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- 1. New Approach to Controlling SuperbugsVirtual Learning Session 1Discovering Positive Deviance
- 2. Meet Our Team Michael Gardam Erika Bailey Leah Gitterman Liz Rykert Mohammad Salhia Linda Morgan Marc Van der Woerd Paige Reason Jessica Ip Susan McDonald Katie Procter
- 3. The Premise Of Positive Deviance No matter how seemingly intractable a problem, in every community there are individuals whose uncommon practices/behaviours enable them to find better solutions to problems than their neighbours who have access to the same resources.
- 4. Why focus on a behaviour change approach? Current “top down” approaches have had limited success Traditional “best practice” approach has been disappointing We need to acknowledge that we are human!
- 5. Sharing best practices Solutions imported from external sources results in “social immune response” in the same way that our body triggers an immune defense response NEW IDEA
- 6. PD and MRSA US pilot project Implementation of PD followed by 20 month follow up period No attempt to decolonize patients 26-62% reduction in MRSA clinical infections 1 site had an 80% drop in MRSA infections SHEA 2009
- 7. Examples from Healthcare Hook story Transportation cards Nursing student Hand Hygiene video http://www.youtube.com/watch?v=rBBSF0GHziQ Vancouver General: HH rates Toronto East: cleaning equipment, antibiotic stewardship
- 8. Quinte Health Visitor Board Making the invisible visible at Vancouver General Improv at Toronto Western Hospital
- 9. The power of storytelling One death is a tragedy; one million is a statistic. Stories can capture the complexity of the situation.
- 10. This is about… Creating sustainable change Helping culture to shift Identifying existing and/or uncommon practices Developing new behaviours to overcome barriers Acting your way into a new way of thinking
- 11. Who have the knowledge? ≈
- 12. 4% Problems known to top managers 9% Problems known to middle managers 74% Problems known to supervisors 100% Problems known to front line managers The Awareness Iceberg
- 13. 100% 74% 9% 4%
- 14. TAKE Talk amongst yourselves Think about someone you know who you suspect might be a positive deviant… What are they doing? What makes you recognize their behaviour as unusual or different?
- 15. Tell us your stories
- 16. Positive Deviance-the 6 D’s Define: the problem and what a successful outcome looks like Determine: if there are any individuals who already exibit desired behaviour Discover: uncommon practices/behaviours Design: activities enabling others to access and practice new behaviours Discern: effectiveness of activities or project through ongoing monitoring and evaluation Disseminate
- 17. How does it work? Invite those who are interested Front-line staff must be there (the “Gurus”) Create conditions for people to discover and adopt their own solutions Identify and analyze the positive deviants Create ways to spread peer to peer Track and publish results
- 18. Who is included? Everybody who touches the problem Get the right people around the table Who isn’t here? “nothing about me without me”
- 19. 4 Phases of Implementation Getting Started (Months 1-2) Engaging the Organization (Month 3) Fuelling Change (Months 4-12) 4. Making Sense and Diffusing (Month 12+)
- 20. Getting Started You have to decide how to “kick off” this process in your facility Examples: UHN US experience CPSI study sites
- 21. Take 15 Talk amongst yourselves What would this look like in your organization? How would you launch it? Anybody you know who might be interested? Front line, middle management, senior management?
- 22. 3 clicks to join a breakout session
- 23. Tell us your stories
- 24. Minimum Specifications Actively seek involvement beyond usual suspects Adapt and build as unit(s) develops momentum Track progress and feed back to community Follow existing science/evidence based practice
- 25. Minimum Specifications Use inquiry based processes “DAD’s” Feed back and rapidly act on suggestions or communicate why they cant be acted upon Create conditions to enable others to share practices Allow for a periodic “booster” shot Cultivate ownership
- 26. PD Tools Kick offs Improvisation Sharing Stories Discovery and Action Dialogues Social Network Analysis Ethnographic mapping
- 27. Resources www.stopsuperbugs.com Faculty office hours: every Monday from 1-2pm www.positivedeviance.ca www.positivedeviance.org The Power of Positive Deviance Inviting everyone: Healing Healthcare through Positive Deviance
Notas do Editor
- Stories can hold the tensions and paradoxes we have to navigate daily.They are a way of sharing ideas and insights but also a way of helping people own and share their own exepriences.
- LR: Reference collections of small behaviours often collectively make a difference – may not be one or more people but what they do
- Vast Majority of the work happens at the frontline or with community residents – you may need to set up ways to meet and make sense of what is happening. Experts are the people themselves.
- Six D’s – See Handbook
- MICHAEL- Just talk to the 4 points, no need to elaborate unless asked. Getting Started (Months 1-2)Build understanding among Senior Management, infectious disease staff and patient safety leadersDevelop process facilitation skills and Discovery and Action Dialogues (D&AD’s)Develop plans for targeting2. Engaging the Organization (Month 3)Engage wider hospital communityStaff across UHN will be invited to learn about the dangers of C. DiffInterested staff will be involved in future meetings to develop plansIdentify pilot unitsExpand core team 3. Fuelling Change (Months 4-12)Uncovering and amplifying existing positive deviant practicesEliciting transmission prevention ideas from front line staff and enabling them to act on ideasEnlarging the pool of skilled D&AD facilitators4. Making Sense and Diffusing (Month 12+)Build understanding among Senior Management, infectious disease staff and patient safety leadersDevelop process facilitation skills and Discovery and Action Dialogues (D&AD’s)Develop plans for targeting