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Engaging Staff to Prevent HAI’s

Engaging Staff to Prevent HAI’s. Massachusetts Coalition for the Prevention of Medical Errors June 24, 2010 Westborough, MA Sharon Benjamin, PhD & Liz Rykert, BSW. Session Objectives. 1. Explore how high-engagement processes can ignite ownership and performance. Have serious fun

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Engaging Staff to Prevent HAI’s

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  1. Engaging Staff to Prevent HAI’s Massachusetts Coalition for the Prevention of Medical Errors June 24, 2010 Westborough, MA Sharon Benjamin, PhD & Liz Rykert, BSW

  2. Session Objectives 1. Explore how high-engagement processes can ignite ownership and performance • Have serious • fun • practicing new conversations and questions

  3. Believing is Seeing… In every community or organization there are certain individuals or groups whose uncommon practices/behaviors enable them to find better solutions to intractable problems than their neighbors or colleagues who have access to the same resources

  4. If we start by looking for existing solutions – and include everyone – especially unusual suspects – the solutions we discover vastly exceed our wildest notions in their elegance, simplicity, scope and speed of implementation. “NOTHING ABOUT ME WITHOUT ME”

  5. What disciplines or staff roles have been involved in infection prevention improvement work in your facility? WHO’S MISSING or ONLY MARGINALLY ENGAGED?

  6. Evoking TRUE Ownership By engaging the very people “whose behavior needs to change to solve the problem” to identify existing solutions from within Staff move from “Yeah, but….” to….. “I make the difference”

  7. Asking everyone who “touches patients” about HAI’s and possible solutions…

  8. Requires 1000’s of conversations… We asked these key questions – • How do you know or recognize when an HAI is is present? • How do YOU protect yourself, patients and others from HAI transmissions? • What prevents you from doing this all the time? • Is there any group or anyone you know who is able to overcome the barriers frequently and effortlessly? How? • Do you have any ideas? • What steps would start to bring these ideas to life? Any volunteers? • Who else needs to be involved?

  9. Focus onPractice 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

  10. “…when a group of individuals becomes a ‘we’, a harmonious whole, they have reached as high as humans can reach.”~ Albert Einstein, 1954

  11. Jasper Palmer discovered a better way to remove gowns and gloves Over and over we discovered staff who had better practices. And staff helped develop even better ideas….

  12. The big shift Telling Problems Buy-in Expert Knowing Asking Ownership Discovering Explorer Solutions Standard outcomes Best practices Teaching Extraordinary results Local expertise Practice Shame & blame Big initiatives Celebrating local success Small changes

  13. Leading Authentic High-engagement Processes Shifts the Role of Leaders We move from being experts to facilitators Requires comfort with uncertainty and power sharing Deliberate and conscious lack of control Experimenting with unusual metrics Increases inability to forecast outcomes & consequences Uncovers & creates new problems… and that’s the good news It’s a profoundly circular process – it’s not efficient! Who’s doing what shifts & it’s labor intensive We move off stage Our answers are not relevant – our questions are!

  14. Key Questions to ASK everyone involved in patient care What would you like to know about this problem? What do youdo about it? What are the barriers that prevent you from doing the right thing 100% of the time? Who do you know who is doing the right thing or who has overcome these barriers? (the positive deviants) Who else needs to be in this conversation that isn’t here? (i.e. “Don’t decide about me without me”) How do we invite those people to be part of the action? What other ideas do you have?

  15. Power of Self-Discovery • We learn best when we discover things for ourselves • Unlocks the secrets of how innovative practices and behaviors enable some individuals to find successful solutions to common problems • With access to no special resources and within the same set of constraints; innovators are revealed right before our eyes!

  16. Discover new ways to ACT • Changes how we interact when solving problems • Trying new approaches is… CONFUSING & POWERFUL • Uncovers new leaders • Invites and recognizes innovation

  17. Take-aways It takes courage and faith! • This is truly social science • Simple actions can generate grand results • Data and our need for certainty can distract us from our work…voices of fear and cynicism shouldn’t keep us from improving. “It’s weak”, “It’s a hoax”, “You don’t know for sure” • Movement is created with limited formal leaders • “Easier to act our way into a new way of thinking than to think our way into a new way of acting.”

  18. Selected Bibliography & Sources Cosgrove, S.E., (2006). The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin. Infect. Dis. 42: S82-9. Elixhauser, A.,& Steiner, C., (2007). Infections with Methicillin-Resistant Staphylococcus Aureus (MRSA) in U.S. Hospitals, 1993–2005. AHRQ Healthcare Cost and Utilization Project, Statistical Brief #35, July. Klevens, R.M., Morrison, M.A., Nadle, J, Petit, S., Gershman, K., Ray, S., Harrison, L.H., Lynfield, R., Dumyati, G., Townes, J.M., Craig, A.S., Zell, E.R., Fosheim, G.E., McDougal, L.K., Carey, R.B., Fridkin, S.K., (2007). Active Bacterial Core Surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. Oct 17;298(15):1763-71. PMID: 17940231 Muto, C.A., Jernigan, J.A., Ostrowsky, B.E., Richet, H.M., Jarvis, W.R., Boyce, J.M., and Farr, B.M., (2003). SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. Infection Control and Hospital Epidemiology 24, no. 5:362-386. Tanner, R., Sternin, J. (2005). Your Company's Secret Change Agents. Harvard Business Review. May. Plsek, P.E., (2001). Appendix B: Redesigning Health Care with Insights. Science of Complex Adaptive Systems in Crossing the Quality Chasm. Institute of Medicine. Krebs, V., & Holley, J., (2006). "Building Network Weaving Through Smart Communities," http://www.orgnet.com/BuildingNetworks.pdf

  19. Session Objectives 1. Explore how high-engagement processes can ignite ownership and performance • Have serious • fun • practicing new conversations and questions

  20. You can get more information about High Engagement Processes including Positive Deviance from: Lisa Kimball, PhD Liz Rykert, BSW Sharon Benjamin, PhD Jon Lloyd, MD www.plexusinstitute.org Monique Sternin Randa Wilkinson www.positiveinitiative.org

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