1. If what you are doing isn’t working…try something else Michael Gardam University of Toronto

2. 2 “Insanity: doing the same things over and over again and expecting different results.”

3. How I got to where I am now

4. Vancouver General Hospital, Kelowna General Hospital, Joseph Brant Memorial Hospital, Trillium Health Centre, Toronto East General Hospital

7. Interviews: Identified Tensions Traditional Healthcare Culture Emergent Culture In a ‘do-er’ culture, need to get things done immediately Taking the time for discovery and learning Evidence-based practice (scientific proof) Practice-based evidence (social proof) Information and data are trustedStories and relationships are trusted Culture change is complicatedChanges can be simple Leaders need to ‘step-up’Leaders need to ‘step-back’ Top-down leadership from traditional leaders Bottom-up leadership from the front line

10. FLO RONT INE WNERSHIP

11. How to get here? From here?

12. 12 The Hand Hygiene Hurdles

13. Our new approach Clear top down leadership to set expectations Transparent audit and feedback Programs expected to meet targets, but not given a roadmap Frontline engagement, including physicians No “one size fits all” strategy

20. “You must be the change you wish to see in the world”

21. michael.gardam@uhn.ca