Hvordan forbedre pasientsikkerheten ved å finne de positive avvikere?,Maurice mittelmarkt,Pasientsikkerhetskonferansen2015

1. Hvordan forbedre pasientsikkerheten ved å
finne de positive avvikere?
(engelsktalende)
Maurice B Mittelmark
Department of Health Promotion and Development
University of Bergen
Pasientsikkerhetskonferansen 2015
Clarion Hotel Bergen Airport, Flesland
24. september 2015

2. What is the
‘positive deviance’
method
of performance
improvement?

3. http://www.uib.no/hemil/81908/positive-deviance-database

5. In many health care practices, there are a
few individuals or groups whose uncommon
but successful behaviors and strategies have
enabled them to find better solutions to
problems…and they are often hardly aware
that are doing something special!!
• They are ‘positive deviants’
• They have , often ‘hidden’ from sight
• You leaders can illuminate & spread these hidden ideas
BRIGHT IDEAS

7. data makes the case for positive deviance…

8. Rupp ME et al (2014) Optimum outlier model for potential improvement of environmental cleaning
and disinfection. Infect Control Hosp Epidemiol, 35;6.
Median efficiency (minutes used to clean patient’s room)

9. Rupp ME et al (2014) Optimum outlier model for potential improvement of environmental cleaning
and disinfection. Infect Control Hosp Epidemiol, 35;6.
Median efficiency (minutes used to clean patient’s room)

10. Rupp ME et al (2014) Optimum outlier model for potential improvement of environmental cleaning
and disinfection. Infect Control Hosp Epidemiol, 35;6.
Median efficiency (minutes used to clean patient’s room)
Problem
Defined
Solution
Space

11. More time does NOT make for better cleaning --- what DOES?
That is the ‘positive deviance’ question
R ns
Rupp ME et al (2014) Optimum outlier model for potential improvement of environmental cleaning
and disinfection. Infect Control Hosp Epidemiol, 35;6.
Median efficiency (minutes used to clean patient’s room)
Positive deviance defined
solution space

12. Lloyd J et al (2008) Staff-driven cultural transformation diminishes MRSA. Prevention Strategist, Spring, 10-13.
Housekeeping staff PD ideas
o How to improve the quality and consistency of room cleaning
 ‘cleaning checklist’ (pre-flight list)
 Coloured photos of room and bathroom
 Black dots on items needing daily cleaning
 Red dots on items needing discharge cleaning
 Laminated ‘list’ placed on all cleaning carts and in all supply closets
BRIGHT IDEAS, I

13. Lloyd J et al (2008) Staff-driven cultural transformation diminishes MRSA. Prevention Strategist, Spring, 10-13.
Patient transport worker’s bright ideas
o Prevent overflowing trash cans
 Stuff used gown into a used glove
o Prevent patient charts from being vectors during transport
 Cover charts with plastic bags when patients were moved
BRIGHT IDEAS, II

14. Lloyd J et al (2008) Staff-driven cultural transformation diminishes MRSA. Prevention Strategist, Spring, 10-13.
 Nurse: “I can almost never find gloves that fit”
A few staff knew of a ward where gloves of all sizes were always
available!!
o Transparent plastic boxes on doors of patient rooms
o Gowns and gloves colour-coded for size – all sizes
o Low stocks were re-supplied
Other wards started this practice: when it spreads and becomes
normative, it is no longer a bright idea
BRIGHT IDEAS, III

15. Marra, et al (2013). A multicenter study using positive deviance for improving hand hygiene compliance.
American Journal of Infection Control, 41(11), 984–988. doi:10.1016/j.ajic.2013.05.013

16. Ellingson K et al (2011) Sustained reduction in the clinical incidence of MRSA colonization or infection associated with a
multifaceted infection control intervention. Infection control and hospital epidemiology, 32:1.

17. Standard practices:
plans, policies, education
developed by a few experts
and rolled out through the
hierarchy
(4 nursing managers)
From bright idea to normative practice, intra-institutional
Increased communication and
Collaboration 18 months, positive
deviance intervention:
“Who else needs to be here”?
Lindberg & Clancy (2010) Positive deviance: an elegant solution to a complex problem. JONA, 40(4):150-153.

18. Lindberg C (2010) Chap 3 in Singhal A et al Inviting Everyone: Healing Healthcare through Positive Deviance. Plexus press, NJ.
From bright idea to normative practice, cross-institutional

21. The positive deviance
management method requires us
to change the way we:
 Think
 Behave
 Lead
 Follow