From Invisible to Visible - Positive Deviance Initiative

Keith McCandless (standing) facilitates a small group discussion on network maps
“How did that happen?”
“Some med students cultured ties and they found
all kinds of organisms. So we have gotten rid of
the neckties, white coats, and long sleeves.”
Ms. Fisk noted: “Also, more visible are GelSan
dispensers, isolation carts, and routine scrubbings
of equipment in hallways.”
“I’m an ID doc,” said Dr. Saberhagen, “and I wash
my hands now more than I ever have in my entire
career.”
“What else has changed since you began fighting
MRSA?”
is observed anonymously, and then the staff in
each unit receives a graph documenting their
observed performance. So, now there is more self
and peer-regulation of hand hygiene procedures.
Further, members of the infection control team
regularly compile numbers on MRSA prevalence,
infections, and transmissions and share widely
with staff in other units. “People now realize
those numbers aren’t dull statistics. They are people,”
says Joanie Schneider, RN. With this orientation,
a CNA can now walk up to a doctor and
hand over a gown. “ She can do so not to question
authority, but as it is in the best interests of
patient safety.”
If not entirely visible, one can sense more “shared
governance” at Billings Clinic, observed Chris
Nightingale: “Most staff now actively take responsibility
for MRSA prevention and control. And
because the staff co-created and own the solutions,
they comply with them.”
Another palpable change at Billings Clinic is with
respect to how infection-control data is collected,
shared, and acted upon. The hand hygiene data
The feed forward and feedback loops associated
with the regularly collected MRSA data have
increased staff involvement, noted Nancy Iversen:
“When they see the data they see the difference
their actions make.”
At one point, physicians worried that patients in
isolation received less care. Nurses disagreed, saying
they planned more and stayed in isolation
rooms longer. They also decided to gather data on
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