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