Posted by: Inside-Out Peace | November 4, 2009

Positively Deviant

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 Chainpositive 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.



  1. That is why I am mostly an Anarchist!

    People can solve their own problems, if we give them a chance. The human brain is more amazing than any machine could ever be…

    I believe in bottom-up solutions always and hope that these ideas catch fire throughout the world!

    Great to see you have been writing a lot lately, this is one of my favorite stops while my brain is fried from staring at reports and contracts, ugh…

  2. Thanks!

    I agree that people are great at solving problems and most of the time solutions work better when they’re bottom-up….but anarchy? Nah. I still think there needs to be a top as well. In a state of anarchy, there would be no mechanism for communicating solutions. Everyone would have to reinvent the wheel. An example I’ve used elsewhere is the law that the doors of public buildings must swing outwards, to facilitate people exiting in case of emergency, like a fire. Do you want to live in a society where individual building owners have to figure that out for themselves, and have a greater chance at getting stuck in a burning building, or do you want to live in a society that has the capability to write and enforce building codes so that everyone benefits from an idea the first time someone figures it out?

    I googled Cicero just now because I was looking for what he said about something like, “the set of rules which produces the greatest possible freedom”. Didn’t find it, but did come across this:

    Here’s an excerpt:

    A Land of Liberty is not a land in which we all have absolute freedom to do exactly as we please. That would be a land of anarchy, since everyone would be free to limit, or eliminate the freedom of anyone else.

    A Land of Liberty is a land in which we are all subject to some restraint in those actions which are harmful or detrimental to others, so that we can all enjoy not absolute, but a measure of Liberty. In this way, the general Liberty can be maximized.

    Without the Rule of Law people would be free to injure one another in the widest possible sense, each attempting to enhance his or her own personal wealth and possessions through the dispossession of others. This is Anarchy.

    The remedy is the kind of Government visualized by Jefferson and Lord Denning, Government which exists specifically to prevent people from doing those things which are injurious, harmful or detrimental to one another.

    When Government as referee identifies those actions which are harmful or detrimental to others, then prevents such actions by Law and its enforcement, Government is limiting individual freedom; but in so doing it creates the conditions in which the general overall Liberty is maximized.

  3. I completely hear you, and with the highest respect want to elaborate a couple points.

    Forgive my verbosity.

    I think when people think of the word anarchy they imagine mobs with spears and torches, looting and pillaging. As Malatesta once wrote: he was frequently asked why not choose another word, to which he replied, the problem is not the word but the concept itself, which will always offend the same group.

    Another term, however, that is synonymous with Anarchy is liberterian socialism.

    It is not completely without form, or utterly without a “top”, but the top is generated from below, instead of from above downwards – much as is spelled out in the ideal vision of democracy. I think the reason that Anarchy appears to currently oppose government and capitalist institutions more than anything other organization is that these two formations and humankind’s devotion to them are the greatest source of misery in this world today.

    In a sense Anarchy posits that humans can better and more justly organize themselves without the demands of an imposing system, that our morality will in fact flourish when not subjugated, leaning towards Locke and considering the mentatlity of Hobbes to be the greatest impediment to meaningful change. If a perfect government could be established that respected all of our natural rights and freedoms, then I think it would cease to be a target for the anarchists.

    A quote from Chomsky, who is probably the most prominant Anarchist intellectual today:

    “A French writer, sympathetic to anarchism, wrote in the 1890s that ‘anarchism has a broad back, like paper it endures anything’—including, he noted those whose acts are such that ‘a mortal enemy of anarchism could not have done better.’ There have been many styles of thought and action that have been referred to as ‘anarchist.’ It would be hopeless to try to encompass all of these conflicting tendencies in some general theory or ideology. And even if we proceed to extract from the history of libertarian thought a living, evolving tradition, as Daniel Guérin does in Anarchism, it remains difficult to formulate its doctrines as a specific and determinate theory of society and social change. The anarchist historian Rudolph Rocker, who presents a systematic conception of the development of anarchist thought towards anarchosyndicalism, along lines that bear comparison to Guérins work, puts the matter well when he writes that anarchism is not:

    ‘a fixed, self-enclosed social system but rather a definite trend in the historic development of mankind, which, in contrast with the intellectual guardianship of all clerical and governmental institutions, strives for the free unhindered unfolding of all the individual and social forces in life. Even freedom is only a relative, not an absolute concept, since it tends constantly to become broader and to affect wider circles in more manifold ways. For the anarchist, freedom is not an abstract philosophical concept, but the vital concrete possibility for every human being to bring to full development all the powers, capacities, and talents with which nature has endowed him, and turn them to social account. The less this natural development of man is influenced by ecclesiastical or political guardianship, the more efficient and harmonious will human personality become, the more will it become the measure of the intellectual culture of the society in which it has grown.’

    One might ask what value there is in studying a ‘definite trend in the historic development of mankind’ that does not articulate a specific and detailed social theory. Indeed, many commentators dismiss anarchism as utopian, formless, primitive, or otherwise incompatible with the realities of a complex society. One might, however, argue rather differently: that at every stage of history our concern must be to dismantle those forms of authority and oppression that survive from an era when they might have been justified in terms of the need for security or survival or economic development, but that now contribute to—rather than alleviate—material and cultural deficit. If so, there will be no doctrine of social change fixed for the present and future, nor even, necessarily, a specific and unchanging concept of the goals towards which social change should tend. Surely our understanding of the nature of man or of the range of viable social forms is so rudimentary that any far-reaching doctrine must be treated with great skepticism, just as skepticism is in order when we hear that ‘human nature’ or ‘the demands of efficiency’ or ‘the complexity of modern life’ requires this or that form of oppression and autocratic rule.”

    To me this is a beautiful dream, one that does not fetter itself with fundamentalist zeal to any fixed concept but instead concentrates all of its efforts on promoting the greater freedom – however this should be accomplished.

    As the Chinese aphorism goes – roughly – the one that is bethrothed to any conception or ideal placed on a dais is more dangerous than the one that is motivated by purely human desires, because even the greedy individual will preserve what they desire, whereas the idealist will destroy anything and everything for the sake of their ideal.

    Thus Anarchy attempts to balance on the tightrope of freedom without overly clinging to any set notion. It is a political philosophy without a politic, in a sense, but also seeks to achieve what Virginia Wolfe called “freedom from unreal loyalties” that place concepts such as “government” and “religion” over living breathing feeling entities. To get there requires not only a political but spiritual revolution as well.

    It is an ethereal conceit, but one that I believe we all yearn for, and one that is embedded in all of our struggles for a better world.

    • Thank you for explaining this further. While I wasn’t quite picturing mobs with torches (LOL!), I was thinking of anarchy as a state of complete disorganization. I never have had any patience for anyone who places a higher priority on form than on substance. So, I do like much of what you’ve said here and feel that for a true global community to ever come to be, it will have to be in a form quite similar to what you’ve described.

  4. Thanks Cheryl!

    Would you mind if I reprinted this conversation on our blog?

    I think it raises some very interesting issues and the question of building codes would be fun to try and brainstorm through.

  5. I don’t mind at all! I’ll be interested to see where it goes over on Active Philosophy. Another question I have for you is about whether it’s possible to have a successful anarchic society (according to your meaning of the word) if it contains individuals who do not have the inclination, or possibly even the capacity, for the degree of independent, critical, rational thought needed to form valid, informed opinions about policies. How do you decide what degree of participation is actually feasible if you can’t succeed with anarchy/ideal democracy? A democratic republic is a nice compromise in theory but as we see in the news every day, it is also subject to unacceptable levels of corruption of those in power. I’ve been working on a post about natural law & morality that’s almost ready to publish. I hope you’ll comment on that one as well.

  6. […] favorite blogs on wordpress, Speak Now Peace Works.  It was specifically in response to the post Positively Deviant, which talks about finding success from within groups instead of outsiders providing mandates, […]

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