1. Positive Deviance Unleashing Creative Action at the Front Line History and Theory Katie Procter

6. Millions of people worldwide are suffering from infections acquired in hospitals and other healthcare settings.

7. Some Canadian Statistics Each year in Canada, more than 220,000 healthcare associated infections result in 8,500-12,000 deaths, and the rates are rising. One in nine hospital patients in Canada get a healthcare associated infection. Infections are the fourth leading cause of death in Canada. From Healthcare Acquired Infections – Canadian Union of Public Employees report 2009

8. MRSA “Superbug” – common, deadly and relentless Some successful eradication of MRSA in some Northern European countries and very isolated American institutions Positive Deviance Initiative and Plexus Institute to explore using PD in healthcare facilities

10. August 2005 PD Institute promoted the use of the PD approach to reduce MRSA in 40 hospitals around the world PDI collaborated with Veterans Administration to work in 6 hospitals in the US Used the MRSA bundle – hand hygiene, active surveillance, contact precautions and environmental cleaning

11. It’s easier to ACT your way into a new way of THINKING than to THINK your way into a new way of ACTING!! Focus on practice rather than knowledge

12. Modified Focus Groups Discovery and Action Dialogues Improvisation Theory of Inventive Problem-Solving (TIPS) or TRIZ in Russian

13. 13 USA Trial Results Clinical results: 35% average drop in MRSA infection The Billings Clinic incidence rate declined by 88% Albert Einstein Medical Center infections dropped 35% so, 57 people went back to their families, homes and lives. Expected organizational results Hand hygiene and gowns & gloves use improved at all sites Self-report data on performance & employee satisfaction improved Unexpected benefits Improved nursing recruitment into tough units Improved process for on-call scheduling

14. 14 Billings Clinic - Healthcare-associated MRSA Infections Housewide Incidence Rates January 1999 – June 2008 Incidence Rate = # cases / patient days X 1,000 Case is defined as healthcare-associated infection.

15. 15 Healthcare-associated MRSA Infections ICU Incidence Rates January 2004 – June 2008 Incidence Rate = # cases / patient days X 1,000 Case is defined as healthcare-associated infection.

16. Canadian Research Project 6 beta sites to start – 2 in BC – Vancouver General and Kelowna General – 5 stayed for the long haul All submitted data and came up with very creative ideas Toronto East General very successful Now projects dotted all across Canada

17. Canadian Research Project In general, the rates of infection have come down across all sites in the preliminary data Vancouver General Hospital was the only hospital that reported hand hygiene compliance – there was an increase from 35% to 83% and has settled back to about 75% Faster response by staff to infection break out

18. To get started you need! Complete top to bottom commitment Management that agrees to just remove the boulders A coach with skilled facilitation in leading the techniques A strong PD core team made up of volunteer interdisciplines – 4 – 6 is ideal

19. Some kind of a kick off and regular meetings Information to staff as to what you are doing Some kind of kick-off Regular core team/coach meetings – suggest once a week for 4 – 6 months then drop back to every 2 weeks/reassess Regular core team/staff meetings as well – suggest once a week for 4 – 6 months then assess what you need based on the energy and work being done – tie these to:

20. Reporting of the data by the STAFF that makes sense to their process changes and how it makes sense to their needs.

21. Good facilitators have NO HOMEWORK – THE STAFF DO!

22. Some challenges Complete shift for practitioners – from being the expert to being facilitator asking questions Need comfort with power sharing and letting go of control Strategies to scale up Time and human resources to have the conversations Need comfort with uncertainty You can’t predict all outcomes and consequences It’s a slower process

23. Unleashing is all about Engaging your PEOPLE, developing SKILLS, changing BEHAVIOR, INSPIRING & MOBILIZING them

24. This is about LOCAL change, NOT borrowing from other institutions

25. Unusual Suspects This is about finding local people or pockets of positivity where the job gets done who have no more resources than anyone else then spread peer-to-peer It might be someone who surprises you. Ask around!

26. You use it when you know that: You have a Wicked Important Problem that is Seemingly Unsolvable Behavior needs to change NOT knowledge Skilled facilitation is available Progress is measureable, it just might be different

27. When you want different outcomes FROM Problems Best practices Buy-in Education Shame and Blame Knowledge Big initiatives Telling Periscoped purpose Prescription Top down Standard outcomes TO Solutions Local emergence Ownership Learning Celebrating local success Behavior Small changes Asking Shared purpose Discovery Unusual suspects Joyful, shared meaning & extraordinary results

28. When you want different conversations Nothing will make a difference! We’re doing everything we can do! We don’t have time! We don’t have the resources! You’ll never get them to change! Just tell us what to do! Don’t tell me what to do! We will always have this problem! ETC ETC ETC We can make a difference! We can do more! We actually do have time! We don’t need anymore resources! We CAN change! We CAN do! We can fix this problem!

29. http://www.positivedeviance.org/pdf/Newsletter/October2012newsletter.pdf