospitals & Skilled Nursing Facilities June 22, 2012 Sharon Benjamin, PhD On behalf of the Massachusetts Coalition for the Prevention of Medical Errors

Objectives The purpose of my work today is to:  Demonstrate, discuss, teach and support the adoption of change strategies that incorporate proven, new methods and techniques to accelerate successful change initiatives.  Provoke thoughtful discussion around approaches for sustaining change momentum in individual facilities.  Elicit enthusiastic participation moving beyond infection control experts

We must change how we change Proven methods for improving your chances of success! You and I do not see things as they are. We see things as we are. ~ Herb Cohen

Source: McKinsey & Company study 2008, survey of 3,199 executives

“85% of all change efforts fail to achieve their intended results.” Problem-solving Outcome-creating

The Importance of Engagement Widens the circle of involvement Involves the whole system Increases commitment and energy Connects people to each other and to ideas Generates better solutions Creates communities for action Turns meetings into working sessions Speeds up implementation

Creating Engagement NO Best practices imported Top-down, outside-in Deficit based “What’s wrong here?” Technical, analytic “expert” training “Mountain-top” personal development Buy-in and alignment strategies to overcome resistance in sub- groups YES Self-discovery in groups Down-up, inside-out Asset based “What’s right here?” Simple methods for mundane & sublime challenges Personal development within a complex social milieu Attracting and inviting ownership + unleashing the wisdom of diverse crowds

Methods that Create Engagement Stories versus PPT Listening, Silence Big Questions Improvising Diversity of formats: pairs, small groups, large groups Focus on purpose Inviting participation, minimizing status differences Rapid learning & prototyping cycles Feedback loops Network weaving Innovative ways to harvest output Natural environment Movement, Fun Social elements, mixing participants

Small Changes with a Big Effects Same people +Same incentives +Same organizational structure + New Approach = NEW CONVERSATIONS We use the minimum structure to liberate the maximum innovation

Examples of High Engagement Methods AKA Liberating Structures Today we will use: Mad Tea Party Discovery & Action Dialogue 15% Solutions Smart Network Mapping We have used in the past: Appreciative Interviews Wise Crowds Consultation Impromptu Speed Networking Whole Group Fishbowl 25 will get you 10 Celebrity Interview Lots of great methods still to try: Open Space Technology Creative Destruction via TRIZ Wicked Questions Min Specs Rapid Prototyping Improv Ecocycle Sifting & Gathering Panarchy: Cross-Scale Change Conversation Café Dialogue Generative Relationships Purpose-To-Practice Design Scenario Planning Troika Consulting 5 Whys & 10 Hows Positive Deviance We search for the minimum structure to liberate the maximum innovation

“ After several other conference sessions with one or two individuals dominating the talk and focusing on their issues only we were able to accomplish much more in a day, than in the previous two days prior.” -Division Chief, US Army Cadet Command “ After several other conference sessions with one or two individuals dominating the talk and focusing on their issues only we were able to accomplish much more in a day, than in the previous two days prior.” -Division Chief, US Army Cadet Command Results Liberating Structures help groups liberate energy, tap into collective intelligence, be creatively adaptable, and build on each other's ideas to get results.

Bias for Action “I didn’t think we were going to be able to pull together so many different departments that had not been at the same meeting before without spending hours making presentations to explain what we were all doing. I was amazed that we just got right to work! By the end of the day we were on the same page and had a way forward on things it would have taken us weeks of meetings to accomplish.” - Program Manager, DC Office of the State Superintendant of Education The process designs come from theories and principles about self-organization, diffusion of innovation, and change.

15 % Solutions

Noticing and using the influence, discretion, and power you have right now What can you do right now to address your biggest professional challenge?

Purposes: 15% Solutions  Move away from blockage & negativism  Discover their individual power and their collective power  Evoke bottom-up solutions  Remember unused capacity & resources  Reduce waste

15% Solution Keys to Success  Include routinely in meeting designs  Use in the moment to respond to opportunities  Make sure question or purpose is clear  Give people time to reflect  Keep the spaces safe  Share judiciously

Tools You’ve Learned Today Mad Hatter Tea Party Discovery and Action Dialogues 15 % Solutions And, in just a minute: Network Mapping

But wait! Here’s more….. Information on how you can involve more people and get better traction solving tough problems visit: uctures html

Smart Networks Engagement can be counted and mapped….. Network maps provide a powerful tool for understanding what’s happening around us.

Stages of Network Development Disconnected Spokes and Nodes Not Smart Hub with Spokes Overly Centralized Multi Hub Getting Smarter Smart Network

BEFORE & AFTER INTERVENTION MAPS

Network Map of Hospital Unit in Montana Before Initiative 1.Clear divisions, network is not unified 2. ICU (light blue) are at the center but not well connected to others in the network 3.Medical ICU form a group on the left side of the map with few connections to the core and ICU cluster 4.The core is dominated by ICU staff – not diverse – where do new ideas come from? 5.Clusters and few ties amongst groups makes the spread of new information, resources and ideas difficult.

Same Hospital Unit Post-interventions 1.Dramatic changes have taken place. 2.Core connections are much more dense (more connections) 3.Core is more diverse – more departments are central to the work (beyond the ICU staff) 4.Information will spread more easily and new idea have a better chance to emerge and flow through the network thanks to new connections 5.Still some room for improvement (still clustering based on role and department)

Over Lunch Please Fill out the exercise sheets on your table, use one for each participant Answer the questions on the second page THEN, Find your own name on the following pages and circle it. For each name on the sheets please put a check mark next to the names of people that: – You have worked with in the past on infection control issues. – You would like to work with in the future on infection control.