A year and a half ago, Grey Bruce Health Service’s Markdale hospital experienced their third outbreak of the hospital- associated superbug known as methicillin-resistant staphylococcus aureus (MRSA). Staff at the small 14 bed site were frustrated and recognized that the traditional control strategies were simply not working. More education, more policies and more checklists were not the answer. A small group of nurses and environmental services staff, supported by Infection Prevention and Control, volunteered to put together a team to explore the problem.
This group is known at Markdale hospital as the SINC (Stop Infections Now Collaborative) and swim team. SINC is an 18-month collaborative sponsored by the Canadian Patient Safety Institute’s Safer Healthcare Now Program, which provides virtual learning sessions and support for patient safety teams across Canada and the US. Teams learn about behavioral change techniques such as Liberating Structures, including Positive Deviance, and how to apply those techniques to the Team’s chosen model for improvement. The program was designed to help healthcare organizations improve compliance with evidence-based strategies to reduce healthcare associated infections and includes hand hygiene, environmental cleaning and surveillance.
The Markdale team is considered to be one of the top five teams participating in this collaborative and have shared their learning’s and experiences with other teams. Markdale’s goal is to achieve a 30 per cent decrease in the spread of MRSA and increase compliance with hand hygiene to a consistent 85 per cent. To do this, staff realized they had to come up with some innovative quality control initiatives to increase staff, patient and public infection control knowledge. The team is now a year into the collaborative and they have surpassed their goals – the hospital is outbreak free and the most recent audit demonstrates that staff have increased hand hygiene compliance to 100 per cent.
Liberating structures are easy to learn microstructures that help to organize how staff interacts with individuals and groups by building shared goals and sharing knowledge. Having learned and practiced Liberating Structures, the team has discovered they are working with one another differently. While exploring the many challenges that prevent staff from complying with infection prevention and control measures, one of the most valuable lessons has been to ensure that everyone at the Markdale Hospital is involved in problem solving. This approach has created a noticeable, positive culture shift within the hospital. All team members, regardless of profession or position, are focused on their common goal and communicate with each other to reach their goal.
Team members recognized that patients also had a role to play in increasing hand hygiene compliance and reducing MRSA. Staff decided to ask a willing patient to help. Each time staff entered or exited the patient’s room, she would remind them to clean their hands. Staff in turn would paste a paper hand on the patient’s wall. By the time the patient was discharged, she had many hands covering the wall. When interviewed the patient told the team she felt good about being part of the team and taking an active role in her own safety. She believes that this shared partnership would be beneficial for many other patients. Staff and the patient enjoyed this innovative method of increasing hand hygiene compliance and are working towards adopting this practice routinely.
The SINC team members are proud of their accomplishments and new ways of working together. They have engaged everyone in new conversations at all levels and have been successful in finding local solutions to problems. When asked how they would feel if they had to go through another outbreak, they said they wouldn’t see it as a failure, but as a situation they are now better prepared to respond to.
Chief Quality Officer at Grey Bruce Health Services says that any leaders who have chosen this pathway need to allow their team to “find their way.” Leaders need to put the structures in place to support their staff to move ahead with new initiatives. With this initiative, the team was not only successful in reducing outbreaks, but they also learned to work better together as a team, an outcome which will have benefits well beyond this project.