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Using Cultural Change to Control Superbugs

Explore a new approach to controlling superbugs by utilizing cultural change strategies. Learn how to tackle behaviors and engage frontline staff effectively. Discover tools and techniques for successful infection prevention and control initiatives. Contact Michael Gardam and Leah Gitterman for more information.

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Using Cultural Change to Control Superbugs

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  1. Using Cultural Change to Control Superbugs • Michael Gardam • Physician Director, CHICA Canada • Medical Director, Infection Control • University Health Network 1

  2. Outline • Different problems require different approaches • Introduction to a New Approach to Controlling Superbugs • What we’ve learned

  3. Why a new approach? • Education, checklists, guidance documents are necessary but not sufficient • Tired to nagging • Tired of owning this problem • Traditional strategies don’t work well enough

  4. “Insanity: doing the same things over and over again and expecting different results.”-Albert Einstein

  5. The Hand Hygiene Hurdles

  6. Current healthcare culture does not put a high value on infection prevention and control

  7. What type of problem are you facing?Controlling superbugs is a complex problem

  8. High Simple Complicated Certainty Complex Low High Low Agreement Adapted from Brenda Zimmerman, 2010

  9. Simple or complicated problems • Search for solutions i.e. “fix it” • Problem solve • Checklists • Algorithms • Best practices 5

  10. Complex problems • “Social immune response” • highly sensitive to local culture and conditions • No one size fits all • Local solutions, multiple actions • Allows for paradoxes • Importance of relationships, intuition • “minimum specifications” 10

  11. The “minimum specifications” of infection control • Hand hygiene • Environmental cleaning • Surveillance (clinical, laboratory) • Routine practices, additional precautions • Appropriate antibiotic use If we do these well, our problems should largely go away…

  12. Strategies • Simple/complicated problems may respond better to “top down” approaches • Complex problems may respond better to “bottom up” approaches • Infinite variations of both approaches

  13. “Up, down and out”

  14. The NACS approach • Tackle behaviour and culture head on • Specific engagement of front line staff • Unusual suspects • Shifting of ownership from infection prevention and control to the front line • Use a variety of techniques referred to as “liberating structures” to achieve this • Positive Deviance is one liberating structure

  15. In any group… Increasing performance

  16. Some examples • Smoking cessation • Medication reconciliation • Malnutrition • Gang violence and inner city youth • Controlling healthcare associated infections

  17. Ideas come from those who are ”touching” the problem The group acts on ideas from “someone just like me” The groups succeeds and fails What works for one group may not work for another despite a similar challenge Key points

  18. Team 1 Team 2 Team 3 Reinventing the wheel • The role of infection control is to define the what the wheel needs to do…not how, or how fast, to build it Fewer infections

  19. Superbug Tools • Sharing Stories • TRIZ • Improvisation • Discovery and Action Dialogues • Social Network Analysis • Wise crowds • 25 gets you 10 • 15% solution

  20. These tools allow you to • Clarify the problem • Improve participation • Unleash the ideas of those touching the problem • Notice patterns, common themes • Spread ideas • Sustain change

  21. TRIZ • Design a system whereby you can ensure that 100% of patients will be infected with a superbug within 2 days of admission to your facility 21

  22. Discovery and Action Dialogues • 15-20 minute facilitated discussions with front line staff in their work setting • Different people will be at different sessions • Allow ideas to float to the surface 22

  23. Who do you talk to about the prevention of superbugs? RN External Clinical Educator Allied Health Director ICP Admin Housekeeping MD Executive Volunteer Resources Ward Clerk Patient Education Manager Legend 23

  24. Who do you want to work with in the future? RN External Clinical Educator Allied Health Director ICP Admin Housekeeping MD Executive Volunteer Resources Ward Clerk Patient Education Manager Legend 24

  25. “It’s a lot easier for an organization to adopt new words than it is to actually change anything.Real change is uncomfortable. If it’s not feeling that way, you’ve probably just adopted new words.”-Seth Godin

  26. Local innovations • Empty hand rub indicators • Disinfectant wipe brackets • New isolation carts • Videos • Antimicrobial stewardship • Point of care hand rub • “green is clean” • New signage • Food tray shelves • Staff and patient clothing hooks • Changes to bedside education • …

  27. What we’ve learned • There is an appetite for a new approach • Long term strategy/approach • “failure to launch” • Teams need more prodding • Teams need to commit • There are limits to virtual programs • Coaching is crucial

  28. “Culture EatsStrategyFor Breakfast.”-Attributed to Henry Ford

  29. Will deviate for change • michael.gardam@uhn.on.ca • leah.gitterman@uhn.on.ca • positivedeviance.ca • stopsuperbugs.com • Twitter: @DrMichaelGardam

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