This document summarizes a virtual learning session on a new approach to controlling superbugs using positive deviance. The session introduces the concept of positive deviance, where solutions to problems are found by observing successful behaviors that already exist among those facing the same challenges. Examples are given of how positive deviance has been used to reduce MRSA infections and improve hand hygiene compliance. The session then discusses tools and methods for implementing a positive deviance approach, including engaging stakeholders, identifying uncommon helpful practices, and disseminating solutions peer-to-peer.

1. New Approach to Controlling SuperbugsVirtual Learning Session 1Discovering Positive Deviance Michael Gardam Leah Gitterman

2. Agenda Intro to WebEx Patient story What is the “new approach”?

4. Raise your hand 10-Jan-11 3

6. Meet Our Team Erika Bailey Michael Gardam Leah Gitterman Liz Rykert Jessica Ip – Project Coordinator Paige Reason Susan McDonald Katie Procter

7. A story…

8. 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!

9. Culture EatsStrategyFor Breakfast

10. Sharing best practices Solutions imported from external sources results in “social immune response” NEW IDEA

11. The Premise Of Positive Deviance No matter how bad things are, there are always people in the group that do a better job, despite having access to the same resources

12. 3 quick examples Malnutrition Smoking cessation Medication reconciliation

13. If you tell people where to go, but not how to get there, you'll be amazed at the results.General George S. Patton

14. 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 SHEA 2009

15. Examples from Healthcare Hook story Transportation cards Isolation signage Nursing student Hand Hygiene video Vancouver General: HH rates Toronto East: cleaning equipment, antibiotic stewardship

16. Quinte Health Visitor Board Making the invisible visible at Vancouver General Improv at Toronto Western Hospital

17. This is about… Creating sustainable change Helping culture to shift Indentifying existing practices Developing new behaviours to overcome barriers Acting your way into a new way of thinking

18. 4% Problems known to top managers 9% Problems known to middle managers 74% Problems known to supervisors 100% Problems known to front line managers

19. “Up, down and out”

20. 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?

21. Tell us your stories

22. The 6 D’s Define: the problem and a successful outcome Determine: if anybody exhibits the 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

23. 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 behaviours Create ways to spread peer to peer Track and publish results

24. Who is included? Anybody who wants to be there Everybody who touches the problem Get the right people around the table Who isn’t here? “nothing about me without me”

25. 4 Phases of Implementation Getting Started Engaging the Organization Fuelling Change 4. Making Sense and Diffusing

26. Getting Started You have to decide how to “kick off” this process in your facility Examples: UHN US experience CPSI study sites

27. 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?

28. PD Tools Kick offs Improvisation TRIZ Sharing Stories Discovery and Action Dialogues Wise crowds Social Network mapping Ethnographic mapping

29. stopsuperbugs.com Google groups: discussion forum Google maps positivedeviance.ca positivedeviance.org Twitter: @DrMichaelGardam Facebook: stopsuperbugs Faculty office hours One-to-one coaching available

30. New website screen shot