This document summarizes programs and strategies to reduce Methicillin-resistant Staphylococcus aureus (MRSA) infections. It discusses the creation of an electronic infection control network across Indianapolis hospitals to track over 17,000 patients with a history of MRSA. Through collaborative initiatives involving multiple hospitals, MRSA rates were reduced by 60-85%. The strategies discussed include fostering organizational change, engaging frontline staff, implementing standardized processes, and using data to document impact and disseminate effective practices nationally. The presentation emphasizes that change initiatives require both top-down support and bottom-up engagement from staff.

1. Programs to Reduce MRSA infectionsSymposium on Healthcare Associated Infections UT Southwestern Medical CenterDallas, Texas Saturday, August 28, 2010Brad Doebbeling, MD, MScProfessor of Medicine, Epidemiology, & Biomedical Engineering, Indiana University School of Medicine Senior Scientist, IU Center for Health Services Research, Indianapolis VA COE, Regenstrief Institute,IndianapolisAward Number: HHSA290200600013I, Task Order No. 4

2. Capacity for ImpactHigh priority project to avert illness, suffering, and deathUnique International Collaborative

3. Learning community of practice (7 hospitals)

4. Electronically and culturally interconnected

5. International consortium

6. Effectiveness -- Reduced rates 60-85%

7. Pittsburgh VA

8. RWJ Sites

9. Phase 1 Indy“Collaboration” – What does it mean?“Coming together is a beginning. Keeping together is progress. Working together is success.” – Henry Ford.“Teamwork divides the task and multiplies the success.” - Unknown“Teamwork is the ability to work together toward a common vision; the ability to direct individual accomplishment toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” – Andrew Carnegie

10. Framework

11. Panarchy or Ecocycle Model of ChangeMaturityRenewalCreative DestructionBirthFor more information on the ecocyle go to http://www.plexusinstitute.org/edgeware/archive/think/main_aides9.html

12. Institutional levelA change in culture A change in laws A change in resource distribution/availabilityOrganizational levelA change in strategiesA change in procedures A change in resource distribution/availabilityNetwork or group levelA change in conversation A change in routine A change in resource commitment or influence Individual levelA change of heart A change of habits A change of ambition“Getting To Maybe: How the World is Changed”Frances Westley, Brenda Zimmerman, Michael Patton, 1996, Random House Canada

13. Strategy

14. Tranformative Change: 7 Effective StrategiesFostering ChangeCommunication & CollaborativesLocal, Focused Implementation Frontline Staff EngagementOrganizational Learning Support, Resources & AccountabilityFeedback & ReinforcementQualitative Thematic Analysis, Healthcare Associated Infections (HAI) Initiative Assessment Program , AHRQ ACTION, HHSA290200600013I , 2010

15. An Operational Citywide Electronic Infection Control NetworkInfection control a regional problem, requiring coordinated effort

16. Created citywide electronic notification system to prospectively track all known patients with MRSA

17. Track over 17,000 patients with a h/o MRSA infection or colonization across Indianapolis.

18. Delivered 2698 admission alerts on patients with a history of MRSA, 19% from another institution.

19. 20 infection control providers (ICPs) spanning 16 hospitals Kho, Lemmon, Dexter, Doebbeling AMIA 2008

20. Unique Strategy for Sustained Organizational ChangeCombining Lean and Positive DevianceLean from manufacturingMajor QI Approach in HealthcarePositive Deviance (PD)Experts within organizationOpportunity to learn & innovate- Challenges and synergies

21. MRSA Phase TwoWhat is Positive Deviance?

22. Technique to engage front line staff in owning & improving processes and sustaining change

23. Based on identification of practices of used by ‘positively deviant’ staff/departments

24. Critical for staff involvement/buy-inIntegrated Lean/PD approachDefine the ProblemBaseline Current ProcessesDiscoveryIdentify Operational BarriersDevelopFuture State ProcessActionProcess ControlStrategy

25. Creative KickoffsMultiple kickoff meetings to maximize participationVery serious and very fun

26. Staff Engagement

27. Partnership MeetingsMonthly meetings with volunteersD&A’sBrainstorm solutionsDiscuss ideas

28. One Is Too ManyDiverse Core & Resource GroupsICP managerDirector of QualityNurse educators from two intervention unitsLean expertOD expertNurse project coordinatorVP Nursing

29. C00

30. ID MD

31. System office grant manager (ACT project)