Discovering Positive Deviance
Organized by members of the PD in the
Community Working group and supported
by the Ontario Agency for Health
Protection and Promotion
Why focus on a behaviour change
approach?
• Current “top down” approaches have had limited
success
• Traditional “best practice” approach has been
disappointing
• We need to acknowledge that we are human!
Power in Relationships
Not Fixing the Parts, the System, or the People
Performance as an emergent property…
arising from local interactions
and patterns of relating
on the front line.
Sharing best practices
• Solutions imported from external sources
results in “social immune response” in the
same way that our body triggers an immune
defense response
The Premise Of Positive Deviance
No matter how seemingly intractable a problem,
in every community there are individuals whose
uncommon practices/behaviours enable them to
find better solutions to problems than their
neighbours who have access to the same
resources.
TAKE
Think about someone you know who you
suspect might be a positive deviant…
What are they doing? What makes you
recognize their behaviour as unusual or
different?
In any group…
Increasing performance
Malnutrition in Vietnam Children
PD and MRSA
• US pilot project
• Implementation of PD followed by 20 month
follow up period
• No attempt to decolonize patients
• 26-62% reduction in MRSA clinical infections
• 1 site had an 80% drop in MRSA infections
SHEA 2009
This is about…
• Creating sustainable change
• Helping culture to shift
• Indentifying existing and/or uncommon
practices
• Developing new behaviours to overcome
barriers
Acting your way into a new way of thinking
Time for an attitude adjustment…
Who have the knowledge?
≈
The “Awareness” Iceberg
4%
Problems known
to top managers
9%
Problems known to
middle managers
74%
100%
This internationally acclaimed study conducted by Sidney Yoshida, was initially presented
at the International Quality Symposium, Mexico city, 1989. It indicated how management's
failure to understand its processes and practices from the perspective of its
customers, suppressed the company's profits by as much as 40%.
Problems known to
supervisors
Problems known to
front line managers
100%
74%
9%
4%
TAKE
Consider your work today…
Who holds the power? Who are considered the
experts? What would it take to flip the
iceberg?
Positive Deviance
Discern
Disseminate
Design
Discover
Define
Determine
How does it work?
• Invite those who are interested
• Front-line staff must be there (the
“Gurus”)
• Create conditions for people to discover
and adopt their own solutions
• Identify and analyze the positive deviants
• Create ways to spread peer to peer
• Track and publish results
Who is included?
Everybody who touches the problem
– Get the right people around the table
– Who isn’t here?
– “nothing about me without me”
PD Tools
•
•
•
•
•
•
Kick offs
Improvisation
Sharing Stories
Discovery and Action Dialogues
Social Network Analysis
Ethnographic mapping
Tracking Impact
• Define the things you will
measure together
• Data potluck – A Menu of
Measures you generate to
make sense of what is
happening, encourage
people to keep going,
generate a sense of
accomplishment, share
stories and impact.
Social Proof
Social Network Analysis
• Reveals communicative patterns
of complex groups and teams
– Identifies the strength and
frequency of connections
(e.g., with whom and how often do you
communicate about the problem you are
working on)
– Can describe current network in
general & specific clusters of
common interest in particular
The power of storytelling
• One death is a tragedy; one million is a
statistic.
• Stories can capture the complexity of the
situation.
Power in Relationships
Not Fixing the Parts, the System, or the People
Performance as an emergent property…
arising from local interactions
and patterns of relating
on the front line.
Learn from the people
Plan with the people
Begin with what they have
Build on what they know.
Of the best leaders
When the task is accomplished
The people all remark
We have done it ourselves
Lao-Tzu’s Tao Te Ching
(6th Century BCE)