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(originally published by Booz & Company)


An Inside Job: Best Practices from Within

Turning these individual solutions into organization-wide practices is the real challenge — and one that the TPS strategy didn’t successfully address. One of the advantages of PD is that it seeks to change behavior through doing, not telling. The idea is that change will meet less resistance if the Positive Deviants show the rest of the group why their solutions work. Equally important is demonstrating progress through hard data. In the year that PD was introduced, the infection rate declined 50 percent and the best practices proliferated in 14 different units in the hospital. The staff credits the prominent posting of weekly statistics as a major factor in helping everyone share responsibility for the results.

The final step is to encourage replication. One of the ways that PD caused a culture shift at the Pittsburgh facilities was by creating an environment in which change is a continuous process. The problem of finding better hygiene solutions resulted in a new set of practices, but these are by no means static. Regular unit briefings maintain the flow of ideas and encourage more and better staff-inspired solutions. And although hand sanitization was a starting point, the staff grew more attuned to the broader context and situations that facilitate the spread of bacteria and infection. Now, nurses actively investigate the sources of new infections; track closely the mobility of infected patients; and make sure that items like portable carts, equipment screens, and EKG wires do not serve as points of transmission.

The success of the PD program at the Pittsburgh VA hospitals has impressed more than just the staff and management at those facilities. Now other health-care centers are paying attention. In 2005, the Robert Wood Johnson Foundation awarded nearly US$300,000 to the Plexus Institute, a nonprofit focused on applying ideas emerging from the science of complexity to solving social and organizational problems, to implement PD and reduce hospital-acquired infection rates in as many as 40 hospitals nationwide. An additional 18 VA hospitals have already launched similar programs and by the end of 2007 the entire network of 160 VA facilities will do the same.

If you ask John Lloyd to explain why PD works and scales more effectively than other change programs, he gives a simple reason. “Where TPS was an outside job on the system,” says Lloyd, “PD was an inside job.” And as the results of the hospital project suggest, more inside jobs might be exactly what the outside world needs.

Author Profiles:

Lisa Kimball ([email protected]) is executive producer of Group Jazz, a consulting company that works with organizations on collaboration and change. Her current focus is on applying ideas emerging from the science of complexity to large-scale problems. She is a member of the board of directors of the Organization Development Network and the Plexus Institute. 
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  1. Plexus Institute Web site: The nonprofit devoted to using the science of complexity to address social and organizational processes. Click here.
  2. Positive Deviance Initiative Web site: The strategy that seeks solutions to community problems from within the community. Click here.
  3. Toyota Web site: The automotive giant’s production system page, explaining its approach to lean manufacturing. Click here.
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