October 14, 2008
DO YOU KNOW ANY POSITIVE DEVIANTS?
Use your star performers to inform learning
From the desk of Lynn Lehman...
Benchmarking is the comparison of one organization’s practices to another organization’s, usually one that has been recognized for its best practices in a particular area. It is an externally focused process undertaken to learn how other companies work in order to have models and comparisons with current practices. When new or innovative ways are discovered, companies can use benchmarking to develop a business case for change.
Positive Deviance, on the other hand, is the concept that every group of people performing a similar function will have certain individuals within it who, as a result of their particular characteristics and/or behaviors, are able to find and implement better solutions than others around them who have the exact same resources and conditions. It is an internally focused process that identifies the “positive deviants” within the group and facilitates the adoption of their special characteristics and/or behaviors by the entire group in order to make improvements.
The process of benchmarking implies that the ideas for significant organizational improvements must come from outside. The founder of Positive Deviance, Jerry Sternin, has a contrary view. Sternin states that “you can’t bring permanent solutions in from outside.” I propose that learning organizations should utilize both of these practices in order to maximize the opportunities for performance improvement, and thus success.
What is Positive Deviance?
To explain the concept of Positive Deviance, let me tell you a story. In the 1990’s, a man named Jerry went to Vietnam as part of the Save the Children group in order to solve the problem of malnutrition in the country’s small and very poor villages. The Vietnamese government gave the group just six months to get results. Facing such an intimidating time frame, Jerry and his team got started by talking with the mothers in four different villages. They asked the women in each village if there were any children under age three who came from poor families, but were well nourished. In each village, the answer was yes.
After talking with the mothers of the healthier children, they discovered that these mothers went against custom and mixed tiny crabs, shrimp and sweet potato greens into their children’s food, supplementing the traditional fare with extra vitamins and protein. In addition, they found these mothers fed their children when they got diarrhea, which was in opposition to the conventional wisdom that children with diarrhea should not be fed. Finally, these busy mothers made the time to ensure that their children were given several small meals throughout the day, which most of the other busy mothers did not do. Upon discovering these differences, the mothers of the malnourished children soon began imitating the behavior of the mothers of the healthier children - the “positive deviants.”
Eventually the work was expanded to 14 villages, and Jerry found that there were positive deviants in every village who had come up with unique solutions that varied with the resources at hand. These mothers were all willing to share their practices with the other mothers and within two years of initiating this Positive Deviance process, the malnutrition level of children dropped by up to 85% throughout the 14 villages that were involved in their initial six-month project. Jerry Sternin went on to create an entire movement based upon Positive Deviance. To quote from his website, www.positivedeviance.org, “Positive Deviance (PD) is a development approach that is based on the premise that solutions to community problems already exist within the community.” While he primarily focuses on global health and wellness issues, Sternin’s concept of Positive Deviance is also being adopted by businesses that want to leverage the knowledge and behaviors of the people within their own organizational community. |
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Positive Deviance in Action
One organization that has effectively implemented the Positive Deviance approach is Waterbury Hospital. After formation of an interdisciplinary Positive Deviance team (PD team) in June of 2005, Waterbury Hospital’s first Positive Deviance project was to improve performance around communication related to the reconciliation and management of medicine upon and after patient discharge. The hospital knew that discharge is a high-risk transition time and through analysis, the PD team determined that only 13.3% of the hospital professionals were communicating effectively at these times. This low level of performance had resulted in 49% of patients having difficulties with their medications – mostly related to inaccurate or unclear instructions – after being discharged from the hospital.
The PD team studied the actual discharge instructions and feedback from a survey of the 51% of the patients who did not have problems with their discharge medications. With the data they gathered, they were able to identify the health providers who had successfully advised their patients about their discharge medications. They then went on to identify the uncommon – but successful – behaviors of these health providers who were identified as the positive deviants. The positive deviant behaviors they identified that were connected to written instructions were:
- Listing all old medications and whether to continue them or not;
- Creating a calendar to help the patient taper medications or take them on alternate days;
- Developing a written instruction sheet to help patients take medications with complex regimens;
- Writing up instructions on whom to contact if the patient has problems; and
- Ensuring that, if needed, family members or other caregivers were given copies of any medication instructions.
After the positive deviant practices were identified, the PD team disseminated the information through a collaborative educational experience. They discussed the positive deviant practices with individuals and pulled together several representative groups of health care professionals to review them. The PD team took these opportunities to solicit even more ideas to improve medication discharge performance as well. To get this first wave of participants more involved, they invited each person to conduct a few patient telephone surveys themselves so they could learn firsthand the challenges that patients were facing upon discharge.
Following this collaborative educational process, the PD team posted the positive deviant practices on posters throughout the hospital. The PD team did not force staff to adopt the new practices; rather, they encouraged staff to try out a few of the solutions on their own. It was through curiosity and self-discovery that the PD team hoped long-term, positive change would take place.
Six months after the completion of the rollout, an evaluation revealed that 78% of their health care professionals had changed their behavior and were using one or more of the positive deviants’ written tools to communicate medication instructions upon discharge. This increase led to patients being 66% more likely to have no problems with their medications after discharge. This was a significantly positive change in performance that resulted from the analysis, not of what outside experts were doing well, but of what their own people did differently that made them stand out from the crowd.
Next Steps
For learning leaders that want to amplify the successful behavior of their own star performers, the process of Positive Deviance is a simple one and can be achieved in four steps known as the “Four Ds of Positive Deviance”:
- Define the problem and the desired outcome in observable and measurable terms.
- Determine if anybody (individual, department, organization, etc.) demonstrates the desired behavior.
- Discover what strategies these people adopt to find better solutions than their counterparts.
- Develop and implement opportunities for others to practice these behaviors.
The key to success is taking action. You can gather great data about your positive deviants for months but if you never use it, you are wasting time, effort, and money. What learning leaders need to do is take the information gathered about the company’s positive deviants and identify the specific change in behavior that will help the rest of the staff perform better. Then, make sure to design, implement, and evaluate a learning initiative based on your findings.
Collecting best practices from other organizations through benchmarking is a procedure that should be done by every company to keep ideas fresh and to ensure that trends and innovative programs do not slip by unnoticed. However, discovering best practices that will improve performance within the ranks of the employees themselves is another great way to continually inform learning.
Lynn Lehman, CorpU Senior Learning Analyst
References:
Positive Deviance Initiative. (2008). Use of the Positive Deviance Approach to Improve Reconciliation of Medications and Patients Medication Management after Hospital Discharge: The Experience of Waterbury Hospital (Connecticut). Retrieved October 9, 2008, from: http://www.positivedeviance.org/projects/waterbury/
Sternin, Jerry (Speaker). (2006, November 7). Social Change from the Inside Out [seminar]. Boston: GCPH Seminar Series 3.
