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Trillium Health Centre
and
The Canadian Positive Deviance Project
Trillium Health Centre’s Positively Deviant Story
Presented by:
Louise Koyanagi, RN, BScN
Monday December 6, 2010
New Approach to Containing Superbugs
Webex Teleconference
December 2010/LKoyanagi 2
Interdisciplinary Team Members
Pilot Site Lead: Louise KoyanagiLead RN, The Betty Wallace Women’s Health Centre
Positive Deviance Core TeamRegistered Nurses (6)IPAC practitioner (1)Hospitality Associate (1)PD Coach (1) - external
Trillium Pilot UnitsWest Toronto-Complex Continuing Care UnitMississauga-Neurosurgery 2B
December 2010/LKoyanagi 3
Aim: Positive Deviance at Trillium
To implement Positive Deviance (PD) methodology to all staff, creating positive social and behavioural change in infection control practices for at least the duration of the project (September 2009 –May 2011).
To reduce and maintain Antibiotic Resistant Organisms (ARO) acquired in hospital (AIH) to zero by utilizing Positive Deviance methodology through the organization.
December 2010/LKoyanagi 4
PD as an Enabler
Support of Janet Davidson O.C., President and CEO, senior management and Infection Prevention and Control
Alignment with Trillium’s Philosophy of Care and Strategic Themes
On-going support from external “PD Coaches”
Monthly all-sites teleconferences, facilitated by project leaders
Enthusiastic core team of staff to initiate the project locally
Generates discussion and involves “front-line” staff
December 2010/LKoyanagi 5
Path to Implementation of PD
News blasts through internal news medium; iCARE and Trillium News and Events
HIROC/Axiom news article (January 29, 2010) about Trillium’s involvement with the PD Project
Meetings with Senior Management team
Lunch and Learn sessions for all staff at Mississauga and West Toronto
“Buzz Meetings” with eight individual units
Discovery and Action Dialogues (DADs)
Social network mapping survey (April 2010)
December 2010/LKoyanagi 6
Lessons Learned
Although a “front-line” approach, support from Managers imperative
Greater participation when individual units/groups approached
Present PD information at scheduled staff meetings
Informal meetings with part-time and allied health staff most effective
Incentives (i.e. coffee shop gift cards)
December 2010/LKoyanagi 7
More Lessons Learned
Hospitality and portering staff appreciative to have a forum for their voices to be heard
Share responsibilities within the Core Team
“Meeting requests” via e-mail
Regular updates to senior management team
TRIZ vs. DADs for time constraints
December 2010/LKoyanagi 8
Barriers to Overcome
Unit demands (patient acuity, staffing)
Time spent on Discovery and Action Dialogues (DADs)
Cultural shift to front-line staff (skepticism)
Time constraints
core team
staff
availability of meeting space
Language
Computer access
Two site hospital model
December 2010/LKoyanagi 9
Pilot Units
Chosen May 2010
Neurosurgery 2B (acute care)
Complex Continuing Care (long term care)
Data collection specific to these two units
In addition, generalized data collection for hospital will be shared
Support from unit Managers to facilitate staff participation
December 2010/LKoyanagi 10
Pilot Units
Complex Continuing Care and Rehabilitation, Trillium – West Toronto (60 beds)Staff Compliment (78):
18 Full-time RNs (including 1 Clinical Educator)14 Part-time/casual RNs 20 Full-time RPNs 14 Part-time/casual RPNs 12 Allied Health staff (Physiotherapist, Occupational Therapists, Pharmacist,
Dietician, Social Worker, Unit Clerks & Hospitality Associates)
Neurosurgery 2B, Trillium – Mississauga (29 beds)Staff compliment (64):
31 Full-time RNs (including 1 ACNP & 1 Clinical Educator)12 Part-time/casual RNs 4 Full-time RPNs 2 Part-time/casual RPNs 15 Allied Health staff (Physiotherapist, Occupational Therapists, Pharmacist,
Dietician, Social Worker, Unit Clerks & Hospitality Associates)
December 2010/LKoyanagi 11
PD in Action
‘Beat It!’ Improvisation
The “Nurse Jackson” concept created through a performance by front line staff and family on Complex Continuing Care (West Toronto)
“Nurse Jackson” revisited with 75 colleagues participating at M-site
Exaggerated poor infection control practices by a health care providers.
The performers used humor to highlight the seriousness of infection transmission in hospital.
This resulted in the implementation of code word “Nurse Jackson”, now used on a regular basis by staff on Q-CCC, to address their colleagues (at all levels) in a non-threatening manner.
(Adapted from presentation to Quality Storyboard submission by Jackie Nugent, Trish Hutton and PD Team, 2010)
December 2010/LKoyanagi 12
Changes Implemented
Culture Shift/Open Communication
Daily DADs between ALL staff creating a ‘no-blame’ culture.
The ‘voice’ of the Hospitality Associate (HA) now stronger and valued.
Improved collaboration between all staff on the unit regarding Infection Prevention and Control measures
(Adapted from presentation to Quality Storyboard submission by Jackie Nugent, Trish Hutton and PD Team, 2010)
December 2010/LKoyanagi 13
Complex Continuing Care (CCC)
0
1
2
3
#
Sep-09
Oct-09 Nov-09
Dec-09
Jan-10 Feb-10
Mar-10
Apr-10 May-10
Jun-10 Jul-10 Aug-10
Sep-10
#OF AIH
Number of Antibiotic Resistant Organisms Acquired in Hospital (AIH) in Complex Continuing Care
Positive Deviance Initiated in Complex
Continuing Care
(Adapted from presentation to Quality Storyboard submission by Jackie Nugent, Trish Hutton and PD Team, 2010)
December 2010/LKoyanagi 14
“Nurse Jackson” Showed Us…
Non-blaming, fun ways address serious unit concerns and show proven long term benefits, out-weighing short term struggles
Staff engagement is the key to making sustainable changes
Acknowledging the expertise of our front line colleagues shifts the focus for change from a ‘top down’ approach to a grass roots model
(Adapted from presentation to Quality Storyboard submission by Jackie Nugent, Trish Hutton and PD Team, 2010)
December 2010/LKoyanagi 15
“Nurse Jackson” Awareness and Satisfaction Survey Results
96% of all staff knew the meaning of code word “Nurse Jackson”
Survey include Nursing, Allied health, Unit Coordination Associates (UCA), HAs and student nurses.
45% indicated they have comfortably used the term “Nurse Jackson” to address IPAC matters.
31% indicated that they have been called “Nurse Jackson”, heightening their awareness and immediate improvement of personal IPAC practices.
93% of staff rated the Nurse Jackson concept as:
“outstanding”
highly functional
relevant to their practice and have witnessed a notable improvement in IPAC practices on the unit.
December 2010/LKoyanagi 16
Evidence of Sustainability
Surveillance: Hand hygiene audits; DADs, Staff/patient surveys
Quarterly reporting of Acquired in Hospital (AIH) Antibiotic Resistant Organisms (ARO) will be displayed for review and discussion of the findings
Quarterly usage reporting will be shared. This will include such items as soap, purell and personal protective equipment (PPE)
Staff requesting to view Improvisation Video.
96% (CCC) staff surveyed indicated interest in future IPAC initiatives.
(Adapted from presentation to Quality Storyboard submission by Jackie Nugent, Trish Hutton and PD Team, 2010)
December 2010/LKoyanagi 17
Next Steps
“Nurse Jackson” presented to Trillium President and Vice President weekly meeting in August 2010 for organization wide awareness and support.
“Nurse Jackson” presented with positive response to:
Halton and Neighboring Districts Infection Control Group
Peel Community and Long-term Care
Regional Infection Control Network.
Nurse Jackson unleashed during Improv Event during Infection Control week with approximately 75 people in attendance.
Nurse Jackson concept to be adopted as a learning/teaching tool to new hires and student orientation of CCC services
Future Nursing Journal Article
(Adapted from presentation to Quality Storyboard submission by Jackie Nugent, Trish Hutton and PD Team, 2010)
December 2010/LKoyanagi 18
Trillium PD Core Team
Louise Koyanagi, RN, Pilot Site Lead, The Canadian Deviance Project
Lead Nurse, The Betty Wallace Women’s Health Centre
Tricia Hutton, RN, Infection Prevention and Control
Diane Wienwurm, Infection Control Practitioner
Gillian Dennis, RN, Oncology Clinic
Doug Hogan, RN, Clinical Leader, 6J Oncology/Medicine
Jackie Nugent, RN, Clinical Leader, Complex Continuing Care
Joe Pasia, RN, Manager, Neurosurgery 2B
Serena Johnson, Hospitality Associate, Complex Continuing Care
Erika Bailey, PD Coach, Erika Lee Bailey and Associates
December 2010/LKoyanagi 19
Contact Information
For further information about Trillium’s PD journey…
Louise Koyanagi, RN, BScNPilot Site Lead, The Canadian PD ProjectTrillium Health Centre-West Toronto150 Sherway DriveToronto, ONM9C 1A5
E-mail: lkoyanagi@thc.on.caTel: 416-259-7580 ext. 5776Fax: 416-521-4036
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