Unleashing Innovation on the Front Lines -Preventing MRSA Transmissions & Transforming Culture

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial infection that kills tens of thousands of people in the United States each year, and most cases of MRSA transmission occur in hospitals or in other healthcare settings.  The spread of MRSA can be prevented using methods that have been known for a long time, but MRSA is still present in many hospitals because hospitals have struggled to fully implement necessary changes.  The Billings Clinic is a 272-bed hospital in Billings, Montana, that once struggled to control MRSA but was recently able to reduce transmission of the bacteria by 89 percent thanks to an innovative program designed to create change from within the existing hospital culture.  The problem-solving strategy used at the Billings Clinic offers valuable insights relevant to the control of MRSA and also to other healthcare challenges.

The approach implemented in Billings relied upon the premise of positive deviance.  This premise states that for any given problem in any given community, there exist individuals who approach the problem more successfully than most of their neighbors.  To improve the ability of a community to deal with a problem, one must find individuals with solutions and share their solutions with the rest of the population.  In Billings, for example, it was eventually discovered that one attending physician sought to limit the spread of MRSA by rounding on patients with MRSA after rounding on uninfected patients.  Other attending physicians who had never thought of this strategy were quick to adopt it once they learned about it.

This method of innovation differs markedly from more traditional approaches.  Often, the leaders of a healthcare organization will decide upon a policy based on hard evidence and will mandate that all employees adhere to the new policy.  This strategy is unsuccessful when employees on the front line do not feel invested in the policy or do not understand the reasoning behind it.  These policies are also limited by their reliance on data from large-scale trials at other institutions.  Each hospital is unique, and strategies are most successful when they reflect conditions on the ground, even if there are no published data available.       

Healthcare innovation based on positive deviance seems to be a promising model for the future.  The model involves a non-traditional way of thinking.  It only works if experts do not try to impose strategies from above but instead try to engage all participants in the formation of strategies from within.  The results of a strategy based on positive deviance are usually difficult to connect to any one particular change but seem to stem from changes in culture.  This strategy of innovation can be easily generalized to other medical settings, and it will hopefully prove useful in the future.    

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