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Sunday, March 31, 2013

Notes on being a positive deviant

I recently finished Atule Gawande's book "Better". It is a great read for anyone in the health care field and perhaps anyone who is interested in what it takes to get better. In my opinion, he left the best to the afterword which is where I lifted the title to this blog piece. He highlights five things:

1. Ask an unscripted question.
2. Don't complain
3. Count (and measure) something
4. Write something
5. Change

As it turns out there is an entire "Positive Deviance" community already formed, with a Wikipedia entry. The principles of the PD approach are outlined as the following (from Wikipedia):

The Positive Deviance approach is a strength-based approach which is applied to problems requiring behavior and social change. It is based on the following principles:[6]
  • Communities already have the solutions. They are the best experts to solve their problems.
  • Communities self-organize and have the human resources and social assets to solve an agreed-upon problem.
  • Collective intelligence. Intelligence and know-how is not concentrated in the leadership of a community alone or in external experts but is distributed throughout the community. Thus the PD process’s aim is to draw out the collective intelligence to apply it to a specific problem requiring behavior or social change.
  • Sustainability as the cornerstone of the approach. The PD approach enables the community or organization to seek and discover sustainable solutions to a given problem because the demonstrably successful uncommon behaviors are already practiced in that community within the constraints and challenges of the current situation.
  • It is easier to change behavior by practicing it rather than knowing about it. “It is easier to act your way into a new way of thinking than think your way into a new way of acting”.
Also from the same article:

Steps of the PD process[6]An invitation to change: A PD inquiry begins with an invitation from a community that wishes to address an important problem they face. This is an important first step of community ownership of a process that they will lead.
Define the problem: This process occurs with the community at the center of defining the problem for themselves. This will often lead to a problem definition that differs from the outside “expert” opinion of the situation. A quantitative baseline is established by the community. This baseline provides an opportunity for the community to reflect on the problem given the evidence at hand, and also measure the progress toward their goals. This is also the beginning of the process to identify stakeholder and decision-makers regarding the issue at hand. Additional stakeholders and decision-makers will be pulled in throughout the process as they are identified.
Determine the presence of PD individuals or groups: Through the use of data and observation, the community establishes that there are Positive Deviants in their midst.
Discover uncommon practices or behaviors: This is the Positive Deviance Inquiry. The community, having identified positive deviants, sets out to find the behaviors, attitudes, or beliefs that allow the PD to be successful. The focus is on the successful strategies of the PD, not on making a hero of the person using the strategy. This self-discovery of people/groups just like them who have found successful solutions provide “social proof” that this problem can be overcome now, without outside resources.
Program design: Now that the community has identified successful strategies, they decide what strategies they would like to adopt, and design activities to help others access and practice these uncommon and other beneficial. Program design is not focused on spreading “best practices” but helping community members “act their way into a new way of thinking” through hands-on activities.
Monitoring and evaluation: PD-informed projects are monitored their programs and evaluated through a participatory process. As the monitoring will be decided on and performed by the community, the tools they create will be appropriate to the setting. This can allow even illiterate community members to participate through pictorial monitoring forms or other appropriate tools. Evaluation allows the community to see the progress they are making towards their goals and reinforces the changes they are making in behaviors, attitudes, and beliefs.
A monitoring tool used by illiterate members of a community.
Scaling up: The scaling up of a PD project up may happen through many mechanisms: the “ripple effect” of other communities observing the success and engaging in a PD project of their own, through the coordination of NGOs, or organizational development consultants. However the project is scaled up, the process of community discovery of PDs in their midst remains vital to the acceptance of new behaviors, attitudes, and knowledge. 

I like this conceptually. It is consensus based and data driven. It is not top down but more bottom up and community driven.

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