C. Difficile Prevention Partnership Collaborative: Bringing Together

Hospitals & Skilled Nursing FacilitiesJune 22, 2012

Sharon Benjamin, PhDsharon@sharonbenjamin.com

On behalf of the Massachusetts Coalition for the Prevention of Medical Errors

www.macoalition.org

ObjectivesThe purpose of my work today is to: Demonstrate, discuss, teach and support the adoption of change strategies that incorporate proven, new methods and techniques to accelerate successful change initiatives.Provoke thoughtful discussion around approaches for sustaining change momentum in individual facilities.Elicit enthusiastic participation moving beyond infection control experts

We must change how we change

Proven methods for improving your chances of success!

You and I do not see things as they are.

We see things as we are.

~ Herb Cohen

Source: McKinsey & Company study 2008, survey of 3,199 executives

“85% of all change efforts fail to achieve their intended

results.”Problem-solving

Outcome-creating

The Importance of Engagement

• Widens the circle of involvement• Involves the whole system• Increases commitment and energy• Connects people to each other and to ideas• Generates better solutions• Creates communities for action• Turns meetings into working sessions• Speeds up implementation

Creating EngagementNO

• Best practices imported

• Top-down, outside-in

• Deficit based “What’s wrong here?”

• Technical, analytic “expert” training

• “Mountain-top” personal development

• Buy-in and alignment strategies to overcome resistance in sub-groups

YES• Self-discovery in groups

• Down-up, inside-out

• Asset based “What’s right here?”

• Simple methods for mundane & sublime challenges

• Personal development within a complex social milieu

• Attracting and inviting ownership + unleashing the wisdom of diverse crowds

Methods that Create Engagement

• Stories versus PPT• Listening, Silence• Big Questions• Improvising• Diversity of formats:

pairs, small groups, large groups

• Focus on purpose• Inviting participation,

minimizing status differences

• Rapid learning & prototyping cycles

• Feedback loops• Network weaving• Innovative ways to harvest

output• Natural environment• Movement, Fun• Social elements, mixing

participants

Small Changes with a Big Effects Same people+Same incentives+Same organizational structure+ New Approach = NEW CONVERSATIONS

We use the minimum structure to liberate the maximum innovation

Examples of High Engagement Methods

AKA Liberating Structures

Today we will use:

Mad Tea PartyDiscovery & Action Dialogue15% SolutionsSmart Network Mapping

We have used in the past:

Appreciative InterviewsWise Crowds ConsultationImpromptu Speed Networking1-2-4-Whole GroupFishbowl 25 will get you 10Celebrity Interview

Lots of great methods still to try:

Open Space TechnologyCreative Destruction via TRIZ Wicked Questions Min Specs Rapid Prototyping Improv Ecocycle Sifting & Gathering Panarchy: Cross-Scale Change Conversation Café DialogueGenerative RelationshipsPurpose-To-Practice DesignScenario Planning Troika Consulting5 Whys & 10 HowsPositive Deviance

We search for the minimum structure to liberate the maximum innovation

“After several other conference sessions with one or two individuals dominating the talk and focusing on their issues only we were able to accomplish much more in a day, than in the previous two days prior.”

- Division Chief, US Army Cadet Command

“After several other conference sessions with one or two individuals dominating the talk and focusing on their issues only we were able to accomplish much more in a day, than in the previous two days prior.”

- Division Chief, US Army Cadet Command

ResultsLiberating Structures help groups liberate energy, tap into collective intelligence, be creatively adaptable, and build on each other's ideas to get results.

Liberating Structures help groups liberate energy, tap into collective intelligence, be creatively adaptable, and build on each other's ideas to get results.

Bias for Action“I didn’t think we were going to be able to pull together so many different departments that had not been at the same meeting before without spending hours making presentations to explain what we were all doing. I was amazed that we just got right to work! By the end of the day we were on the same page and had a way forward on things it would have taken us weeks of meetings to accomplish.”

- Program Manager, DC Office of the State Superintendant of

Education

The process designs come from theories and principles about self-organization, diffusion of innovation, and change.

15 % Solutions

15% Solutions

Noticing and using the influence, discretion, and power you have right now

What can you do right now to address your biggest professional challenge?

Purposes: 15% Solutions

15% SolutionKeys to Success

Include routinely in meeting designsUse in the moment to respond to opportunitiesMake sure question or purpose is clearGive people time to reflectKeep the spaces safeShare judiciously

Tools You’ve Learned Today

Mad Hatter Tea PartyDiscovery and Action Dialogues15 % Solutions

And, in just a minute:Network Mapping

But wait! Here’s more…..

Information on how you can involve more people and get better traction solving tough problems visit:http://www.liberatingstructures.com/

http://www.plexusinstitute.org/?page=liberatingstructures

http://www.positivedeviance.org/about_pdi/index.html

Smart Networks

Engagement can be counted and mapped…..

Network maps provide a powerful tool for understanding what’s happening around us.

Stages of Network Development

Disconnected Spokes and Nodes

Not Smart

Hub with Spokes

Overly CentralizedMulti Hub

Getting Smarter

Smart Network

BEFORE & AFTER INTERVENTION MAPS

Network Map of Hospital Unit in Montana Before Initiative1.Clear divisions, network is not unified2. ICU (light blue) are at the center but not well connected to others in the network3.Medical ICU form a group on the left side of the map with few connections to the core and ICU cluster4.The core is dominated by ICU staff – not diverse – where do new ideas come from?5.Clusters and few ties amongst groups makes the spread of new information, resources and ideas difficult.

Same Hospital Unit Post-interventions 1.Dramatic changes have taken place.2.Core connections are much more dense (more connections)3.Core is more diverse – more departments are central to the work (beyond the ICU staff)4.Information will spread more easily and new idea have a better chance to emerge and flow through the network thanks to new connections5.Still some room for improvement (still clustering based on role and department)

Over Lunch PleaseFill out the exercise sheets on your table, use one for each participant

Answer the questions on the second pageTHEN, • Find your own name on the following pages and circle it.•For each name on the sheets please put a check mark next to the names of people that:

– You have worked with in the past on infection control issues.

– You would like to work with in the future on infection control.