How alert hospital employees improved hospital's MSRA infection rate

The paper received the 2012 Best Paper Award from the Organization Development and Change Division of the Academy of Management. It will be presented in August at the organization's annual meeting in Boston and published in the Academy's Best Paper Proceedings. Sage Publications, United Kingdom, also accepted a more detailed article developed from the research project for publication next year in its journal Leadership.

The research focus resulted from a long-term project to reduce the Staphylococcus aureus (MSRA) infection at Maine Medical Center through an organizational change technique, known as "Positive Deviance." It had been clear for some time that the transmission rate of infectious diseases can be reduced by frequent hand washing and other obvious techniques. Yet, complicated patient care issues and policy along with power differentials (such as hospital staff who witness doctors neglecting to wash their hands but fear the doctor's wrath for pointing this out) are among the hurdles to overcome in reducing this deadly infection.

"Our theory was that good people who are accomplishing excellent results already exist in organizations and can become wonderful agents of change," says Schneider. "But oftentimes their accomplishments remain unknown. We wrote this paper to call attention to the good work that is already being done, but is either unnoticed or unappreciated. My hope is to encourage more people to look more deeply within their own organizations to effectuate positive change."

The technique is based on the application of complexity theory to organizational leadership. It encourages behavioral change through revealing and tapping into "positive deviants" or notable individuals who come to lead the change process from within based on their own behaviors that deviate from the organization's norms and accomplish extraordinary results using ordinary resources.

"How do they lead this change?" Schneider asks. "They are wise regarding the organization's work processes, history and norms. The change and development process known as positive deviance unearths these folks, and their stories become compelling and motivating to others. But rather than merely train others to copy the deviants' behaviors, the positive deviance process is also about continuous improvement and generation of new ideas and behaviors through a team-based, collaborative effort."

Themes that emerged in the study include the roles of anxiety, attachment and relationships in facilitating change efforts; and power shifts and the subsequent emergence of leadership that occurred across the MSRA collaborative.

It is important to realize that organizational change efforts cause anxiety and skepticism among even the best employees, and this must be acknowledged and overcome for any change to occur. The means for overcoming anxiety and skepticism include tapping into our need for attachment/affiliation and relationships. If people experience the change together, support each other, and reflect upon and share their experiences with the change, the change becomes part of their culture and identity, and they embrace rather than fight it.

In terms of power shifts, complexity theory illustrates that leadership is often an "emergent" process coming from the bottom-up or occurring laterally among peers.

One of the strongest leaders in fighting MRSA infection at Maine Medical Center was a patient transporter/van driver, who had developed great practices and ideas but was initially filled with fear and intimidation at the idea of talking about his positive deviance practices.

The study illustrates that several major changes in patient care policy occurred based on the Positive Deviance initiative.

Yet, the study also illustrates the requisite role of top management in an often bottom-up organization. In order for the change effort to be successful, top management must sincerely endorse and support the effort with resources, emotion, and interest; and must recognize and reward those associated with the effort.

Further, powerful groups such as doctors must learn to understand that patient care comes first, and that the lowest-level employee is doing his/her job by reminding a busy, distracted doctor to follow practices that reduce infection transmission.

One nurse's aide described how she realized that deep change had occurred when she overcame her fears and corrected a doctor politely in front of several patients, as the correction needed to occur at that moment, and the doctor sincerely thanked her for the reminder. So some aspects of traditional hierarchical and positional power remain, but they must evolve to become more egalitarian in order for all employees to have voice and contribute toward improving the organization's performance.

The application of complexity theory to leadership is one of Schneider's research interests. "I am thrilled," she said, "that this work is helping to illustrate the human side of complexity-informed change in organizations, and does so within a healthcare setting."

Provided by New Jersey Institute of Technology