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 (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 “improving handwashing rates” was all their job was. They weren’t part of the “community” of doctors and nurses whose hands needed to get washed. Nothing stuck… until they found some people who did wash their hands, asked them how they managed to accomplish that, and had them share those strategies with the rest of their own doctor-and-nurse 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.