engaging staff to prevent hai’s massachusetts coalition for the prevention of medical errors june...
TRANSCRIPT
Engaging Staff to Prevent HAI’s
Massachusetts Coalition for the
Prevention of Medical Errors
June 24, 2010
Westborough, MA
Sharon Benjamin, PhD&
Liz Rykert, BSW
Session Objectives1. Explore how high-engagement processes
can ignite ownership and performance
2.Have serious
fun practicing new conversations and questions
Believing is Seeing…
In every community or organization there are certain individuals or groups whose uncommon practices/behaviors enable them to find better solutions to intractable problems than their neighbors or colleagues who have access to the same resources
If we start by looking for existing solutions – and include everyone – especially unusual suspects – the solutions we discover vastly exceed our wildest notions in their elegance, simplicity, scope and speed of implementation.
“NOTHING ABOUT ME WITHOUT ME”
What disciplines or staff roles have been involved in infection prevention improvement work in your facility?
WHO’S MISSING or ONLY MARGINALLY ENGAGED?
By engaging the very people “whose behavior needs to change to solve the problem” to identify existing solutions from within
Staff move from “Yeah, but….” to….. “I make the difference”
Evoking TRUE Ownership
Asking everyone who “touches patients” about HAI’s and possible solutions…
Requires 1000’s of conversations…We asked these key questions –
► How do you know or recognize when an HAI is is present?
► How do YOU protect yourself, patients and others from HAI transmissions?
► What prevents you from doing this all the time?
► Is there any group or anyone you know who is able to overcome the barriers frequently and effortlessly? How?
► Do you have any ideas?
► What steps would start to bring theseideas to life? Any volunteers?
► Who else needs to be involved?
Focus on Practice Rather than Knowledge
It’s easier to ACTACT your way into a new way of THINKING, than to THINK your way into a new way of ACTING
“…when a group of individuals becomes a ‘we’, a harmonious whole, they have reached as high as
humans can reach.”~ Albert Einstein, 1954
Gown Usage at Billings Clinic, MTJune 2003 through July 2008
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Over and over we discovered staff who had better
practices. And staff helped develop even better ideas….
Jasper Palmer discovered a
better way to remove gowns and gloves
The big shiftProblems
Best practices
Buy-in
Shame & blame
Knowing
Big initiatives
Telling
Teaching
Expert
Standard outcomes
Solutions
Local expertise
Ownership
Celebrating local success
Discovering
Small changes
Asking
Practice
Explorer
Extraordinary results
Leading Authentic High-engagement Processes Shifts the Role of Leaders
We move from being experts to facilitatorsRequires comfort with uncertainty and power
sharingDeliberate and conscious lack of controlExperimenting with unusual metricsIncreases inability to forecast outcomes &
consequencesUncovers & creates new problems… and that’s
the good newsIt’s a profoundly circular process – it’s not
efficient!Who’s doing what shifts & it’s labor intensiveWe move off stageOur answers are not relevant – our questions
are!
Key Questions to ASK everyone involved in
patient careWhat would you like to know about this problem?What do you do about it? What are the barriers that prevent you from doing
the right thing 100% of the time?Who do you know who is doing the right thing or who
has overcome these barriers? (the positive deviants)
Who else needs to be in this conversation that isn’t here? (i.e. “Don’t decide about me without me”)
How do we invite those people to be part of the action?
What other ideas do you have?
Power of Self-Discovery
We learn best when we discover things for ourselves
Unlocks the secrets of how innovative practices and behaviors enable some individuals to find successful solutions to common problems
With access to no special resources and within the same set of constraints; innovators are revealed right before our eyes!
Discover new ways to ACT Changes how we interact
when solving problems Trying new approaches
is… CONFUSING & POWERFUL
Uncovers new leaders Invites and recognizes
innovation
It takes courag
e and
faith!
Take-aways
This is truly social science Simple actions can generate grand results Data and our need for certainty can distract us
from our work…voices of fear and cynicism shouldn’t keep us from improving.“It’s weak”, “It’s a hoax”, “You don’t know for sure”
Movement is created with limited formal leaders “Easier to act our way into a new way of
thinking than to think our way into a new way of acting.”
Selected Bibliography & Sources
Cosgrove, S.E., (2006). The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin. Infect. Dis. 42: S82-9.
Elixhauser, A.,& Steiner, C., (2007). Infections with Methicillin-Resistant Staphylococcus Aureus (MRSA) in U.S. Hospitals, 1993–2005. AHRQ Healthcare Cost and Utilization Project, Statistical Brief #35, July.
Klevens, R.M., Morrison, M.A., Nadle, J, Petit, S., Gershman, K., Ray, S., Harrison, L.H., Lynfield, R., Dumyati, G., Townes, J.M., Craig, A.S., Zell, E.R., Fosheim, G.E., McDougal, L.K., Carey, R.B., Fridkin, S.K., (2007). Active Bacterial Core Surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. Oct 17;298(15):1763-71. PMID: 17940231
Muto, C.A., Jernigan, J.A., Ostrowsky, B.E., Richet, H.M., Jarvis, W.R., Boyce, J.M., and Farr, B.M., (2003). SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. Infection Control and Hospital Epidemiology 24, no. 5:362-386.
Tanner, R., Sternin, J. (2005). Your Company's Secret Change Agents. Harvard Business Review. May.
Plsek, P.E., (2001). Appendix B: Redesigning Health Care with Insights. Science of Complex Adaptive Systems in Crossing the Quality Chasm. Institute of Medicine.
Krebs, V., & Holley, J., (2006). "Building Network Weaving Through Smart Communities," http://www.orgnet.com/BuildingNetworks.pdf
Session Objectives1. Explore how high-engagement processes
can ignite ownership and performance
2.Have serious
fun practicing new conversations and questions
You can get more information about High Engagement Processes including Positive Deviance from:
Lisa Kimball, PhDLiz Rykert, BSW
Sharon Benjamin, PhD
Jon Lloyd, MDwww.plexusinstitu
te.org
Monique SterninRanda Wilkinson
www.positiveinitiative.org