The Power of Positive Deviance

by Davi Kallman

The Power of Positive Deviance is an inspiring true tale of how trained experts develop into facilitators in order to give the community responsibility and power. Positive deviance unlike other social change models is anything but a model itself, it relies on a vertical scale that suggests invitation rather than force. The premise is based on the notion that at least one person in the community, working with the same resources as everyone else has already solved the problem. It is through this knowledge that people can bind together to make change possible through enactment and consistency. Stressed throughout the book is the idea that the experts or trained leaders are anything but leaders in this situation, they serve merely as facilitators through a role reversal in which the “experts become learners and the teachers become students” (Pascale and Sternin, 2010). Since leadership is no longer defined by roles it is up to the community to step up and identify the problem by discovering the solution. Leadership itself then begins with a conceptual challenge of being able to engage others in generating a different outcome. As a facilitator, the task then is simple, to initiate conversation, paying attention to norms and customs, identifying the “how”, and most importantly to listen and pay attention to the community wisdom. This structure is best defined by a Taoist sage, Lao-Tzu:

Learn from the people

Plan with the people

Begin with what they have

Build on what they know

Of the best leaders

When the task is accomplished

The people all remark

We have done it ourselves

(p.193) 

In addition to the role of the facilitator, positive deviance takes many other roles, one can be defined as discovering the “who, how, and what” of every situation. In the book the who describes the people who are doing things differently, those who are deviating from the norm, the how is the different practices that are being done (this can be as simple as ladling practices), and lastly the what defines what are some of the things that deviate from the norm that help define the solution. The three roles of positive deviance help to distinguish the presence of positive deviance in a community overwhelmed by obstacles and burden. The following three stories were selected because of their overall importance to PD as well as their unintended outcomes that resulted as a side effect of the PD process. Instances such as leveling the hierarchy, flipping the gender role scripts, and the implementation of women advocacy groups in a country where women didn’t have a voice are just some of the many outcomes that arose from implementing positive deviance at a community level. More importantly PD stresses how unlikely people can do incredible things and the true answer and the solution resides in the community itself.

Lisa’s Story/Spread of MRSA

Lisa is a 44 year old nurse that came into contact with MRSA (a bacterial infection that is highly resistant to some antibiotics) with her 13 year old son. Unknowingly Lisa spread MRSA to her husband who had just undergone spinal surgery. With his immune system down, MRSA took hold of his body and as a side effect had to undergo numerous surgeries and was in bed for months. As a result of the MRSA, depression soon followed and Lisa’s husband committed suicide. Lisa is just one of many whose life is severely tormented by MRSA. 

Dr. Llyod a retired general surgeon was asked by the Center of Disease Control to help reduce the spread of MRSA and so he enlisted the help of the PD initiative. Through the PD approach, Dr. Llyod and his team were able to develop several tactics to combat MRSA. The implementation of DAD’s (discovery and action dialogues) helped to invite others for enactment and consistency, meaning that people could generate questions on what could be done and what other departments were doing differently to solve the problems. Through DAD’s they invited everyone from housekeepers, clergy, physical therapists, patients and even janitors. Everyone was able to help in the process. Even the smallest changes made the biggest differences. Changes such as putting soap dispensers in vans that transported patients, the hospital pastor who learned that MRSA was passed from his bible so they developed disposable bible covers, to the squish alert which changed the placement of hand dispensers so that it faced the patients’ beds. But most importantly this PD approach had unintended outcomes such as leveling the hierarchy. Now new protocol brought top management to each unit for a bi-weekly meeting, the janitors were presenting data about MRSA prevention; this also led to shared authority between patients, staff, and administration.

Khira’s Story/ Female Circumcision

“A wound that never heals”

The day after Easter, Khira was 12; she was playing with friends when suddenly her mother and her aunts took her to a tent along with a couple other girls. Later Khira found out that this day was not just a holy day but it was an occasion to circumcise young girls. While in the tent Khira overheard the women talking and whispering, “khira overheard her mother ask if Khira could go first, so the razor would be sharp and cut swift and clean”. Khira fainted during the procedure and awoke to a pain she could not even describe. Her wound was not only physical but it was emotional, it was a pain she could not fathom, something so deep. She wondered how people she had come to trust and love her whole life could inflict something so horrible on her, little did she know, she was not alone. She could not walk for days she was ashamed, she could never trust her family again. 

Khira experienced what is known as Female Genital Mutilation (FGM) also known as Il Rittan (excision). In Egypt, FGM is a common practice and is done from small villages and towns to larger cities. While the ritual is the same, the manner in which it is performed is different in every situation. The use of dirty and unclean razors and blades often lead to infection or even death, this is a burden that many women suffer as early as 12 years old. When Jerry Sternin went to Egypt he encountered several girls who wanted to identify exceptions in their own communities to convince mothers to stop the practice. Unfortunately finding those who were willing to tell their tales seemed quite daunting because they were ashamed and embarrassed. The idea came to videotaping PD interviews in order to build rapport, questions arose such as “how do we create trust” this led to members in the community to initiate answers on who to invite. Warda and Khira both told their stories while completely different outcomes, they both experienced similar shame. Warda was ashamed that she had not been circumcised while Khira was always wounded by the fact that she was. This particular instance of positive deviance focused on social proof. In this situation positive deviance was spread by the fact that community members saw that other people were defying this unjust practice; seeing is believing. In this particular situation the unintended outcome was the creation of women’s advocacy groups that defied the odds. Thousands of female circumcisions averted in Egypt over the past 8 years leading to the creation of FGM-free communities and the implementation of women’s advocates.

An Infant’s Story/ Infant Mortality in Pashtun

In Pashtun Pakistan there are approximately 85 deaths in every 1,000 births. In a country that is typically male driven childbirth was seeing as a woman’s job and any illness or death that is related to the birth is seen to be the woman’s fault, “babies and childbirth are women’s business.” The collection of data was another issue, while men were the original advocated to figure out why infant mortality was so high, women began to take an active role in the process, for women beans were the artifact of choice for mapping/ they understood what happened after the child was born. An important thing to note is the framing aspect, from the “what” to the “how”, dolls were used to see what people did rather than what they know : ex: delivering baby in an animal shed, newborn on mud floor for prayers led to (hypothermia). They started looking for what people were doing differently to prevent infant mortality. After they found the positive deviants within the group they were able to implement several things such as, put babies on pillows after they are born, clean delivery kit (clean razor), grab bag, role play: used razor blade covered with a black felt tip to show how infection was spread (husbands took responsibility to buy new blades), had healthy baby contest (0-1, 1-2, and 2-3) parents received prizes. The unintended outcome that resulted was that husbands and wives shared common experiences and interests/ for the first time men and their wives became partners.