From Invisible to Visible - Positive Deviance Initiative

Billings Clinic’s vision of sharing and caring.
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.”
Jennifer Mellgren-Blackford, MT (ASCP), CIC,
quality specialist in infection control, recalled
that she and colleagues had been shocked when
they first saw the declining rates. Dr. David
Graham, one of two infectious disease physicians,
agrees. “I don’t know how you could not be surprised
by these results,” he said. “We were all
looking for ways they could be wrong. How did
we get here?” Nancy Iversen, director of patient
safety and infection control, sums up the impact:
“The declining graph is more than mere lines
etched on paper. It tells the story of lives saved,
pain avoided, and suffering reduced.”
The Billings Clinic MRSA reduction has profound
public health implications. MRSA has become a
national story, and an October 2007 story in the
Journal of the American Medical Association reported
that 85 percent of all MRSA cases originate in
healthcare settings. Evidence now shows rising
hospital-acquired infections (HAIs), considered
for years as an intractable problem, can be overcome.
And not by technical directives, punitive
action, or pharmaceutical intervention, but by
tapping the inherent wisdom of the organization’s
frontline staff.
approach to MRSA prevention focuses on what
works, believing that among its vast pool of
employees—doctors, nursing staff, housekeepers,
therapists, patient transporters, technicians, pastors,
social workers, and support staff—there are
individuals who practice certain simple yet
uncommon behaviors that prevent MRSA transmission.
For instance, in doing his hospital
rounds, a Billings Clinic physician purposely sees
his MRSA patients last—a simple practice that
greatly reduces the risk of transmitting MRSA.
An ICU nurse disinfects the patient’s side rails
several times throughout her shift to keep MRSA
from being picked up and spread to other
patients.
In the new lexicon of the Clinic, these individuals
are “positive deviants.” They are “deviants”
because their behaviors are not the norm and
“positive” as they model the desirable MRSA-prevention
behaviors.
So, the Billings’ MRSA-reduction story is about an
organization tapping its readily-available resource
to unleash innovative ways of preventing transmissions.
Join us on a visit to Billings Clinic.
For too long, the U.S. health care industry has
been too focused on fixing errors and preoccupied
with correcting what is wrong. The Clinic’s
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