Form follows Function, or Function follows Form

[try saying that 10x straight]
I've been a little busy lately and have not had the time to write anything or follow up with my solicitations for guest bloggers. Hopefully I will have lots of stories written by the people directly involved, soon! I promise.

But- just a quick story I wanted to share.
Curt and I had the chance to visit a pilot site this Monday and heard about some pretty awesome stuff happening there. They have a new PD unit up and running for about 3 or so months now and the unit has been making tremendous progress. So when we got to visit the unit, Curt and I were especially excited since we don't really get to "hang out" with the hospital staff, we only hear stories about them and what they're doing. The unit manager, Gene, shared with us some really great stories and the one of how the unit became involved was especially interesting.

Gene has been involved in the project since day one[ 9 or 10months ago] but only as a sideline participant. But once she began hearing stories from the other units she was slowly getting excited about getting her unit on board as well. Although she has been sharing what she had heard and learned with her unit, it is a huge unit and she was worried about the workload and the reaction of her staff. So one day, during one of her regular staff meetings, she talked about bringing the unit on board and how best to start and her concerns and how they can go about getting ready to start. Then one of the staff, a LPN, casually mentioned "What's wrong with now?" And that was it; they started that day.

I know, I know, my narrative is not giving the story due justice. I might be ruining it but this story totally makes me jump out of my seat so I thought I share it here.
Why I think it is so cool? In my experience, whenever I am embarking on something new, I'm usually worrying too much about getting myself prepared to start. Like- getting ready so that I can be ready to start something. Essentially, its fussing over form and function; so really "what's wrong with now?"

I am trying to get the nurse manager to write something for the blog, but if you are familiar with healthcare at all, she has a million and one things still left unchecked on her to-do list.

Meeting the pioneers of Positive Deviance.....

Jerry and Monique Sternin, pioneers of the PD approach and also leading Plexus PD/MRSA Initiative will be keynote speakers at the annual Organization Development Network Conference at the Baltimore Inner Harbor October 21-24th. Here you can learn more about the PD approach and how it can be applicable for problem solving in your organization- PD has been applied to solve intractable issues such as child malnutrition, genital mutilation, medication reconciliation, child trafficking...

Intrigued? Registration information can be found here and today[ Sept 14th] is the last day for early bird rates so do it soon!

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Anyhow, I am working on getting guest pieces from the frontline so hold tight, more great stories to come!

SAVE THE DATE!

When: January 8-9, 2008
Where: Albert Einstein Medical Center
5501 Old York Road
Philadelphia, PA 19141

Positive Deviance: Busting the MRSA Myth

Healthcare associated infections are one of the top ten leading causes of death in the United States. These infections afflict two million patients every year and a growing number of infections are resistant to standard antibiotic treatment. The antibiotic resistant infection most frequently identified in US hospitals is Methicillin Resistant Staphylococcus Aureus (MRSA). The prevalence of MRSA increased 32-fold between 1976 and 2004. For every 1,000 persons in the US there are 46 people who are either infected or colonized with MRSA.

Despite its nationwide increase, MRSA is preventable. Plexus Institute, under a grant from The Robert Wood Johnson Foundation, is spearheading a prevention initiative that involves a partnership among Plexus, the Positive Deviance Initiative at Tufts University, the federal Centers for Disease Control and Prevention, the Southwest Pennsylvania MRSA Prevention Collaborative, the Delmarva Foundation, the Maryland Patient Safety Center, and a nationwide network of 40 hospitals. Six “beta site” hospitals are using Positive Deviance, an innovative social change process, in their MRSA prevention work.

Fighting MRSA is not just a responsibility for epidemiologists and infection control professionals. It requires the attention and energy of every person in the healthcare environment, from van drivers, housekeepers, administrators, and doctor sand nurses to patients, families and visitors. Positive Deviance is one way to create that engagement. We began this project a year ago, and early results in declining MRSA rates are very encouraging. In addition, hospital staffs are reporting improved relationships with patients and among people who work traditionally together as well as those who have not previously collaborated. We’ve known for decade how to prevent infection. The hard part is making sure that all those things are done, all the time. New cooperation and new relationships allow people to find creative ways to make sure all the necessary steps are followed, and to remove the unexpected barriers that prevent them from being followed consistently.

Join us as experienced practitioners present their experiences with PD and the results they have achieved in preventing MRSA transmissions. Learn with team members and PD support coaches who will share their insights on a successful approach to stopping the spread of MRSA. All are welcome!

Stay tuned for more details..............

Thinking about the words we use: a look at buy-in vs ownership

There is a great article in Indianapolis Star yesterday, highlighting a pilot project in Indianapolis in which all hospital systems are screening for MRSA in their ICUs and work with staff to improve hand hygiene and compliance to isolation precautions. Heading this 18-month project is Dr.Brad Doebbeling researcher from the Indiana University School of Medicine and whom we are also working with in our work against MRSA.

One of the really neat things about this particular initiative is the focus on staff involvement in the implementation. When asked about the declining infection rates at a participating site, St.Francis Hospital and Health Centers, the manager of infection control mentioned that getting staff input in the process of planning and implementation of the measures is a major component of its success. But what makes me feel uncomfortable was when she used the words "staff buy-in" to describe this engagement. Am I too picky about this? Maybe, but is it buy-in? or is it something else a little bit more....? So here is the origin of this confusion. I found a great piece written by Henri Lipmanowicz, Plexus board chairman and a PD coach, about this exact thing: And then to see why he is quite an authority in this area, click here.

I think it is very, very important to make a clear distinction between buy-in and ownership and not present them as if they were the same or interchangeable. It is important because buy-in is what everybody talks about and it more often than not doesn’t work precisely because it is the opposite of ownership.

Ownership is when you own or share the ownership of an idea, a decision, an action plan, a choice; it means that you have participated in its development, that it is your choice freely made.

Buy-in is the opposite: someone else or some group of people has done the development, the thinking, the cooking and now they have to convince you to come along and implement their idea without you having been invited at the table upfront before the goose was cooked. They decided without you but now they need your buy-in because without you their great ideas and plans can’t get implemented and so are worth nothing. But since you were not part of the process this great idea is a strange one; you cannot fully understand its history or genesis. Since you were not part of the process you cannot be aware of all the other options that were considered and rejected, and of the thinking that went into these choices. You feel ignored, imposed upon, pushed around, unappreciated and your immune system naturally kicks in to reject this foreign idea. You will look like you agree eventually to this new idea because you have no choice and your masters will cheer believing that you have bought in and that you are now as convinced as they are. Your implementation will inevitably be a pale imitation of what it could have been had you been an owner instead of a “buyer-in” and be truly convinced.

What is wrong with buy-in is the notion that it is perfectly ok for a few to make the decisions and then to impose them on all the others and still expect that they will be willing and able to implement them perfectly as if they had made the decisions themselves. That is a total illusion. It is an illusion that exists because in most organizations there is no evidence showing the difference between what people can accomplish when they implement ideas they developed together versus what happens when they implement ideas that were imposed on them.

Most organizations have no clue about the value of true enthusiasm and true commitment because they have never seen it. And the reason they have never seen it is because they have never created conditions for people to implement ideas they own without reservations. When experts are working very hard at making plans for others (those they consider non-experts) to execute, it is impossible for them to consider, and least of all admit, that enthusiasm and deep understanding by those others (inferior non-experts) could double or triple the impact of their expert ideas. That obviously would defeat their value as experts!!!

Deep understanding can only be achieved by making oneself the journey of discovery and invention. Someone else’s story of the journey will always be a pale imitation of the experience.

If leaders involved UPFRONT all the people that will be involved later on in the implementation there would be no need for buy-in for the simple reason that there would be ownership.

Of course the immediate reaction to such a proposition is that it is ludicrous because it is obviously impossible to involve everybody upfront. Wrong!!! Since it is possible to involve all the people afterwards, it has to be possible to involve them all upfront. And therefore the proper question is not whether but how. There are ways and processes from which to choose depending on the circumstances.

Hence my message is: ANYTIME YOU OR SOMEONE AROUND YOU THINKS OR TALKS ABOUT BUY-IN BEWARE! It is a danger signal telling you that your development and implementation process is missing the essential ingredient of involving all who should be. Reconsider your process before you waste a lot of time and energy or achieve mediocre results. One key is to not separate the development of ideas from the implementation of ideas: the same people should be involved in both and it should be one single integrated process.

To conclude, trying to achieve buy-in is most often an attempt to compensate for a problem that should not have been created in the first place, namely the exclusion of all the people whose buy-in is now being sought from the development process. It is a little bit like the need to motivate people; more often than not it is a sign that the real problem is to avoid de-motivating them in the first place.

I have of course oversimplified and exaggerated in order to make my point sharper. Some disagreement and debate around situations when what I wrote doesn’t apply should help in making the whole distinction between buy-in and ownership clearer.