Network Maps In Practice

You may have seen the recent stories in the New York Times that described the wonderful successes of the Pittsburgh Veterans Administration in decreasing the prevalence of the penicillin resistant staph infection (MRSA) that has been responsible for the deaths of perhaps 100,000 patients nationwide. What the story didn’t describe is that much of the lower rates were due to a strategy called Positive Deviance that encourages staff to work across roles to generate dozens of small actions that together bring about reduced rates. Housekeeping staff, in particular, began working with nursing staff on new cleaning strategies, innovative ways to deal with potentially contaminated gowns, etc

Working for Plexus Institute, I recently completed a project mapping and analyzing 4 units in the VAPHS and comparing the network metrics for each unit with the MRSA transmission rates. Read the full report here. We collected surveys from MRSA and nursing staff, who answered a set of questions: “Who did you work with on MRSA prevention strategies prior to the beginning of this Positive Deviance MRSA initiative? Who are you working with now? Who would you like to work with on MRSA prevention projects in the coming year?”

The results were fascinating! The unit with the lowest transmission rate had a network pattern distinctly different from the unit with a high transmission rates. The least successful unit (see the red nodes in the map above) was centralized and isolated. Individuals in the most successful unit (see the greeen nodes in the map), in contrast, were more evenly connected to each other and well-connected to a wide range of outside resources. Nursing was collaborating with the housekeeping staff, ward clerks and even patients in their efforts. Just imagine how the quality of health care could improve if we were able to spark this same innovative and collaborative environment in all hospital settings!

We are hoping to implement network mapping in several other hospitals, mapping at the start of the MRSA prevention project and using the results to move the hospital much more quickly to the kind of Smart Network that encourages effective innovation.