The Power of Positive Deviance

1. Positive Deviance: Harnessing the Power of Outliers

Positive deviance? An awkward, oxymoronic term. The concept is simple: look for outliers who succeed against all odds.

Positive Deviance (PD) is a problem-solving approach that identifies and leverages existing solutions within communities facing seemingly intractable problems. It focuses on individuals or groups who, despite facing the same constraints as their peers, manage to find better solutions.

Key aspects of the PD approach:

• Seeks out "positive deviants" who have already solved the problem
• Assumes solutions exist within the community
• Emphasizes behavior change over knowledge transfer
• Relies on community engagement and ownership

The PD process has been successfully applied to various issues worldwide, including:

• Reducing childhood malnutrition in Vietnam
• Curtailing female genital mutilation in Egypt
• Decreasing hospital-acquired infections in the United States
• Improving retention rates in Argentine schools

2. Uncovering Solutions Hidden in Plain Sight

Invisible in plain sight. As will be seen in the chapters that follow, invisible positive deviants often "don't know what they know" (i.e., don't realize they are doing anything unusual or noteworthy).

The PD approach reveals hidden solutions by focusing on successful outliers within a community. These individuals or groups often don't realize they're doing anything special, making their practices "invisible" to both themselves and others.

Steps to uncover hidden solutions:

1. Identify the problem and desired outcome
2. Determine common practices within the community
3. Discover individuals or groups achieving better results
4. Study their behaviors and strategies
5. Design a way for the community to practice these successful behaviors

Example: In Vietnam, some poor families had well-nourished children because they were:

• Collecting tiny shrimps and crabs from rice paddies
• Adding sweet potato greens to children's diets
• Feeding children more frequently throughout the day

These practices were readily available to all but not widely adopted until uncovered through the PD process.

3. Community Engagement: The Key to Sustainable Change

Because positive deviants are deviant only within the context of their divergence from the norm (in this case, the traditional feeding, caring, and sanitation behaviors), we needed to identify common practices and behaviors before we could distinguish what the positive deviants were doing that was different.

Community involvement is crucial for the success and sustainability of the PD approach. By engaging the community in identifying problems, discovering solutions, and implementing changes, the process ensures ownership and long-term adoption of new practices.

Key elements of community engagement in PD:

• Allow the community to define the problem in their own terms
• Involve diverse stakeholders, including those often overlooked
• Use participatory methods to discover and share PD practices
• Enable the community to design their own implementation strategies

Benefits of community engagement:

• Builds trust and overcomes skepticism
• Ensures culturally appropriate solutions
• Leverages local resources and knowledge
• Creates a sense of ownership and empowerment

4. From Knowledge to Practice: Acting into New Ways of Thinking

It's easier to act your way into a new way of thinking, than to think your way into a new way of acting.

Behavior change is central to the PD approach. Rather than simply providing information or education, PD focuses on creating opportunities for people to practice new behaviors and experience their benefits firsthand.

Strategies for promoting behavior change:

• Design action-oriented learning experiences
• Create opportunities for repeated practice
• Provide immediate feedback and visible results
• Leverage social proof and peer influence

Examples of action-oriented approaches:

• Nutrition workshops in Vietnam where mothers practiced preparing new foods
• Hospital staff in Pittsburgh simulating MRSA transmission with chocolate pudding
• Egyptian communities sharing stories of families who didn't practice FGM

These hands-on experiences help people internalize new behaviors and overcome cultural or personal barriers to change.

5. Reframing Problems: The Power of Perspective Shift

The initial framing of the problem often turns out to be a placeholder. If experience teaches one lesson, it is that problem reframing usually occurs along the way.

Reframing problems is a critical step in the PD process. It allows communities to see issues from new angles and uncover previously overlooked solutions.

Steps in problem reframing:

1. Start with the initial problem definition
2. Engage the community in discussions about the issue
3. Encourage diverse perspectives and questioning of assumptions
4. Look for underlying causes and interconnected factors
5. Collaboratively develop a new problem statement that resonates with the community

Examples of problem reframing:

• In Egypt, FGM curtailment shifted from a public policy issue to identifying and sharing stories of families who resisted the practice
• In Jakarta, HIV/AIDS prevention among transvestites expanded to include improving access to compassionate healthcare providers
• In a U.S. hospital, hand hygiene compliance became a broader communication issue

Reframing helps communities take ownership of problems and opens up new avenues for solutions.

6. Scaling Success: Challenges and Opportunities

PD successes scale far better "vertically" (i.e., within the community involved) than they do horizontally (i.e., replicating successes across communities).

Scaling PD initiatives presents unique challenges due to the context-specific nature of solutions. While PD can be highly effective within a community, replicating that success elsewhere requires careful adaptation.

Challenges in scaling PD:

• Solutions are often tailored to specific local contexts
• Community ownership is essential for success
• The process of discovery is as important as the solutions themselves

Strategies for effective scaling:

• Focus on scaling the PD process rather than specific solutions
• Create "Living Universities" where communities can learn from each other
• Adapt the process to fit different cultural and organizational contexts
• Maintain core principles while allowing for local variation

Example: The Vietnam nutrition program scaled to 2.2 million people across 250 communities by creating a Living University where teams could experience the PD process firsthand.

7. Unintended Consequences: Catalysts for Broader Change

Cultural and social change, although not discrete objectives of PD interventions, are almost always a second-order outcome.

PD initiatives often lead to unexpected positive outcomes beyond their initial goals. By addressing concrete problems and changing behaviors, PD can catalyze broader social and cultural shifts.

Examples of unintended positive consequences:

• In Pakistan, efforts to reduce infant mortality led to improved communication between husbands and wives
• In U.S. hospitals, MRSA prevention initiatives resulted in flattened hierarchies and improved teamwork
• In Egypt, FGM curtailment empowered women to become advocates for broader social issues

Factors contributing to unintended positive outcomes:

• Increased community dialogue and collaboration
• Empowerment of previously marginalized groups
• Challenging of traditional power structures and norms
• Development of new skills and confidence among community members

These unexpected changes often contribute to the sustainability and broader impact of PD initiatives.

8. Nature's Way: Incremental Adaptation Trumps Radical Reinvention

Nature is selective in the way it innovates. It evolves piecemeal. A mutation that alters the size of the brain cavity does not require a change to the arms, legs, and torso.

The PD approach mirrors nature's incremental adaptation process, focusing on small, targeted changes rather than wholesale reinvention. This approach is often more effective and sustainable than large-scale, top-down change efforts.

Principles of natural adaptation in PD:

• Focus on specific, concrete problems rather than broad systemic issues
• Preserve existing cultural DNA while making necessary adjustments
• Encourage diverse variations and select the most successful
• Allow for self-organization and emergence of new solutions

Benefits of incremental adaptation:

• Reduces resistance to change
• Minimizes unintended negative consequences
• Allows for continuous learning and adjustment
• Builds on existing strengths and resources

Example: In Pakistan, the PD approach to reducing infant mortality preserved most cultural practices while introducing small but significant changes in newborn care, leading to gradual shifts in gender roles and family dynamics.

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Last updated: October 19, 2024