Guest Blogger: Curt Lindberg on Positive Deviance

Jul 20, 2007, 12:46 PM, Posted by RWJF Blog Team

For the last few years, Pioneer has been working with the Plexus Institute on the puzzle of Methicillin-Resistant Staphylococcus Aureus (MRSA) in hospitals. Plexus is working with six hospitals and their goal is ambitious; they want to spur a nearly 75 percent reduction in MRSA infections among participating facilities.  We asked Curt Lindberg of Plexus to bring the blog's readers up-to-date on Plexus' approach, and he responded:

At Plexus Institute I’ve had the chance to be involved in an effort to bring the social change process Positive Deviance (PD) into the healthcare quality improvement world. One aspect of this work deals with the challenge of MRSA. With support from RWJF’s Pioneer Portfolio we’ve organized a network of hospitals to learn about and use PD to reduce MRSA rates. With a bit of experience under our belts now we have our first story, written by Arvind Singhal, a communications scholar at Ohio University and a long-time collaborator with Everett Rogers, about the PD MRSA work at the VA hospital in Pittsburgh, one of our Beta Site hospitals.

As you read through this story I think you will pick up a sense for some of the key elements of PD:

  • Broad engagement of staff and patients, meaning involvement of more than the “usual suspects.”
  • Discovery by the staff of practices by colleagues in the organization who have achieved better results (these are the PD people and practices).
  • Encouragement of conversations and connections among a diverse group of people who ordinarily do not work on quality issues together but whose work bears on the problem (like hospital clergy, environmental workers, unit secretaries, nurses, transport staff in the case of MRSA). In the VA story you’ll see that some environmental service workers became real MRSA prevention heroes. The purpose of these conversations is to uncover PDs and barriers to good practice, create innovative new solutions, and build a network of people concerned with the issue.
  • A belief that the expertise to tackle tough problems is in the room.
  • An acknowledgement that for solutions to last they need to fit the unique history and dynamics of an organization.
  • Managers, quality improvement staff and, in the case of MRSA, infection control practitioners, who see their role as not primarily as providing answers and plans to “roll out” but supporting participation and action at the “local level.”

Lots of information about PD can be found on the Positive Deviance Initiative site and in the Plexus newsletter emerging.

I would really like to know what strikes you about PD and the MRSA story.

I am also wondering if there are tough quality problems you are facing that you believe might benefit from a PD approach (as PD is really new in healthcare in the US, the only two issues which have been addressed so far are MRSA and medication reconciliation).

-Curt

This commentary originally appeared on the RWJF Pioneering Ideas blog.