Transcript No Slide Title

Harnessing Positive Deviance
to Reduce MRSA Infections
at the Billings Clinic
Nancy Iversen, RN, BSN, CIC
Director, Patient Safety & Infection Control
Billings Clinic
 Not-for-profit, community
owned and governed
 Integrated Delivery System
 3400 employees
 230+ employed physicians
representing 35 specialty
departments
 272-bed hospital, 90-bed
nursing home
 7 regional branch clinic
locations
 Multi-state management
affiliations and support
services
POSITIVE DEVIANCE
A Different PROCESS
Better RESULTS
Our Experience:
MRSA Incidence Rates
MRSA Incidence Rates
(Healthcare-associated Infection Only)
1.00
M ay 2006
P D/ M RSA
P roject began
Jan 1, 2005-Dec 31, 2008
84% reduction in Healthcareassociated MRSA Infections
p < 0.001
0.80
0.75
(33 people
infected)
0.60
0.40
0.21
0.20
0.15
(4 people
infected)
0.00
1999
2000
0.32
(9 people
infected)
2001
2005-2007
65%
decrease
0.44
(20 people
0.34
(14 people infected)
infected)
2002
2003
0.85
(38 people
infected)
0.77
(34 people
infected)
Active
Surveillance
began in ICU
Jan '07
0.30
(14 people
infected)
2006-2007
55% decrease
0.13
(6 people
infected)
2007-CYTD 2008
57% decrease
2004
2005
2006
Active
Surveillance
began in IP M
Nov'08
2007
CY 2008
Jan-Dec
Incidence Rate = # cases / patient days x 1,000
Positive Deviance - MRSA
Chaotic
Waiting out a storm
Complex
Raising a teenager
Complicated
Close to
Sending a rocket to the moon
Simple
Lean - Six Sigma
Following a recipe
Close to
Certainty
Clear Evidence
Far from
What is Positive Deviance?
• An approach used to solve problems requiring
social and behavioral change
• Achieves sustainable results by changing
cultural norms
Positive Deviance (PD)
Key Principles
•
•
•
•
•
•
Community Ownership
Self-Discovery
The people are “the experts”
Immediacy of action
Emphasis on practice
On-going measurement reinforcing
change
Key Interventions ~
The “Science” Bundle
•
Hand hygiene
•
Decontamination of the environment and
equipment
•
Contact precautions for infected and
colonized patients
•
Active surveillance cultures (ASCs)
Measurements
• Prevalence Study
• Active Surveillance – nares culture on
admission, discharge, transfer or death
• MRSA Infections
• Adherence to hand hygiene and contact
isolation
The “Cultural” Bundle
• Make the invisible, visible
~ chocolate pudding to simulate contamination ~
• Reinforce with Feedback
• Solutions that are co-created and owned
~ ownership vs. buy-in
~ discovery & action dialogues ~
• Act your way to a new way of thinking ~
create experiences that allow self-discovery ~
Theatre In the Round
A diverse
audience, from
many units
across the clinic,
assembles in
the conference
room… now an
inpatient medical
room.
For the next 60
minutes, no one
knows what to
expect.
G
o
w
n
s
/
M
o
n
t
h
Ju
n0
A 3
ug
-0
O 3
ct
-0
3
D
ec
-0
3
Fe
b0
A 4
pr
-0
Ju 4
n0
A 4
ug
-0
4
O
ct
-0
4
D
ec
-0
4
Fe
b0
A 5
pr
-0
Ju 5
n0
A 5
ug
-0
5
O
ct
-0
5
D
ec
-0
5
Fe
b0
A 6
pr
-0
Ju 6
n0
A 6
ug
-0
6
O
ct
-0
6
D
ec
-0
6
Fe
b0
A 7
pr
-0
Ju 7
n0
A 7
ug
-0
O 7
ct
-0
7
D
ec
-0
7
Fe
b0
A 8
pr
-0
Ju 8
n0
A 8
ug
-0
O 8
ct
-0
8
D
ec
-0
8
Gown Use
June 2003 – December 2008
June 2003 through December 2008
Gown Usage
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
Month
The Power of “Improv”
•
•
•
•
Experiential
Allows self-discovery
Creating sustainable behavior change
Enjoyable and highly effective learning
experience
Questions ?