Nuts and Bolts: Positive Deviance

“In every group there is aminority of people who find better solutions to the challenges at hand. … Eventhough they have access to exactly the same resources as the rest of the group,their uncommon practices or behaviors allow them to flourish.”—Jerry Sternin

While “positive deviance” is a fun, alluring term, it’s notabout just breaking rules. The “deviance” must have a positive outcome. It’snot quite just innovation or creative thinking, though those can certainly bepart of it. It’s not just a random act of kindness, like paying for the coffeeof the next customer in line. It’s more about deploying uncommon but successfulbehaviors or strategies to achieve some better result.

In 1990, Jerry Sternin, director of Save the Children inVietnam, was tasked with finding a sustainable solution for overcoming theproblem of child malnutrition. At the time, 65 percent of the children underage five in Vietnamese villages were malnourished. Prior attempts to implementsolutions—such as supplemental feeding programs—did not succeed for long. Alongwith his wife, Monique, Jerry looked at a question that researchers were workingon at Tufts: “Why, with all resources being equal, are some children in acommunity not malnourished?” Workingin four communities, the Sternins turned to the members of poor villages whoseemed to overcome the malnutrition problem and have healthier children. Thereemerged a group of positive deviants, the families who, despite identicalresources, were able to achieve better outcomes through doing things others didnot. It turned out those families were giving more frequent meals than was the custom,and were feeding items—such as brine shrimp and crab—considered inappropriatefor young children.

It isn’t about imposing solutions, but helping the communitysurface the solution it already has

You know the drill: Organization has a problem. Organizationbrings in “experts” to study the problem, devise a solution, run a pilot (whichmay mean a training program), and then leave. Organization members quicklyrevert back to old behaviors.

The solution in Vietnam was sustained precisely because thesolution was not just imposed on the villagers. The Sternins didn’t go aroundlecturing about feeding more frequent meals and unusual foods. They leveraged thehelp of community members—the mothers of the healthier children—in workingdirectly with other families to spread the different practices. Ultimately, theinitiative cut childhood malnutrition by two-thirds because the familiessustained the change.

What are positive deviants like?

They see the holes, not the net

Where others saw constraints—food sitting there yet regardedas unusable—the mothers in Vietnam saw protein. Years ago, in my ownorganization, we saw the opportunities eLearning offered to solve some of ourreal problems, but there were just no funds to be had. So we looked past thatnet to a hole: “What can we do without money?” The answer ended up involvingthings like basic HTML pages, but we launched a program. Where a friend wastold he couldn’t supplement classroom training with social tools—because theorganization blocked Facebook—he found other tools that the organization wouldallow, some already getting heavy use from workers.

They have a low regard for social convention

Have you ever felt the fallout from trying to change aseemingly innocuous tradition in your own family? The mothers in Vietnam werefeeding foods in defiance of community norms and traditions maintained byvillage elders. Positive deviants push the limits and check the edges of usualpractice.

They tend to be passionate about their work and act from a senseof greater purpose

Positive deviants are not trying just to execute tasks but tocontribute to a greater goal. They don’t see themselves as just breaking uprock, but as helping to build a cathedral.

A quick start? Flip the question

As you saw with the Sternins, a key behavior of positivedeviants is their ability to reframe the question. Instead of asking, “Why areso many children malnourished?,” they asked: “Why are these other children not malnourished?”

Other examples:

• Not“How can we stop distracted driving?” but “How can we make cars safer?” Eveninexpensive new cars have sensors that prevent following too closely and thatoffer help with staying in lanes.
• Not“How can we get money?” but “What can we do with no money?”
• Not“How can we force people to finish courses?” but “How can we make the coursesmore interesting and worthwhile?”

Years ago, I was working with a hospital for adults withdevelopmental disabilities, where I supervised the staff who taught emergencyresponse courses. All workers were required to be regularly recertified in standardfirst aid, and we had a terrible time getting this done. In most instances, theever-present nursing staff handled emergencies, so other staff did not perceiverecertification as a high priority. Getting people to class involved a lot offoot-dragging, endless floor-coverage issues, last-minute cancellations, andeven threats. One of my staff suggested that we start adding on infant andchild CPR at the end of the training day. It didn’t cost us anything, as wealready had staff and equipment to do it, and by trimming down breaks we didn’textend the day by much. It solved our attendance problem overnight, as thetraining was suddenly seen as more valuable to the parents and grandparents whoconstituted a huge proportion of our audience.

The related field of appreciative inquiry offers similarflip-the-question approaches but is more specific, asking us to look for andbuild on the positive case or “outlier.” Is there someone in the communityalready exhibiting the desired behavior? What is enabling them to outperform?What resources are they tapping into that others are not?

• Not“Why are staph infections so high in the hospital?” but “Why are staphinfections lower on the third floor?”
• Not“Why are sales down in Regions 6 and 9?” but “Why are sales up in Region 4?”
• Not“Why do so few graduates of our leadership academy get promoted?” but “Why didthese seven graduates get promoted?”
• Whyis the accident rate lower in _______? Why is the turnover rate lower in______? Why are there fewer ethics complaints about ______ division?

I was speaking at a conference the other day when aparticipant said, “We would really like to see more female executives. We’ve gatheredlots of data about why they are hesitant to move into management, like possiblerelocation, but we don’t seem to be getting anywhere.” Flip the question: Insteadof talking to the women who are resistant, talk to the ones who were not. Whatworked for them? What challenges did they face, and how did they overcome them?What supports were in place? And finally, use the community: How can they helpyou with this?

Think about behaviors, about practice over knowledge, and about things thatcan be done today. The Sternins were given six months to work on themalnutrition problem. Sure, most things are complex with interlocking andunderlying pieces. But find something you can work on today. Help“communities,” whatever they are, discover their own solutions

Think about your resources. Money, sure, but what about people,tools, ideas, space? Back in our late-1990s “how do we do eLearning withoutmoney?” days, I found that I had many more assets at my disposal than I’d firstconsidered, including a co-worker who had once been a radio DJ so had a great,polished voice; an office copy of Dreamweaver, which at the time had achallenging but useful add-on interaction-creation tool called CourseBuilder; astockpile of not-too-old VHS training tapes for which we’d bought reproductionrights and the right to edit; and a friend with a machine at home that couldconvert VHS tapes to digital formats.

Finally: Think about community. While thereare individual positive deviants who work alone, a key factor is working withthe community to surface, spread, and sustain solutions rather than try toforce outside-in answers—as is so often the case with training. I frequentlymeet designers who say they do not—or are not allowed to—talk with workers whowill be their target audience. Often the workers are the ones who have thebetter answer, know whether the proposed solution is already in placesomewhere, and can help you get at the real issues. Try to get access to andbuild regular contact with the communities of workers you ultimately serve. Leveragingsocial tools and workplace communities, and encouraging people to show theirwork, can help to surface and spread solutions and to sustain application ofnew learning to the workplace.

Want more?

• About the Positive Deviance Initiative
• Field guide to the Positive Deviance Approach
• Resources from my conference presentations andwebinars
• Gawande, Atul. Better:A Surgeon’s Notes on Performance. New York: Picador, 2008. (Note especiallyhis five steps for becoming more like a positive deviant.)
• Marra,Alexandre, et al. Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance. InfectionControl and Hospital Epidemiology, Vol. 31, No. 1. January 2010. (Conclusion:A positive deviance strategy yielded a significant improvement in hand hygiene,which was associated with a decrease in the overall incidence of hospital-acquiredinfections.)