Designing and Facilitating Sustainable Change Initiatives

Lisa Kimballlisa@groupjazz.com

MinneapolisApril 13, 2012

MNODN 1

Plexus Institute

www.plexusinstitute.org

2

Eliminating MRSA Infections

Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change

20,000die every year

in the U.S. from

MRSA infections…

20,000

…more than die from AIDS

Where do you find

MRSA in Hospitals?Everywhere!

MRSA CAN be stopped!MRSA incidence rates – Billings ClinicHousewide – January 1999 – December 2008

1st Jan, 2005 – 30th June, 2008

84%Reduction in HA MRSA infections

Active surveillance began in ICU Jan 2007

May 2006 PD/MRSA project began

84%

(4 people)

(9 people)

(14 people)

(20 people)

(33 people)

(38 people)

(34 people)

(14 people) (6 people)0.13

June - Dec

Preventing MRSA

infections is primarily a

complex social and

behavioral challenge

rather than a knowledge

or technical problem.

“

”

All invited and included

Theatre In the RoundA 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 collaborativeEvery 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?

• Who will do what when next?

Dr. Jon Lloyd, Pittsburg VA

They all pointed at the ICP staff

When we asked the staff:Who is responsible for infection control?

A year later everyone raised his hand

“ ”

The Palmer Method

Jerry Zuckerman, MD, medical director of infection prevention and control, Albert Einstein Medical Center

I’ve seen more

change at Einstein

in the last six

months than in my

16 year career in

infection control.

“

”

Results

Healthcare associated MRSA

infection rates for

RWJF/Plexus pilot units from

2006 to 2008 declined

74%

Close to ZeroMRSA incidence rates – PD MRSA Intervention Unit - ICUJanuary 2004 – December 2008

2.61(13 people infected)

2.72(14 people infected)

2.76(14 people infected)

0.38(2 people infected)

0.20(1 person infected)

2004 2005 2006 2007 CY 2008Jan-Dec

4

3

2

1

0

Jan 1, 2006 – Jun 30 2008100% reduction in HA

MRSA infections

2006 –200786% decrease

2007 –2008100% decrease

2 others achieved reductions of

65-70%

While national rates

of MRSA HAI’s go

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 benefitsHospitalReputation

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 toTHINK your way into a new way of ACTING”

PD Enables us to Act TODAY

The presence of Positive Deviants demonstrates that it is possible to find successful solutions TODAY before all the underlying causes

are addressed!

Although most problems have complex, interlinked underlying causes . . .

Contrasting Approaches

TRADITIONAL

• 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”

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)