A case study from the US shows how “positive deviance” in internal staff members could help organisations achieve better practice on issues such as hospital acquired infections, quickly and cost-effectively. Jane Lewis explains the study.

In every organisation there are positive deviants, who when faced with the same challenges, manage to successfully overcome the problems by acting differently. The positive deviance process unlocks internal hidden wisdom and uses them to address the problem, creating cost effective, high impact and often very quick solutions to organisational problems. It is not a top-down or professional-led approach, which often comes with a hefty price tag and is met with resistance.

The “community” i.e. the staff, become the process owners, they define the “right” problem and look to the practices and strategies of positive deviants, which are then disseminated throughout the organisation using practical activities. 

The positive deviants’ small, apparently insignificant successful behaviours are spread throughout the organisation with minimal resistance. The community owns the measuring and recording of the process providing positive change, reducing resistance and creating a needed boast to morale. 

The VA Pittsburgh Healthcare System in the USA used PD to advance their Getting to Zero MRSA Initiative. This began in 2004 and has since been extended to all of its 153 hospitals nationwide and other healthcare providers in the US, Canada, Brazil and Colombia are using PD in similar ways.

Hospital acquired infections such as MRSA kill up 100,000 people a year in the USA. The positive deviance approach was used to identify the spread of effective MRSA prevention practices to every person who comes into contact with patients. By engaging every person in the healthcare environment, including the frontline hospital staff, from janitors to consultants, it was possible to find positive deviance practices that reduced the spread of infection.

Once found, these differences in behaviour were spread using practical activities. This has seen every member of staff take effective infection control measures at all times. Rather than “thinking their way into a new way of acting” based on outsider policy, they have “acted their way into a new way of thinking”, driven by their own wisdom. This has redrawn internal relationships and boosted morale.

Although each of the hospitals uncovered different PD approaches to managing infection control, a very interesting example comes from the Albert Einstein Medical Center where a patient escort developed a unique method of disposing of his soiled gloves and gown. The escort worked out that by quickly sliding out of the gown, inverting it, folding it tightly and precisely stuffing it into a medical glove, he was able to compress the potential biohazard into a wad the size of a cricket ball prior to proper disposal. This eliminated the threat of the virus spreading and the technique has since been circulated throughout the hospital.  

It is easy, cost effective and because the change was determined by a staff member – not a top down instruction – it caused a positive and lasting change. The solution to the problem was already within the hospital and using the staff’s internal wisdoms has had a huge impact.

Results of the study show that MRSA infections dropped by as much as 62 per cent in hospitals employing positive deviance. In addition, as MRSA rates dropped, the hospitals saw a decline in the proportion of hospital acquired infections caused by MRSA, signifying that hospitals can make headway in the fight against drug-resistant superbugs.

John A. Jernigan, MD, MS, an epidemiologist at the National Centres for Disease Control and Prevention (CDC) and part of the CDC team that conducted the positive deviance analysis has been reported as saying: “Reports of successful multicentre interventions to reduce endemic antimicrobial resistance problems among U.S. hospitals are extremely rare.

These encouraging findings add to a growing body of evidence that hospitals can make a difference in their endemic MRSA rates, and further might be able to improve the chances that infected patients have the best possible treatment options available. It shows that hospitals can make an important difference in antimicrobial resistance even at a time when the availability of new antibiotics has stagnated.”

Positive deviance works quickly to deliver significant results, and relatively cheaply. Hospitals in the UK can learn from this MRSA case study. In the age of austerity, authorising expensive management consultants to come in briefly, prescribe actions and then leave is not only costly, it is unlikely to have the same positive and lasting impact as using the organisation’s internal knowledge and wisdom.