Discussion: Applying the Concept of Positive Deviance

Focus on the successful exceptions (i.e., positive deviants), not the failing norm.

—Pascale, Sternin, & Sternin, 2010

Positive deviants—those who are able to innovate and create affirmative results—do so within the same constraints that others face. These outliers reveal how the desired outcomes can be achieved by expanding beyond the boundaries of the status quo, while maintaining a focus on what is professionally, legally, and morally appropriate.

Consider the following example:

In 1990, Save the Children (SC), a nongovernmental organization in the United States, was asked by the government of Vietnam to create a program to enable poor villages to solve the overwhelming problem of childhood malnutrition. Given just six months to create a sustainable solution, those involved realized that they needed to look at the positive results that some had been able to achieve relative to the lack of success others had encountered under similar circumstances. They posed the question: “If some individuals in a community were better able to solve problems than others with access to exactly the same resources, could we use that provocative discrepancy?” Taking this tack, they were able to identify approaches that differed from the norm and apply this knowledge to produce positive results that led to a dramatic improvement in child health (Dura, Singhal, and Sternin, 2009).

In this Discussion, you examine a health care problem or issue and consider how you could apply the concept of positive deviance to produce systems-level change that leads to improved quality.

To prepare:

Review the information in this week’s Learning Resources, including the first chapter in Pascale, Sternin, and Sternin book and the Bradley, Curry, Ramanadhan, Rowe, Nembhard, and Krumholz article.

Reflect on health care quality problems or issues that warrant systems-level change. Consider the significance of each problem/issue. Identify one, in particular, that you would like to focus on for this Discussion. Note: You may use the quality improvement issue that you selected for your Course Project, if appropriate.

With this problem or issue in mind:

How would you apply the principles of positive deviance to address this problem/issue? What specific steps would you take to move from identification of the problem/issue through evaluation of outliers to implementation of a larger scale change to improve quality?

What examples of positive deviance, if any, are you aware of related to this problem/issue? Conduct research as necessary to see if you can locate one or more instances of positive deviance.

Post a brief description of the health care quality problem or issue you selected and explain how it could be addressed using the principles of positive deviance. 

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional resources.

Required Readings

Bradley, E. H., Curry, L. A., Ramanadhan, S., Rowe, L., Nembhard, I. M., & Krumholz, H. M. (2009). Research in action: Using positive deviance to improve quality of health care. Implementation Science, 4(25), 1–11.

Retrieved from the Walden Library databases.

The authors of this article review literature on positive deviance as well as break down a step-by-step approach in applying positive deviance in a research model to improve quality.

Dingfelder, H. E., & Mandell, D. S. (2011). Bridging the research-to-practice gap in autism intervention: An application of diffusion of innovation theory. Journal of Autism & Developmental Disorders, 41(5), 597–609. 

Retrieved from the Walden Library databases.

The authors discuss the need to apply Roger’s diffusion of innovation theory in an effort to improve autism intervention for patients.

Seidman, W., & McCauley, M. (2009). A scientific model for grassroots O.D. Organization Development Journal, 27(2), 27–37.

Retrieved from the Walden Library databases.

Seidman and McCauley explore the grassroots nature of an organization’s culture and the effect of positive deviance, fair process, and neuroscience on creating change in the culture.

Required Media

Laureate Education (Producer). (2013h). Risks and benefits of positive deviance. Retrieved from https://class.waldenu.edu

Note:  The approximate length of this media piece is 4 minutes.

Dr. Kenneth Rempher discusses how to encourage positive deviance while maintaining ethical and moral standards.

Accessible player  

Optional Resources

Pascale, R. T., Sternin, J., & Sternin, M. (2010). The power of positive deviance: How unlikely innovators solve the world’s toughest problems. Boston, MA: Harvard Business Press.

Chapter 1, “Introduction: Against All Odds” (pp. 1–18)