I’ve just finished reading Better: A Surgeon’s Notes on Performance by Atul Gawande.  Here I learned of a name for a concept I only vaguely intuited when I wrote A New Version of the Golden Rule:  positive deviance.  (Had I known this at the time, I might have called it Be A Positive Deviant.)  In the book, Gawande briefly describes how Jerry Sternin used this concept during his work with Save The Children to reduce child malnutrition in Vietnamese villages by 65 to 85% in six months (also described in more detail here, by David Dorsey in Fast Company magazine).  Gawande then goes on to show how amplifying positive deviance was used to improve workers’ diligence in hand washing at a hospital, resulting in a drop in MRSA infection rate from nine percent of patients to zero.  This stunning success followed years of trying many different things to get people to wash their hands, all of which resulted in no lasting improvement at all.  What all those unsuccessful things had in common is that the changes originated from outside the hospital worker community.

When a community has a problem, people often seem to think that the solution lies “out there” somewhere, and they go looking for someone who can give them the answer to their problem.  However, even if this is true, it pretty much never works, because people simply do not listen to anyone from outside their community telling them how their community should do things.  The immediate reaction tends to be, “but you don’t know how things really are here – what you’re saying may have worked somewhere else but it’s too hard for us because we have this, this and that to contend with.”  In the case of the hospital handwashing problem, this was true even when it was people who worked for the same hospital who were offering solutions – because that’s all their job was.  They still weren’t part of the “community” of workers whose hands needed to get washed.  Nothing stuck… until they found workers who did wash their hands, asked them how they managed to accomplish that, and shared those strategies with the rest of the worker community.

In very basic terms, the idea of amplifying positive deviance is to find someone from within the community (however that community is defined by the members of that community themselves), who is successful already, figure out what they’re doing differently, and publicize the fact that it works.  In Vietnam, it was mothers who added sweet potato greens and tiny crabs and shrimp they caught in the rice paddies to their childrens’ rice and fed them several small meals a day, rather than one or two larger ones, whose children were the best nourished.  These practices flew in the face of the local culture’s conventional wisdom.  When outsiders tried to get them to change these practices, prior to Jerry Sternin’s visit, it never worked.  But it is almost impossible to argue with direct evidence, and this is what positive deviance relies on. 

So.  Why am I blogging about it here?  The answer to that is more questions:  What communities are you a member of?  What do you do differently that could serve as a positive example to the rest of your community?  What do others do that you can learn from?  These are valuable questions to develop a constant awareness of, and answer again and again throughout our lives.  We all have circles of influence, and no matter how small your circle may seem to you, you can bring about tremendous positive change if you use that influence.  The people you influence in your circle are themselves members of other circles as well, which they can then have a positive impact on.  When you pull the end of a chain, every link moves.  Where do you want your chain to go?

Click to learn about the Positive Deviance Initiative.

Nicholas Kristof has recently written an editorial saying just about the same thing I said here.

What he said… 

Best line: “It breaks my heart that we don’t invest in schools as much as medieval, misogynist extremists.”

I just read the following, quoted in a note on someone else’s Facebook, and wanted to share it here.  It’s a beautiful reminder of the greatness that lies within the small moments, and that it’s what we do for others that brings meaning to our own lives.

The Cab Ride by Kenneth Wesson
Twenty years ago, I drove a cab for a living.
When I arrived at 2:30 a.m., the building was dark except for a single light in a ground floor window. Under these circumstances, many drivers would just honk once or twice, wait a minute, and then drive away.
But, I had seen too many impoverished people who depended on taxis as their only means of transportation. Unless a situation smelled of danger, I always went to the door. This passenger might be someone who needs my assistance, I reasoned to myself.
So I walked to the door and knocked. “Just a minute”, answered a frail, elderly voice.
I could hear something being dragged across the floor.
After a long pause, the door opened. A small woman in her 80’s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie.
By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets.
There were no clocks on the walls, any knickknacks or utensils on the counters.
In the corner was a cardboard box filled with photos and glassware.
“Would you carry my bag out to the car?” she said. I took the suitcase to the cab, and then returned to assist the woman.
She took my arm and we walked slowly toward the curb.
She kept thanking me for my kindness.
“It’s nothing”, I told her. “I just try to treat my passengers the way I would want my mother treated”.
“Oh, you’re such a good boy”, she said.
When we got in the cab, she gave me an address, and then asked, “Could you drive through downtown?”
“It’s not the shortest way,” I answered quickly.
“Oh, I don’t mind,” she said. “I’m in no hurry. I’m on my way to a hospice”.
I looked in the rear-view mirror. Her eyes were glistening.
“I don’t have any family left,” she continued. “The doctor says I don’t have very long.”
I quietly reached over and shut off the meter. “What route would you like me to take?” I asked.
For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator. We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.
Sometimes she’d ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing.
As the first hint of sun was creasing the horizon, she suddenly said, “I’m tired. Let’s go now.”
We drove in silence to the address she had given me.
It was a low building, like a small convalescent home, with a driveway that passed under a portico.
Two orderlies came out to the cab as soon as we pulled up.
They were solicitous and intent, watching her every move. They must have been expecting her.
I opened the trunk and took the small suitcase to the door.
The woman was already seated in a wheelchair.
“How much do I owe you?” she asked, reaching into her purse.
“Nothing,” I said.
“You have to make a living,” she answered.
“There are other passengers,” I responded.
Almost without thinking, I bent and gave her a hug. She held onto me tightly.
“You gave an old woman a little moment of joy,” she said.
“Thank you.”
I squeezed her hand, then walked into the dim morning light.
Behind me, a door shut. It was the sound of the closing of a life.
I didn’t pick up any more passengers that shift. I drove aimlessly lost in thought. For the rest of that day, I could hardly talk.
What if that woman had gotten an angry driver, or one who was impatient to end his shift?
What if I had refused to take the run, or had honked once, then driven away?
On a quick review, I don’t think that I have done anything more important in my life.
We’re conditioned to think that our lives revolve around great moments.
But great moments often catch us unaware-beautifully wrapped in what others may consider a small one.

Health care reform is such a huge issue right now I’m feeling like this blog is a bit incomplete without at least a little something about it.  A person’s health certainly does have a direct bearing on their inner peacefulness, and the injustices and waste that are rampant in our current system are neither an equitable nor sustainable use of resources.  That change is necessary, cannot rationally be disputed. 

BUT.  The way the politicians in Washington, D.C. are going about creating that change leaves a great deal to be desired as well.  When we humans undertake a conscious act, we are responsible for all the consequences of that action. 

On one side, some are seeking to create change of such enormous magnitude that they can’t possibly know what all the consequences will be.  This is irresponsible. 

On the other side, some are opposing that change by capitalizing on humans’ inherent nervousness in response to change, creating irrational fears among their constituents and igniting and fanning flames of rebellious anger with their exaggerated misrepresentations.  It has become more about “winning” than about health.  This is also irresponsible. 

If both sides continue in this manner then, regardless of which side prevails, they and the American people as a whole will lose something very important to good governance: control.

In a small system, it’s possible to make multiple changes at once and accurately predict the outcome of those changes.  The health care system is not small.  It is gigantic.  There are so many dependencies we couldn’t even name them all if we tried.  The best approach to improving a large system is an incremental approach.  Pick the one thing that is the most egregiously wrong with the system, and just fix that.  (I don’t know enough to say which thing that is, but others out there do.)  See what effect that one small change has, and then fix the next-most egregious thing.  And so on. 

A series of small changes is not as politically glamorous as passing one huge reform bill, but it is much more likely to result in real, sustained improvements without throwing half the country into a panic and the whole country into turmoil.

On October 13, 2009, KWTX reported:

The Amazing Grace Baptist Church in Canton, N.C. will celebrate Halloween by burning Bibles that aren’t the King James Version, as well as music and books and anything else Pastor Marc Grizzard says is a satanic influence.
Among the authors whose books Grizzard plans to burn are well known ministers Rick Warren and Billy Graham because he says they have occasionally used Bibles other than the King James Version, which is the sole biblical source he considers infallible.
 According to the church’s Web site, members will also burn “Satan’s music such as country, rap, rock, pop, heavy metal, western, soft and easy, southern gospel, contemporary Christian, jazz, soul (and) oldies.

There is little I find more ominous than people burning books.  “There, where they have burned books, they will in the end also burn human beings.” (German: “Dort, wo man Bücher verbrennt, verbrennt man am Ende auch Menschen.”)—Heinrich Heine, from his play Almansor (1821).  Read more at the American Library Association’s website page on book burning, and at this site by the Florida Institute of Technology – Evans Library Instructional Programs Team.  I’ve taken the following quote from the latter:

If all mankind minus one, were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person, than he, if he had the power, would be justified in silencing mankind. Were an opinion a personal possession of no value except to the owner; if to be obstructed in the enjoyment of it were simply a private injury, it would make some difference whether the injury was inflicted only on a few persons or on many. But the peculiar evil of silencing the expression of an opinion is, that it is robbing the human race; posterity as well as the existing generation; those who dissent from the opinion, still more than those who hold it. If the opinion is right, they are deprived of the opportunity of exchanging error for truth: if wrong, they lose, what is almost as great a benefit, the clearer perception and livelier impression of truth, produced by its collision with error.
- On Liberty, John Stuart Mill

Can’t say it any better than Mill.

This post is dedicated to T., who suffered extreme emotional abuse at his schools.  May we all live to see the day when no more kids are allowed to be damaged mentally, emotionally, or physically by their peers (or anyone else).

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~

This post is a response to the following quotation, from the article Coming Out in Middle School by Benoit Denizet-Lewis (NYT, September 23, 2009):

A middle-school counselor in Maine summed up the view of many educators I spoke to when she conceded that her school was “totally unprepared” for openly gay students. “We always knew middle school was a time when kids struggle with their identity,” she told me, “but it was easy to let anti-gay language slide because it’s so imbedded [sic] in middle-school culture and because we didn’t have students who were out to us or their classmates. Now we do, so we’re playing catch up to try to keep them safe.”

It really bothers me that someone who has responsibility for the safety of children could allow herself to be this passive about it.  What makes it especially irritating is that she prefaced what she said by commenting on what a difficult period of time middle school is in the lives of many young people.  Knowing this, she should have felt it was more incumbent upon her, not less, to be proactive in making the school a place where students at least feel safe.

I am also very bothered by her reasoning that derogatory language, toward any group, only matters if there is actually somone of that group present.    Having no students who were “out” is - it should be obvious - not the same thing as having no students who are gay.   

Even if there was not one gay student in the school - whether “out”, or not - all the students should be taught that words matter.  When a student speaks in a way that dehumanizes an entire group of people, silence is not an acceptable response; silence is tacit approval.  It doesn’t matter what the characteristic is that identifies the group.  This is true for race, ethnicity, gender, nationality, religion, political affiliation, or anything else you can think of that defines a group in any way. 

If we are serious about making a priority of education, the most basic prerequisite to learning is that students feel safe in their school.  Until dehumanizing language is eliminated from schools, there will be students who don’t feel safe, and therefore will not learn to their full potential.  We don’t have that potential to waste, with our economic, political, and climatic conditions the way they are. 

Eliminating dehumanizing language is not impossible.  There are already rules and systems in place regarding speech that is prohibited for students to use in schools, e.g. profanity.  As one student quoted in the article points out, he would definitely not be allowed to say, “That’s so black”, so why is “That’s so gay” overlooked?  Stopping this kind of language will only require that teachers and administration apply the same consequences that are already in use against those other types of speech.  If anti-gay speech is as embedded in her school as the quoted counselor perceives it to be, that makes it all the more important to act quickly to curtail it, not something to just give up on.   Habits are hard to break, and there will have to be a focused effort for a time.  Once a new status quo is established, however, it should require much less effort to maintain it.

The overall message students must receive is that the dehumanization of groups is not acceptable, period.  This message is not conveyed when schools make exceptions, prohibiting dehumanizing speech for some groups, but allowing it for others.  Doing that is, in fact, a further form of dehumanization of the groups for whom it is permitted, because it says that they are worth less than the groups for whom it is prohibited.  It is time to raise the bar on our standards.

On a positive note, the article also describes an extracurricular club called the Gay-Straight Alliance which is in a rapidly increasing number of schools across the country, and works to promote a tolerant atmosphere in the school.  The GSA clubs are just one of the many great efforts of the Gay, Lesbian and Straight Education Network (GLSEN).  I’ve added a link to their website to my sidebar, under Education.

Recently on The Daily Show with Jon Stewart, I saw a video clip of a woman who was literally sobbing as she spoke at a health care reform town hall, saying, “I have never seen my America turned into what it has turned into, and I. Want. My. America. Back!”, to loud applause and cheers from the rest of the audience.  I wish I could find her and talk to her.  I would ask her, “what exactly do you mean by ‘my America’?” 

America has changed continuously, ever since it was founded.  Which point in time does this woman define as being “her” America?   People have also been shouting out at these town halls that they are afraid of Obama.  I don’t really understand what they are so afraid of, but I’m genuinely sorry that they are, because living in fear is awful.  I wish I could meet that sobbing woman and learn what her actual concerns about health care reform are.  Saying “I want my America back”, or ranting about “my rights” as some others have done, tells me nothing about the actual issue being discussed. 

We are all “real Americans”, to borrow Sarah Palin’s term.  It’s hard to say that without sounding trite but it needs to be said.  I feel like there are people out there who are looking at other Americans and seeing an enemy, rather than a fellow citizen with different opinions about some things.  We need to stop making politics so personal and talk – really talk – about what our problems are and how we can solve them.  Discussions are only productive when they are based in reality.  People are ranting hysterically in opposition to things that no one is even proposing. 

The problem is, reality-based, rational discussions are apparently too bland for cable news networks.  They earn money based solely on how many people watch their channel, so they broadcast whatever attracts the most attention, and nothing attracts attention as much as an angry, shouting mob.  Anyone who’s angry enough gets to be on TV and have their viewpoint disseminated, which means that the only viewpoints everyone sees are those of really angry people — the extremes of any issue.  But the “news” networks are in a bind because if they get fewer viewers in one quarter than in the previous quarter, their stock price goes down.

The reason we need health care reform is that insurance companies earn money based solely on finding new and ever more creative ways to deny coverage to sick people.  If they happen to pay more in benefits in a quarter than the previous quarter, their stock price goes down.

Our politicians depend on money to get elected.  Whoever raises the most money, has a pretty good chance of winning – and is then somewhat under obligation to those who funded the campaign.  Also, after the elections, whoever has the most money and funds the most lobbyists gets the most influence over the legislation that then determines much of the quality of life for the masses of regular people whom Congress is purported to represent. 

Summing that up in the other direction, our government officials depend on corporations and extremely wealthy individuals to finance their campaigns, and make their decisions based on what will have favorable results for those benefactors.  The corporations and extremely wealthy individuals make their decisions based on what will have favorable results in the stock market.  In other words, our country is being run by the stock market – the most unpredictable, insatiable, uncontrollable construct humans have ever created. 

Come to think of it, I guess I want my America back, too:  back from the tyranny of money.

Updated August 24, 2009:

I was apparently channeling Upton Sinclair when I wrote this post, as I learned from Paul Krugman today:

“It is difficult to get a man to understand something,” said Upton Sinclair, “when his salary” — or, I would add, his campaign contributions — “depend upon his not understanding it.”

I just took the quiz on YourMorals.org regarding my views on war and peace.  Here are my results:

The scales you completed were the Attitudes Toward War and Peace scales developed by Van Der Linden, Bizumic, Stubager, and Melon (2008). As the name suggests, the scale is a measure of an individual’s separate attitudes toward the concept of war and the concept of peace.

The reason why we are interested in this is that research has shown that attitudes toward war and peace, while related, represent two separate factors, meaning that just because one sees the merits of war does not mean that one is not pro-peace. This is a relatively new construct and we hope to help untangle the ideas of war and peace from each other, possibly connecting them to theorized ideas about the relationships to ideas about inequality, empathic tendencies, and threat sensitivity.

The graph below shows your scores on these scales. The scores range from 1 to 9 and higher scores indicate stronger endorsements. Your score is shown in green (1st bar) . The score of the average Liberal survey respondent is shown in blue (2nd bar) and that of the average Conservative respondent is in red (3rd bar) .

Yeah, as I suspected, I’m on the fringe on this one.  I might even have gotten a zero for war except for allowing that there might, possibly, sometime, be some reason that war could be necessary. 

Like most people, I sometimes have to struggle with understanding the reasoning of people with widely disparate viewpoints to my own.  Usually, though, I can at least imagine what the reasoning might be.  But I can’t come up with one idea explaining anyone’s reasoning behind having a more positive view of war than of peace.  Conservatives, out there?  Care to explain?

John Bolton, former US ambassador to the UN, has this opinion piece in today’s WaPo:

“Time for an Israeli Strike?” 

With Iran’s hard-line mullahs and the Islamic Revolutionary Guard Corps unmistakably back in control, Israel’s decision of whether to use military force against Tehran’s nuclear weapons program is more urgent than ever.

Iran’s nuclear threat was never in doubt during its presidential campaign, but the post-election resistance raised the possibility of some sort of regime change. That prospect seems lost for the near future or for at least as long as it will take Iran to finalize a deliverable nuclear weapons capability.

Accordingly, with no other timely option, the already compelling logic for an Israeli strike is nearly inexorable. Israel is undoubtedly ratcheting forward its decision-making process. President Obama is almost certainly not.

I’m finding a double standard: he’s saying Israel should unilaterally short-circuit the diplomatic efforts of the US and EU, by acting militarily to remove the nuclear threat in Iran (which is also a threat to the EU at least, if not the US), when in all other aspects of self-defense (even those which are a threat only to Israel) Israel is expected to hew to the line of the US, EU, Russia and the UN. 

Bolton says, later in the article:

Significantly, the uprising in Iran also makes it more likely that an effective public diplomacy campaign could be waged in the country to explain to Iranians that such an attack is directed against the regime, not against the Iranian people.

Yeah, because that explanation worked sooooo well in Iraq.  Your house is blown to smithereens?  Your husband is dead?  Your children can’t go to school?  You can’t work to support them?  There’s no power or water?  Don’t worry, we’re actually only fighting your government, not you.

In a survey done in Iran in May, the ratio of those with a favorable to unfavorable view of Jews was only 5:4.  I’m going to guess that this follows the general global trend of tolerance and acceptance of others, and that younger people have the more favorable view compared to older ones.  Do you know would it do to that, for Israel to singlehandedly take down Iran’s nuclear facilities?  It would create a whole new generation of Iranians bent on Israel’s destruction.

Mr. Bolton, if a military strike on Iran is really the only possible solution, you should be able to find someone else to do it.

I’m getting really frustrated with people who criticize Obama’s reactions to the Iranian election protests, and say the US should be more “involved”.  The US was “involved” in 1953 and we have still not regained any credibility there since.  (If you don’t know what I’m referring to, read All The Shah’s Men by Stephen Kinzer.)

Anything we might do would only undermine the protesters, not help them.  Any hint of US involvement would take away the ownership they rightfully feel over their own election.  It would give Ahmadinejad and Khamenei the “out” of opposing the US rather than facing and addressing the legitimate complaints of Moussavi’s supporters.  The US must not give them that option.