Plexus Institute. Designing and Facilitating Sustainable Change Initiatives Lisa Kimball firstname.lastname@example.org. 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
Designing and Facilitating
Sustainable Change Initiatives
April 13, 2012
Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change
die every year
in the U.S. from
…more than die from AIDS
May 2006 PD/MRSA project began
Active surveillance began in ICU Jan 2007
(4 people)MRSA CAN be stopped!
MRSA incidence rates – Billings Clinic
Housewide – January 1999 – December 2008
Reduction in HA MRSA infections
1st Jan, 2005 – 30th June, 2008
June - Dec
infections is primarily a
complex social and
rather than a knowledge
or technical problem.
across the clinic, assembles in
the conference room… now an inpatient medical room.
For the next 60 minutes, no one knows what to expect.
Spreading effective practices, creating new practices and deciding what changes they need to make personally and together
Discovering which of their practices can play a role in the transmission of MRSAEngagement, engagement, engagement!
…in an array of proven social change processes, featuring Positive Deviance, designed to engage everyone in:
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)Monitoring tools
…for the staff to track their OWN performance with essential infection control practices on their unit
Every hospital implementing the Plexus MRSAPractice Change Bundle is connected with other facilities engaged in the same process and others who have already implemented it
When we asked the staff:
Who is responsible for infection control?
They all pointed at the ICP staff
A year later everyone raised his hand
I’ve seen more change at Einstein in the last six months than in my 16 year career in infection control.
Jerry Zuckerman, MD, medical director of infection prevention and control, Albert Einstein Medical Center
Healthcare associated MRSA infection rates for RWJF/Plexus pilot units from 2006 to 2008 declined
100% reduction in HA MRSA infections
86% decreaseClose to Zero
MRSA incidence rates – PD MRSA Intervention Unit - ICU
January 2004 – December 2008
2 others achieved reductions of
2.76(14 people infected)
2.72(14 people infected)
2.61(13 people infected)
0.38(2 people infected)
(1 person infected)
While national rates of MRSA HAI’s go up, RWJ/Plexus PD beta site rates are going down.
Dr. John Jernigan, CDC
Potential liabilityHow many $$$$ could you save by reducing MRSA infections?
MRSA infections result in…
Break Down Silos
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
“It’s easier to ACT your way into a new way of THINKING, than to
THINK your way into a new way of ACTING”
Although most problems have complex, interlinked underlying causes . . .
The presence of Positive Deviants demonstrates that it is possible to find successful solutions TODAY before all the underlying causes are addressed!
Externally Fueled (by “experts” or internal authority)
Deficit Based “What’s wrong here?”
Begins with analysis of underlying causes of PROBLEM
Solution Space limited by perceivedproblem parameters
Triggers Immune System “defense response”
Internally Fueled (by “people like us”, same culture and resources)
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)Contrasting Approaches