Plexus Institute
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Designing and Facilitating Sustainable Change Initiatives Lisa Kimball [email protected] Minneapolis April 13, 2012 MNODN 1 Plexus Institute www.plexusinstitute.org
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Plexus Institute. Designing and Facilitating Sustainable Change Initiatives Lisa Kimball [email protected]. Minneapolis April 13, 2012 MNODN . Eliminating MRSA Infections . Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change. 2. 20,000. 20,000. die every year - PowerPoint PPT Presentation
Transcript of Plexus Institute
Designing and Facilitating Sustainable Change Initiatives
Lisa [email protected]
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 MRSAinfections is primarily a
complex social andbehavioral challenge
rather than a knowledgeor 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)
