Transcript Hello Lisa!
Plexus Institute Designing and Facilitating Sustainable Change Initiatives Lisa Kimball [email protected] www.plexusinstitute.org Minneapolis April 13, 2012 MNODN 1 Eliminating MRSA Infections Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change 2 20,000 die every year in the U.S. from MRSA infections… …more than die from AIDS Where do you find MRSA in Hospitals? Everywhere! MRSA CAN be stopped! MRSA incidence rates – Billings Clinic Housewide – January 1999 – December 2008 (38 people) (33 people) (34 people) 84% Reduction in HA MRSA infections 1st Jan, 2005 – 30th June, 2008 (9 people) (20 people) (14 people) (4 people) May 2006 PD/MRSA project began Active surveillance began in ICU Jan 2007 (14 people) (6 people) 0.13 June - Dec “infections is primarily a Preventing MRSA complex social and behavioral challenge rather than a knowledge or technical problem. ” All invited and included 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. Engagement, engagement, engagement! …in an array of proven social change processes, featuring Positive Deviance, designed to engage everyone in: Discovering which of their practices can play a role in the transmission of MRSA Spreading effective practices, creating new practices and deciding what changes they need to make personally and together Monitoring tools …for the staff to track their OWN performance with essential infection control practices on their unit Staff may choose to track the percentage of swabbing at admission, discharge or transfer and conduct periodic surveys on compliance with hand washing and standard isolation precautions (gloving and gowning) Learning collaborative Every hospital implementing the Plexus MRSA Practice Change Bundle is connected with other facilities engaged in the same process and others who have already implemented it Team Coaching D&A Dialogues • What do you know/think about ________? • What do YOU do about ______________? • What keeps you from doing that all the time? • Who/Where have you seen overcome those barriers? • What other ideas do you have about removing barriers? (or supporting desired behavior) • What has to happen next to make that happen? When we asked the staff: “ ” Who is responsible for infection control? They all pointed at the ICP staff A year later everyone raised his hand Dr. Jon Lloyd, Pittsburg VA The Palmer Method “change at Einstein I’ve seen more in the last six months than in my 16 year career in ” infection control. Jerry Zuckerman, MD, medical director of infection prevention and control, Albert Einstein Medical Center Results Healthcare associated MRSA infection rates for RWJF/Plexus pilot units from 2006 to 2008 declined 74% Close to Zero MRSA incidence rates – PD MRSA Intervention Unit - ICU January 2004 – December 2008 4 Jan 1, 2006 – Jun 30 2008 100% reduction in HA MRSA infections 3 2.61 2 (13 people infected) 2.72 (14 people infected) 2 others achieved reductions of 65-70% 2.76 (14 people infected) 2006 –2007 86% decrease 2007 –2008 100% decrease 1 0.38 0.20 (2 people infected) (1 person infected) 0 2004 2005 2006 2007 CY 2008 Jan-Dec “ of MRSA HAI’s go While national rates up, RWJ/Plexus PD beta site rates are going down. ” Dr. John Jernigan, CDC How many $$$$ could you save by reducing MRSA infections? MRSA infections result in… Increased lengths of stay Opportunity costs Unreimbursed expenses Potential liability Long term benefits Hospital Reputation Leadership Development Break Down Silos Liability/Risk Reduction Reduction of MRSA Burden Process Skills Applicable to Other Issues The work of Plexus Institute initiative using PD to fight MRSA in hospitals, was one of The New York Times Magazine featured ideas of the year for 2008 PD Focus on Practice Rather than Knowledge “It’s easier to ACT your way into a new way of THINKING, than to THINK your way into a new way of ACTING” PD Enables us to Act TODAY Although most problems have complex, interlinked underlying causes . . . The presence of Positive Deviants demonstrates that it is possible to find successful solutions TODAY before all the underlying causes are addressed! Contrasting Approaches TRADITIONAL • • • • • • Liberating Structures • Internally Fueled (by “people like us”, same culture and resources) • Down-up, Inside-out • Asset Based “What’s right here?” • Begins with analysis of demonstrably successful SOLUTIONS • Solution Space enlarged through discovery of actual parameters • Bypasses Immune System (solution shares same “DNA” as host) Externally Fueled (by “experts” or internal authority) Top-down, Outside-in Deficit Based “What’s wrong here?” Begins with analysis of underlying causes of PROBLEM Solution Space limited by perceived problem parameters Triggers Immune System “defense response”