Jasper Palmer is a patient escort who had a good idea.

To prevent cross-contamination, or germs spreading from one patient to the next as he took them around the hospital he went through several paper gowns a day, disposing of each by turning it inside-out and stuffing it inside a surgical glove. This simple practice, once adopted by other members of the hospital, cut MRSA infections by nearly 30%.

Such low-tech, bottom-up solutions introduced at other institutions cut rates of the drug-resistant infection by over 60%.

Jasper Palmer is an example of Positive Deviance.

Positive Deviance is a development approach that is based on the premise that in every community, certain individuals (the "Positive Deviants") exhibit unique behaviors that enable them to function more effectively than others with the same resources—solutions to community problems already exist within the community, they just need to be shared.

And sharing ideas like this is easier than asking people to follow guidelines that are handed down. According to Dr. Jeff Cohn, chief quality officer at Albert Einstein Healthcare Network in Philadelphia, where Palmer works, having the idea come from inside the hospital's own staff helped other staffers accept it more readily: "Jasper, who is a patient transporter, is the one being viewed as an expert and teaching quote unquote professionals -- nurses, doctors… This is flipping things on their heads.”

A good idea is a good idea, no matter where it originates, and positive deviance recognizes this. But more interesting to me is how we get people to adopt beneficial behaviors. If a practice is more likely to catch on when introduced by a peer than an authority figure, (I realize it seems pretty obvious, but so many things that seem obvious aren't actually the case) well, that might be where the true value of this approach lies.

The CDC conducted an analysis of a multifaceted MRSA prevention program sponsored by the Robert Wood Johnson Foundation that employed positive deviance to trigger reductions in MRSA incidence. The results were presented at a special late-breaker session during the Society for Healthcare Epidemiology of America's 19th Annual Scientific Meeting this past Saturday.

From the NYT News Blog:

Dr. Jernigan [CDC scientist who helped analyze the results] said it is not possible to determine how much of the improvement might be attributable to the behavioral change encouraged by positive deviance, relative to the other steps taken. “It’s quite possible the hospitals may have seen exactly the same effect had they not used positive deviance at all,” he said. “It’s also quite possible they would have seen the exact same effect if they had only used positive deviance.

“But I’ve been impressed with the level of engagement it seems to have engendered among the frontline staff, the way it involves what they call the unusual suspects.”

He also said the hospitals’ experience argues against the universal testing, or active surveillance, of hospital patients for MRSA, an ongoing debate in hospitals. “I think this shows that hospital-wide active surveillance is not necessary to show a big decrease in MRSA,” he said. “It’s not the active surveillance itself that makes the difference. It’s what you do with the information that makes it important.”