Applying the power of the positive deviant to hand hygiene improvement

Applying the Power of the Positive Deviant to Hand Hygiene Improvement

John Lerner


By John Lerner

SMARTLINK™ Solutions Business Development Vice President

Positive deviants are people within a community who face the same challenges as their peers, yet find a way to overcome those challenges and achieve their goal(s).

A classic example of positive deviance comes from sociologists studying malnutrition in Vietnamese children during the 1960s. The researchers identified one group of babies that was thriving in comparison to others who were showing signs of malnutrition. Upon closer examination, they found the mothers with better-nourished babies were feeding shrimps from the rice paddy to their babies – providing vital protein. The malnourished babies were only getting rice – impeding their growth and development.

All of these mothers faced the same challenges, but the positive deviants found a simple way to get their babies the nutrition they needed. We can apply this same concept to hand hygiene improvement in healthcare.

Identify Your Positive Deviants

Everyone involved in patient care faces the challenge of taking time to stop and clean their hands before moving on to the next patient. There are multiple reasons why a person might feel they don’t have time for hand hygiene – they’re carrying a lot of things, or the closest dispenser is empty, or they’re just in a rush – but there are some individuals who consistently find a way to do the right thing.

In every nursing unit, there are likely to be a few of these positive deviants who, in spite of the challenges, manage to comply with recommended hand hygiene practices.

Assemble a Performance Improvement Team

When you are forming a team to lead your performance improvement project, you should include positive deviants from your nursing staff. Those are the people who will be best positioned to help move the project along, because they have first-hand knowledge of the barriers to improvement - and how to overcome them.

It is often difficult for hospitals to take valuable staff members away from their daily responsibilities to attend a meeting or work on a process improvement initiative – but successful interventions require time away from the floor for planning and measuring results. Applying your positive deviants in this way can make a noticeable difference in the success of your hand hygiene improvement project.

Apply Successful Practices Across Your Organization

Start with a unit that is currently performing relatively well on hand hygiene. This will enable you to build on existing practices that are working, and then apply successful intervention strategies or best practices to other units that might be struggling more with hand hygiene compliance.

Positive results will ripple out to other units as nurses start to adopt the habits that are proving successful. In this way, your positive deviants can help with more than just hand hygiene. For example, you might have people who have figured out a better process for IV insertion, which helps to reduce the risk of infection.

Empower Your Positive Deviants With SMARTLINK™ Solutions

GOJO supports hand hygiene performance improvement in hospitals with SMARTLINK™ Solutions – an integrated suite of compliance monitoring technologies and clinician-based support. When GOJO clinicians engage with a hospital, we work with the unit director or performance improvement project leader to identify positive deviants on the nursing staff. Sometimes in our preliminary observations of work flow patterns, we’ll start to see the positive deviants and suggest people who might be a good addition to the performance improvement team.

When you have an engaged, knowledgeable team that’s dedicated to improving their performance and helping their peers, you’ll be in the best position to sustain improved hand hygiene performance.

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