Trillium Health Centre’s Positively Deviant Story

Trillium Health Centre

and

The Canadian Positive Deviance Project

Trillium Health Centre’s Positively Deviant Story

Presented by:

Louise Koyanagi, RN, BScN

Monday December 6, 2010

New Approach to Containing Superbugs

Webex Teleconference

December 2010/LKoyanagi 2

Interdisciplinary Team Members

Pilot Site Lead: Louise KoyanagiLead RN, The Betty Wallace Women’s Health Centre

Positive Deviance Core TeamRegistered Nurses (6)IPAC practitioner (1)Hospitality Associate (1)PD Coach (1) - external

Trillium Pilot UnitsWest Toronto-Complex Continuing Care UnitMississauga-Neurosurgery 2B


Aim: Positive Deviance at Trillium

To implement Positive Deviance (PD) methodology to all staff, creating positive social and behavioural change in infection control practices for at least the duration of the project (September 2009 –May 2011).

To reduce and maintain Antibiotic Resistant Organisms (ARO) acquired in hospital (AIH) to zero by utilizing Positive Deviance methodology through the organization.


PD as an Enabler

Support of Janet Davidson O.C., President and CEO, senior management and Infection Prevention and Control

Alignment with Trillium’s Philosophy of Care and Strategic Themes

On-going support from external “PD Coaches”

Monthly all-sites teleconferences, facilitated by project leaders

Enthusiastic core team of staff to initiate the project locally

Generates discussion and involves “front-line” staff


Path to Implementation of PD

News blasts through internal news medium; iCARE and Trillium News and Events

HIROC/Axiom news article (January 29, 2010) about Trillium’s involvement with the PD Project

Meetings with Senior Management team

Lunch and Learn sessions for all staff at Mississauga and West Toronto

“Buzz Meetings” with eight individual units

Discovery and Action Dialogues (DADs)

Social network mapping survey (April 2010)


Lessons Learned

Although a “front-line” approach, support from Managers imperative

Greater participation when individual units/groups approached

Present PD information at scheduled staff meetings

Informal meetings with part-time and allied health staff most effective

Incentives (i.e. coffee shop gift cards)


More Lessons Learned

Hospitality and portering staff appreciative to have a forum for their voices to be heard

Share responsibilities within the Core Team

“Meeting requests” via e-mail

Regular updates to senior management team

TRIZ vs. DADs for time constraints


Barriers to Overcome

Unit demands (patient acuity, staffing)

Time spent on Discovery and Action Dialogues (DADs)

Cultural shift to front-line staff (skepticism)

Time constraints

core team

staff

availability of meeting space

Language

Computer access

Two site hospital model


Pilot Units

Chosen May 2010

Neurosurgery 2B (acute care)

Complex Continuing Care (long term care)

Data collection specific to these two units

In addition, generalized data collection for hospital will be shared

Support from unit Managers to facilitate staff participation


Pilot Units

Complex Continuing Care and Rehabilitation, Trillium – West Toronto (60 beds)Staff Compliment (78):

18 Full-time RNs (including 1 Clinical Educator)14 Part-time/casual RNs 20 Full-time RPNs 14 Part-time/casual RPNs 12 Allied Health staff (Physiotherapist, Occupational Therapists, Pharmacist,

Dietician, Social Worker, Unit Clerks & Hospitality Associates)

Neurosurgery 2B, Trillium – Mississauga (29 beds)Staff compliment (64):

31 Full-time RNs (including 1 ACNP & 1 Clinical Educator)12 Part-time/casual RNs 4 Full-time RPNs 2 Part-time/casual RPNs 15 Allied Health staff (Physiotherapist, Occupational Therapists, Pharmacist,

Dietician, Social Worker, Unit Clerks & Hospitality Associates)


PD in Action

‘Beat It!’ Improvisation

The “Nurse Jackson” concept created through a performance by front line staff and family on Complex Continuing Care (West Toronto)

“Nurse Jackson” revisited with 75 colleagues participating at M-site

Exaggerated poor infection control practices by a health care providers.

The performers used humor to highlight the seriousness of infection transmission in hospital.

This resulted in the implementation of code word “Nurse Jackson”, now used on a regular basis by staff on Q-CCC, to address their colleagues (at all levels) in a non-threatening manner.

(Adapted from presentation to Quality Storyboard submission by Jackie Nugent, Trish Hutton and PD Team, 2010)


Changes Implemented

Culture Shift/Open Communication

Daily DADs between ALL staff creating a ‘no-blame’ culture.

The ‘voice’ of the Hospitality Associate (HA) now stronger and valued.

Improved collaboration between all staff on the unit regarding Infection Prevention and Control measures



Complex Continuing Care (CCC)

0

1

2

3

#

Sep-09

Oct-09 Nov-09

Dec-09

Jan-10 Feb-10

Mar-10

Apr-10 May-10

Jun-10 Jul-10 Aug-10

Sep-10

#OF AIH

Number of Antibiotic Resistant Organisms Acquired in Hospital (AIH) in Complex Continuing Care

Positive Deviance Initiated in Complex

Continuing Care



“Nurse Jackson” Showed Us…

Non-blaming, fun ways address serious unit concerns and show proven long term benefits, out-weighing short term struggles

Staff engagement is the key to making sustainable changes

Acknowledging the expertise of our front line colleagues shifts the focus for change from a ‘top down’ approach to a grass roots model



“Nurse Jackson” Awareness and Satisfaction Survey Results

96% of all staff knew the meaning of code word “Nurse Jackson”

Survey include Nursing, Allied health, Unit Coordination Associates (UCA), HAs and student nurses.

45% indicated they have comfortably used the term “Nurse Jackson” to address IPAC matters.

31% indicated that they have been called “Nurse Jackson”, heightening their awareness and immediate improvement of personal IPAC practices.

93% of staff rated the Nurse Jackson concept as:

“outstanding”

highly functional

relevant to their practice and have witnessed a notable improvement in IPAC practices on the unit.


Evidence of Sustainability

Surveillance: Hand hygiene audits; DADs, Staff/patient surveys

Quarterly reporting of Acquired in Hospital (AIH) Antibiotic Resistant Organisms (ARO) will be displayed for review and discussion of the findings

Quarterly usage reporting will be shared. This will include such items as soap, purell and personal protective equipment (PPE)

Staff requesting to view Improvisation Video.

96% (CCC) staff surveyed indicated interest in future IPAC initiatives.



Next Steps

“Nurse Jackson” presented to Trillium President and Vice President weekly meeting in August 2010 for organization wide awareness and support.

“Nurse Jackson” presented with positive response to:

Halton and Neighboring Districts Infection Control Group

Peel Community and Long-term Care

Regional Infection Control Network.

Nurse Jackson unleashed during Improv Event during Infection Control week with approximately 75 people in attendance.

Nurse Jackson concept to be adopted as a learning/teaching tool to new hires and student orientation of CCC services

Future Nursing Journal Article



Trillium PD Core Team

Louise Koyanagi, RN, Pilot Site Lead, The Canadian Deviance Project

Lead Nurse, The Betty Wallace Women’s Health Centre

Tricia Hutton, RN, Infection Prevention and Control

Diane Wienwurm, Infection Control Practitioner

Gillian Dennis, RN, Oncology Clinic

Doug Hogan, RN, Clinical Leader, 6J Oncology/Medicine

Jackie Nugent, RN, Clinical Leader, Complex Continuing Care

Joe Pasia, RN, Manager, Neurosurgery 2B

Serena Johnson, Hospitality Associate, Complex Continuing Care

Erika Bailey, PD Coach, Erika Lee Bailey and Associates


Contact Information

For further information about Trillium’s PD journey…

Louise Koyanagi, RN, BScNPilot Site Lead, The Canadian PD ProjectTrillium Health Centre-West Toronto150 Sherway DriveToronto, ONM9C 1A5

E-mail: [email protected]: 416-259-7580 ext. 5776Fax: 416-521-4036

Trillium Health Centre’s Positively Deviant Story

Health & Medicine

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