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Plexus Institute. Designing and Facilitating Sustainable Change Initiatives Lisa Kimball 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

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plexus institute
Plexus Institute

Designing and Facilitating

Sustainable Change Initiatives

Lisa Kimball


April 13, 2012


eliminating mrsa infections

Eliminating MRSA Infections

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





die every year

in the U.S. from

MRSA infections…

…more than die from AIDS

mrsa can be stopped

(38 people)

(34 people)

(33 people)

(9 people)

(20 people)

May 2006 PD/MRSA project began

(14 people)

(14 people)

(6 people)

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


Preventing MRSA

infections is primarily a

complex social and

behavioral challenge

rather than a knowledge

or technical problem.

theatre in the round
Theatre In the Round

A 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

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 MRSA

Engagement, engagement, engagement!

…in an array of proven social change processes, featuring Positive Deviance, designed to engage everyone in:

monitoring tools

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

learning collaborative
Learning collaborative

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

d a dialogues
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

Dr. Jon Lloyd, Pittsburg VA

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


close to zero

Jan 1, 2006 – Jun 30 2008

100% reduction in HA MRSA infections

2007 –2008

100% decrease

2006 –2007

86% decrease

Close 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)






CY 2008



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

Increased lengths of stay

Opportunity costs

Unreimbursed expenses

Potential liability

How many $$$$ could you save by reducing MRSA infections?

MRSA infections result in…

long term benefits
Long term benefits




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
PD Focus on Practice Rather than Knowledge

“It’s easier to ACT your way into a new way of THINKING, than to

THINK your way into a new way of ACTING”

pd enables us to act today
PD Enables us to Act TODAY

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!

contrasting approaches

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 perceivedproblem 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)

Contrasting Approaches