What makes some groups succeed where others have failed? When equivalent teams, cohorts or communities are exposed to similar pressures, provided the same resources, training and education, outcomes vary, and, in some instances, certain groups can produce results that so far exceed those of peers that they become deviants. Skewed away from the average.
Work began in this area described by Jerry and Monique Sternin and Richard Pascale in their book ‘The Power of Positive Deviance1’ – in which, for example, they report on similar groups of impoverished people in Vietnam working out different ways to nourish their children and so avoid malnutrition, with one group taking advantage of a freely available resource – in this instance, crustaceans, supplementing the diet of their children, which the other group did not.
We see positive deviance across the world and no more so than in healthcare. Why, do some patients, when exposed to similar diseases survive and even thrive, when others deteriorate and die; why, do some older people enter long-term care at a rate that is double the national average, or die prematurely, or fall; why do some GP’s prescribe double the rate of antibiotics as others, why are some patients subjected to many more investigations – blood tests, x-rays, biopsies than others, with either similar or even better outcomes in the former groups.
This question, given the global economic and resource constrained world we are all living-in is more relevant now than ever. The American Institute for Healthcare Improvement has produced what it calls its ‘Triple Aim2’ – providing higher quality care to more people at less cost.
How is it that some hospitals, carers, providers can do this so successfully and others not?
This is clearly an enormously complex area with factors such as patient education, affluence and health, access to staffing, leadership, organisation, culture, geography, amongst a multitude of others.
How does positive deviance play into this work? Why, when relatively straightforward solutions, work for certain groups do we not more rapidly learn and diffuse learning? This I believe is the problem.
We all see the world through the subjectivity of our own experience – what one group sees as good, or the way to behave, another sometimes can’t understand. In this world of constant challenge, we need to sometimes stick to what we believe, even though what we believe is not necessarily ‘true’ – whatever true, is.
I suspect we need to not only focus on rooting-out the positive deviants amongst us but also look at what is stopping the widespread adoption of their approaches; what cultural, historical or philosophical obstacles lie in the way of turning good into great, spreading good practice and magnifying the effect, turning the deviants into the natural way of behaving.
This is, after all, as George Por3 says, is evolution, something we have been practicing for billions of years, the adoption of what works and the falling away of what doesn’t – it should be something humans are good at after all this time.
1 Pascale, Richard, Jerry Sternin, and Monique Sternin. “The power of positive deviance.” Harvard Business School Publishing, Boston, MA (2010).
2 Berwick, Donald M., Thomas W. Nolan, and John Whittington. “The triple aim: care, health, and cost.” Health Affairs 27.3 (2008): 759-769.
3 Atlee, Tom, and George Por. “Collective intelligence as a field of multi-disciplinary study and practice.” En ligne.< http://www. community-intelligence. com/files/Atlee (2000).