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Apr 10, 2023 2

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New Approach to Controlling SuperbugsVirtual Learning Session 2

The Discovery Phase

Agenda:1. Welcome and Introductions

2. The Discovery Phase

3. Discovery and Action Dialogue

4. Improvisation

5. Wise Crowd

6. TRIZ

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The Premise Of Positive Deviance

No matter how bad things are, there are always people in the group that do a better job, despite having access to the same resources

Positive Deviance-the 6 D’sPositive Deviance-the 6 D’s

1. Define: the problem and a successful outcome

2. Determine: if there are any “positive deviants”

3.3. Discover: uncommon practices/behavioursDiscover: uncommon practices/behaviours

4. Design: activities enabling others to access and practice new behaviours

5. Discern: effectiveness of activities or project through ongoing monitoring and evaluation

6. Disseminate

• Discover uncommon practices/behaviors enabling the PDs to outperform/find better solutions to the problem than others in their “community”

Discover

PD Tools

• Kick offs • Improvisation• Sharing Stories• Discovery and Action Dialogues• TRIZ• Improv• Wise crowds• Social Network Analysis• Ethnography

• Emphasizes hands-on learning

• Focuses on actionable behaviours

“it is easier to act your way into a new way of thinking than to think your way into a new way of acting”

Using an inquiry based process: DAD

Discovery and Action DialoguesHow They Work

• Group selects a specific problem

• The group as a whole identifies what the solution looks like including key measures of success

What this looks like:• 15-20 minute sessions • Ideally done right on the unit• Include those that want to be involved• Encourage a multidisciplinary group• Facilitator runs through a series of questions

that affirm the problem, identify barriers, uncover existing solutions, generate ideas/actions

• Be sure not to ignore little changes, suggestions and adaptations that emerge

• Answers and successful strategies that emerge will differ by organization, unit etc…

• Provide feedback to others and rapidly act on suggestions or communicate why they can’t be acted on

• Try not to be silent or wishy-washy on suggested actions

1. How do you know or recognize when ____ the problem selected is present?

2. How do YOU contribute effectively to solving the problem?

3. What prevents you from doing this or taking these actions all the time?

4. Is there anyone you know who is able to frequently___ solve the problem, overcoming barriers?

5. Do you have any ideas?6. What needs to be done to make it happen? Any

volunteers?7. Who else needs to be involved?

Tips for FacilitatorsDo:

• Hold the dialogue in the participants’ local context – e.g. the unit

• Make impromptu invitations as you enter

• Designate a scribe to take notes

• Start with the purpose, We are here to stop…

Do:• Give questions back to the group-wait 20 seconds

for a response• Encourage everyone to speak• Work through all questions without worrying about

the order• Demonstrate genuine curiosity in everyone’s

contributions

Do Not:• Answer questions that have not been asked• Miss opportunities to “catch butterflies” – record

actions to be taken by participants• Come away with a to-do list for yourself• Avoid responding positively or negatively to

contributions-let the group sift through their own assessments

Always remember:

“Nothing about me without me”

Take 5

• Questions?

• Experience with DAD?

• Outcomes?

Wise Crowd

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ImprovMohammad Salhia

Toronto Western Hospital

“Act your way into a new way of thinking…”

ImprovizationAn Approach for

Practicing Positive Deviance

Our Road to ImprovDiscovery & Action

Dialogues

Departmental Improv (e.g. General Surgery Unit)

Site-Wide Improv Day

Improv Day at Toronto Western Hospital

Discovery & ActionDialogues

Departmental Improv (e.g. General Surgery Ward)

Site-Wide Improv Day

• Players (cast)

• Planted core group; audience

participation

• Artistic Director

• Can instruct Players to “play up” certain

behaviours; sentiments

• Keep the element of surprise/improv

3. Site-Wide Improv

Lights… Camera… Discovery & Action!

Improv DayDiscovery & Action

Dialogues

Departmental Improv (e.g. General Surgery Ward)

Site-Wide Improv Day

• Four 45 minute sessions

• Agenda per session

• Introduction: What is PD; Why Improv?

• Set-up improv

• Discussion DAD

Core Group Member

Residents

ICPs; Nursing; Government

Lessons Learned

• Less can be more

• Provide very basic scenario outlines

• ID player; their relationships

• Use artistic director to uncover interesting

themes.

• Take advantage of multi-disciplinary group

• Have a DAD!

• Follow-up with participants – they may have

different perspectives/ideas for next improv

TRIZ the power of creative destruction

• Define an unwanted result e.g. hospital acquired infections

• Design a system that would reliably create the unwanted result

• Compare the adverse system to the current system

Next Steps

• Continue to work on core team and “launch”

• Start using the DAD process and other methods on the floors

• Begin to think about data collection

• Next Coaching Call: Monday October 28th 1pm EST

• Next Learning Session: Monday November 15th 12pm EST

www.stopsuperbugs.com

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