The Positive Deviance Approach to Combating MRSAAs a follow-on to yesterday's post, I'd like to cite another example of how the positive deviance approach to problem-solving has been used successfully.
The example in question is the story of how the Veterans Administration Pittsburgh Healthcare System (VAPHS) substantially tightened control of MRSA (Methicillin-resistant Staphylococcus aureus) infections in their facilities.
A particularly interesting aspect of the story is that VAPHS began their campaign against MRSA by adopting techniques borrowed from the Toyota Production System (TPS). As explained by Arvind Singhal and Karen Greiner in a long article detailing the VAPHS story, though TPS techniques notably, standardization and continuous improvement were effective in pilot efforts in two surgical units, the TPS approach didn't scale.1
TPS had two shortcomings it required dedicated staff to manage the process, and there was an over-dependence on the TPS leaders, instead of having broad ownership of the anti-MRSA efforts throughout the staff.
To extend the anti-MRSA program cost-effectively to more of its thirteen units, VAPHS decided to adopt the positive deviance (PD) approach, with excellent results in terms of reduced infection rates. Ira Richmond, associate director for patient care services, notes:
The evolution of the PD program has been phenomenal in helping to support a model of what in nursing we call "shared governance." The clinical practice issues are back in the hands of the frontline workers where they belong. The traditional management paradign of "You need to do this or that" or force-feeding top-down solutions has been replaced with all staff taking responsibility for MRSA prevention and control. And because the staff owns the solutions they propose, they comply with them. [emphasis in original]Drawing on the experience of VAPHS, the VA has now rolled out the anti-MRSA initiative to all its hospitals.
[You can read a shorter version of the VAPHS positive deviance story here.]
1 Arvind Singhal is currently a professor of communication at the University of Texas-El Paso. Karen Greiner is a graduate student in communication studies at Ohio University.