By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    improving patient experience
    6 Ways to Improve Patient Satisfaction Within Hospitals
    December 1, 2021
    degree for healthcare job
    What Are The Health Benefits Of Having A Degree?
    March 9, 2022
    custom software development is changing healthcare
    Digital Customer Journey Mapping and its Importance for Healthcare
    July 21, 2022
    Latest News
    How Probate Planning Shapes the Future of Your Estate and Family Care
    July 16, 2025
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Debunking Another Eco Scare
    August 20, 2011
    How 12 Million are Putting “The Big C” Behind Them
    September 21, 2011
    Weekly Roundup: Eyeing the Solutions
    October 23, 2011
    Latest News
    How Health Choices and Legal Actions Intersect After an Injury
    July 16, 2025
    How communities and healthcare providers can address slip and fall injuries with legal awareness
    July 16, 2025
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
    Top HIPAA-Compliant Messaging Apps for Healthcare Teams
    June 25, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Liberating Structures to Create Enduring Culture Change: The Superbug Story
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Hospital Administration > Liberating Structures to Create Enduring Culture Change: The Superbug Story
Hospital AdministrationPublic Health

Liberating Structures to Create Enduring Culture Change: The Superbug Story

psalber
psalber
Share
10 Min Read
SHARE

 

This is a two-part post. Part 1 features how Liberating Structures (LS) have been applied to prevent the transmission of superbugs in Canada.  It features the work of Dr. Michael Gardam.  Part 2 will feature how Liberating Structures can be applied to many challenges that benefit from including and unleashing everyone. 

by Keith McCandless

 

More Read

Can “Portfolio Theory” Be Applied to NIH Funding Decisions?
Multiple Lifestyle Interventions May Help Those at Risk for Alzheimer’s
People Suffering From Hearing Loss Can Be Helped By Technology
Using Homecare for Positive Change in Healthcare
Four Principles of Patient Care for Nurses to Remember

This is a two-part post. Part 1 features how Liberating Structures (LS) have been applied to prevent the transmission of superbugs in Canada.  It features the work of Dr. Michael Gardam.  Part 2 will feature how Liberating Structures can be applied to many challenges that benefit from including and unleashing everyone. 

by Keith McCandless

Co-Founder, Social Invention Group

Dr. Michael Gardam is the medical director for infection prevention and control at the University Health Network in Toronto. In 2009 he put together an 18-month research project to prevent the spread of superbugs in hospitals. Superbugs are virulent or antibiotic resistant organisms (MRSA, VRE, C-difficile) that cause serious infections and are well known to spread in hospital settings. Despite sustained attempts to break the chain of transmissions, these infections remainone of healthcare’s most serious challenges and rates generally are increasing each year. Five hospital sites across Canada joined in the effort.

“What took me by surprise was how this project fundamentally changed people’s lives and how they work,” says Dr. Michael Gardam. “Of course we needed scientific proof as well. Infection rate reductions of 40-100% across hospital sites get the attention of the medical establishment.”

To fund the project, Michael went way out on a limb with the sponsor. He recommended unknown social interventions called Positive Deviance and Liberating Structures to solve this complex infection control problem. “It looked like an insurmountable problem. Now, three years later we have scientific evidence that a social intervention works!’”

The CBC news show “The National” features Michael and hospitals that succeeded in preventing spread of superbugs in a segment called, “Germ War: One of Canada’s Leading Infection Control Experts has Started a Simple, but Unorthodox Project That’s Getting Iincredible Results in the Battle against Hospital Infections.” The segment was aired on March 19, 2012.

How it works

Liberating Structures (LS) invites small changes in the pattern of interaction that help to create a more inclusive and respectful culture. Based on the complexity science principle that small changes can make a big difference, LS focus on routine microstructures that guide relational coordination. Conventional microstructures—presentations, brainstorming, management discussions, open discussions, and update briefings—are not well designed for engaging people. In contrast, Liberating Structures make it practical to include and unleash everyone in responding to challenges.

Like Wikipedia, LS create simple rules to guide and liberate everyone’s contributions. Wikipedia’s must-dos and must-not dos specify how anyone can write articles, edit content, reach consensus about the facts, and share with attribution. This structure makes it possible for a diverse community to generate and sustain accurate content that compares favorably with professionally edited encyclopedias.  With Liberating Structures, innovation “novices” become expert contributors.

Four of 33 LS that were used widely in Canada include

  • Improv Prototyping
  • Discovery and Action Dialogue
  • 1-2-4-All
  • TRIZ

These microstructures helped to solve the superbug problem in a way that changed the way other problems are addressed. They will be discussed in more detail in Part 2 of this post.

 A Deeper Look with Social Network Analysis and Ethnography

The project was innovative and so were the evaluation methods. Social Network Mapping was employed to measure how relationships grew among people in different functions and units. Before-and-after data revealed that participation in prevention work had increased at all the sites, with staff members increasing the number and types of people that they work with to control infections. Better still, a diverse mix of non-experts from multiple functions were taking an active role in prevention for the first time. For example, housekeepers were now being included. There work is critical to protecting patients from superbugs yet were rarely part of the conversation. Clearly, participation was way up but very little was known about the quality of relationships that formed.

In the last months of the project, ethnographic interviews were collected at each site. The research team wanted to learn if and how culture had shifted. Cultural attributes included visible habits, espoused values, and beliefs (unexamined assumptions). Interviews were conducted with people in different functions and levels—from room cleaners to VPs to project coordinators.

Michael A Gardam, MSc, FRCPC, MD, Toronto General Research Institute

For the interview, Michael and the research team used an Appreciative Interview format. They asked about successful experience in preventing infections and what made the success possible. “Some of the answers moved me. I am not a super emotional guy… but I was. It is wonderful to think that a research project could have this type of effect on people.”

Two stories from the field linger for Michael: “A unit manager told me a story, ‘I used to come to work braced to find out what kind of trouble the nurses had gotten into. I was expected to fix it. Now when I come in, they tell me what they have done to fix anything that came up.’”

In the second story, a unit participating in the superbug project was starting a new cardiac program. Staff members took it on themselves to form a cardiac club. They knew they were the experts to plan a launch on their unit. After the fact, they told the project manager about the club.

Michael muses, “Now, locally grown ideas surface and frontline people on the unit take action. People can see their own ideas spread. That’s enticing. After experiencing the freedom and the results that you can achieve, I cannot imagine going back to the old way.”

Cultural Attributes Opposing Yet Comingling

Michael and project co-investigators are trying to make sense of the cultural shift afoot. Most surprising, the new and old “behaviours” are comingling. One is not displacing the other. A creative melding is underway.

Based on interview results, researchers found that staff more often go-to people with local know-how, ask more questions, and use stories to communicate what works. At the same time “old” dominant patterns persist: paying attention to rank in the hierarchy, telling not asking, and using hard scientific data to make decisions.

Most welcome is the enhanced capability to work collaboratively while tapping the up-and-down functional expertise as needed. More frontline staff see their role in the context of a larger system. As a result, managers can step back and responsibly encourage more self-organization while letting go of over-control. Nirvana.

With a wry smile Michael asserts, “The interviews revealed much more than scientific proof. Culturally speaking, I think we got beyond a point of no return. We will not be able to put the toothpaste back in the tube.”

Frontiers Ripe for Liberation

“While the results of this study are very promising, this work has affected me in ways that other studies I have been involved with have not,” say Michael. “It is hard to recognize that many of the behaviours that are unintentionally drilled into you in medicine such as ‘I talk, you listen’ are contributing to problems rather than helping to bring about solutions. This work has changed the way I work and interact with others—I am far, far more likely to answer a question with a question. I’m sure it irritates some people to no end, but I am interested in their opinion and approach to the problem. Why should I think that I should be the one with all the answers just because I’m a doctor?”

This project revealed the practicality of fundamental change emerging from the bottom-up. Even before the project’s end, study participants started to apply Liberating Structures to new challenges in-and-out of hospital settings. Without much direct help from Michael and the research team, diverse projects have blossomed in nursing homes, clinics, and NGOs in provinces across Canada.

“Looking forward,” Michael muses, “I find I am more attracted to complex problems—the impossible stuff. In part because I don’t believe that many things are impossible. Like surfing a big wave, if you don’t try to control everything it’s a great ride.”

TAGGED:ConnectivityLiberating Structuresteamwork
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

paramedics in surgical gloves and masks
How Health Choices and Legal Actions Intersect After an Injury
Health care
July 16, 2025
a woman giving a key
How Probate Planning Shapes the Future of Your Estate and Family Care
Health
July 16, 2025
a woman with kinesio tapes on her back arm
How communities and healthcare providers can address slip and fall injuries with legal awareness
Health care
July 16, 2025
healthcare providers
Hidden Injuries After An Accident: What Healthcare Providers Should Watch For
Infographics
July 15, 2025

You Might also Like

Mobilizing Stakeholders For Better Health, Better Care And Lower Costs

April 13, 2012
Coke Joins Obesity
Public Health

Coke and Obesity- a Weight Loss Surgeon’s Perspective

January 17, 2013

Incidence and Prevalence of Morbid Obesity

June 21, 2011
iStock_000015301424_Small
BusinessHospital Administration

There May Be Zombies in Your Hospital

July 24, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?