New Approach to Controlling SuperbugsVirtual Learning Session 2

The Discovery Phase

Agenda:1. Welcome and Introductions2. The Discovery Phase3. Discovery and Action Dialogue4. Improvisation5. Wise Crowd6. TRIZ

The Premise Of Positive Deviance

No matter how bad things are, there are always people in the group that do a better job, despite having access to the same resources

Positive Deviance-the 6 D’sPositive Deviance-the 6 D’s1. Define: the problem and a successful outcome

2. Determine: if there are any “positive deviants”

3.3. Discover: uncommon practices/behavioursDiscover: uncommon practices/behaviours

4. Design: activities enabling others to access and practice new behaviours

5. Discern: effectiveness of activities or project through ongoing monitoring and evaluation

6. Disseminate

PD Tools

• Kick offs • Improvisation• Sharing Stories• Discovery and Action Dialogues• TRIZ• Wise crowds• Social Network Analysis• Ethnography

“Act your way into a new way of thinking…”

ImprovizationAn Approach for

Practicing Positive Deviance

Our Road to ImprovDiscovery & Action

Dialogues

Departmental Improv (e.g. General Surgery Unit)

Site-Wide Improv Day

Improv Day at Toronto Western Hospital

• Players (cast)

• Planted core group; audience

participation

• Artistic Director

• Can instruct Players to “play up” certain

behaviours; sentiments

• Keep the element of surprise/improv

Lights… Camera… Discovery & Action!

Core Group Member

Residents

ICPs; Nursing; Government

Lessons Learned• Less can be more

• Provide very basic scenario outlines

• Use artistic director to uncover interesting themes.

• Take advantage of multi-disciplinary group

• Have a DAD!

• Follow-up with participants – they may have different perspectives/ideas for next improv

Discovery and Action Dialogues:• 15-20 minute sessions • Ideally done right on the unit• Include those that want to be involved• Encourage a multidisciplinary group• Facilitator runs through a series of questions

that affirm the problem, identify barriers, uncover existing solutions, generate ideas/actions

Discovery and Action Dialogues:How They Work

• Group selects a specific problem• The group as a whole identifies what the

solution looks like including key measures of success

1. How do you know or recognize when ______ is present?

2. How do YOU contribute effectively to solving _____?3. What prevents you from doing this or taking these

actions all the time?4. Is there anyone you know who is able to frequently

overcome barriers?5. Do you have any ideas?6. What needs to be done to make it happen? Any

volunteers?7. Who else needs to be involved?

Tips for FacilitatorsDo:• Hold the dialogue in the participants’ local

context – e.g. the unit• Make impromptu invitations as you enter • Designate a scribe to take notes• Start with the purpose, We are here to

stop…

Do:• Give questions back to the group-wait 20 seconds

for a response• Encourage everyone to speak• Work through all questions without worrying about

the order• Demonstrate genuine curiosity in everyone’s

contributions

Avoid:• Answering questions that have not been asked• Missing opportunities to “catch butterflies” – record

actions to be taken by participants• Coming away with a to-do list for yourself• Responding positively or negatively to contributions-

let the group sift through their own assessments

Always remember:

“Nothing about me without me”

Take 5

• Questions?• Experience

with DAD?• Outcomes?

Wise Crowd

TRIZ “theory of inventive problem solving”

• Define an unwanted result e.g. hospital acquired infections

• Design a system that would reliably create the unwanted result

• Compare the adverse system to the current system

Example• Design a system where you will reliably

infect 100% of patients with a superbugs within a few days of admission

Next Steps

• Continue to work on core team and “launch”

• Start using the DAD process and other methods on the floors

• Begin to think about data collection

• Next Learning Session: Monday February 7th 1 pm EST

• Next Coaching Call: Monday February 14th 1pm EST

www.stopsuperbugs.com