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Train the Trainer, reducing MRSA rates with positive deviance

Briefings on Infection Control, June 1, 2009

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Few question the ingrained hierarchy present in most healthcare facilities. In many cases, administration and management have established control over the policy and educational changes that frontline staff members are expected to adopt and carry out. But a new theory is having an effect on the process of healthcare quality and improvement. Positive deviance (PD) is defined as a behavioral process based on the premise that ?in every organization or community, there are people who solve problems better than peers who have exactly the same resources,? according to the Positive Deviance Initiative (PDI), founded by Jerry and Monique Sternin in 2001. In 2006, the Plexus Institute collaborated with the PDI, the CDC, and the Robert Woods Johnson Foundation to begin a MRSA prevention program in the healthcare setting called the Positive Deviance MRSA Prevention Partnership. The CDC presented analysis of the program March 21 at the Society for Healthcare Epidemiology of America?s annual meeting in San Diego. The CDC concluded that implementation of PD resulted in ?significant reduction in pooled MRSA incidence, with sustained decreases demonstrated over time.? The three hospitals involved in the analysis?the University of Louisville (KY) Hospital, the Albert Einstein Medical Center in Philadelphia, and the Billings (MT) Clinic?reported decreases of 26%, 31%, and 62%, respectively, in MRSA incidence. The results have fostered a transition in the way healthcare workers approach infection prevention. IPs and frontline staff members already know what to do to prevent infections, but how to implement those measures remains a struggle for many programs. First impressions Jerry Zuckerman, MD, the medical director of infection prevention and control at the Albert Einstein Medical Center, admits he was skeptical when his facility first decided to implement PD. ?It was a different process,? says Zuckerman. ?It was something that we were not used to or familiar with. But I think over the last couple of years, I have seen the benefit of it and appreciated the changes that it?s helped in terms of infection prevention.? The sites that participated in the Positive Deviance MRSA Prevention Partnership needed time to adjust, but the initiative found success because they were open to the method from the beginning, says Curt Lindberg, chief learning and science officer at the Plexus Institute. ?They were very interested in the methodology because they had all tried many of the typical and standard approaches to improving quality and MRSA prevention and were not seeing really good results from those efforts, so they were kind of frustrated and open to new approaches,? Lindberg says. Although PD?s main focus discards the typical top-down approach in hospitals, initial interest from leaders at the facility is imperative to getting the initiative started. ?You need leaders to understand the importance of frontline staff engagement that make it possible for them to be involved,? Lindberg says. ?And I think they need to be exquisitely responsive when staff identifies organizational policies or system issues that kind of go beyond the purview of individuals or units, and they need to respond promptly to those needs.?

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