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It’s Not Unusual

Posted By Jeff Cohn, Wednesday, July 09, 2014
Updated: Friday, September 19, 2014

Jasper Palmer died last week. He was a patient transporter at Einstein Medical Center in Philadelphia for more than 20 years. Jasper and I became connected closely in 2005 when Einstein became a participant in the Positive Deviance/MRSA project, facilitated by Plexus Institute. The role of the patient transporter is to do just that: transport patients throughout the medical complex to wherever they need to go. When that patient is identified as harboring the "superbug" MRSA, preventing the bacteria from spreading during that transport is quite a challenge, one that even experts from the CDC hadn’t figured out. We recognized that working with the transporters and asking them how to transport MRSA-positive patients could uncover solutions and barriers of which we weren’t aware.

Jasper emerged as a leader when he pointed out a significant barrier to safe contact with these patients. MRSA-positive patients are placed in "contact isolation,” meaning that staff entering their rooms are required to put on gowns and gloves prior to entry. Jasper noted that trash cans were often overflowing with gowns that had been worn and disposed. This left the next person entering with a dilemma - does one do the right thing by wearing a gown, only to have no reasonable place to dispose it? Or does one avoid the disposal problem, take a risk, and perform the patient task without a gown? Not only did Jasper identify the challenge, he developed a solution that worked for him that could work for others. See him demonstrate his simple solution in the video.


Given a forum to share his concerns and solution, Jasper took it upon himself to help others learn this approach. He would stop physicians facing the disposal dilemma and tell them, "I think I have a method that could help.” He worked with his transport colleagues to develop safer methods of transporting patients, even those connected to ventilators and monitors. Not everyone adopted the Palmer Method. However, it garnered attention to the challenge and ultimately investments were made in different disposal apparatus that could accommodate the large volume of gowns being disposed much more effectively than the small, rigid trash cans in place before.

We wound up referring to Jasper as an "unusual suspect.” By this we meant he wasn't a typical infection prevention expert (i.e., physician, nurse, pharmacist). We learned that we needed to look beyond the usual suspect to those unusual ones, from which diverse perspectives and new innovations would emerge. Instead of asking, "whom do we need to involve?” we asked, "who doesn’t need to be involved?” and then tried to engage everyone else.

Upon learning of Jasper's death, I began to think about the concept of unusual suspects. On reflection, it strikes me as, while well intentioned, a bit demeaning and indicative of our fixation with hierarchy and position. Jasper had served his country in the military, was a family man, had worked at Einstein for many years, had lots of friends, and cared about patients. Why wouldn’t we think someone like him could be beneficial to our improvement efforts? Using this lens, who would qualify as someone unlikely to be a source of new behaviors and ideas, an unusual suspect? Someone wedded to the status quo? No, there are likely many benefits of the current state that deserve preservation. A skeptic? No, their contrary position can help expose blind spots. Maybe a good example is a content expert who is unwilling/unable to see any other perspectives. In the case of our MRSA work, those would typically be clinicians and the same people we initially thought would be our key contacts.

Jasper, I think you've taught us all a critical lesson. Anyone- no, everyone who cares about a challenge, who wants to be involved in any way, and who is willing to share collaboratively can be a useful contributor. In fact, we depend on the diverse perspectives of many to discover and create the solutions for our big challenges. Thank you, Jasper, for helping us to appreciate the wisdom that lies within our networks. Your legacy will live on through the work we and others you've touched carry forward.

Tags:  catching butterflies  cohn  healthcare  positive deviance  relationships 

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