By Janice Molloy
In the midst of the rancorous, partisan debate on healthcare reform, at least one person has identified a potential leverage point for change. Speaking to graduates of the University of Chicago Pritzker School of Medicine in June, Dr. Atul Gawande, surgeon, New Yorker staff writer, and 2008 Pegasus Conference keynote speaker, encouraged these new young doctors to help save our medical system by paying attention to the "positive deviants" in the medical field.
Despite the seemingly paradoxical moniker, "Positive Deviance" isn't the name of a rock band or an HIV/AIDS prevention initiative. It's a public health methodology that has saved the lives of thousands of children around the world--and just might offer a grassroots approach to minimizing healthcare costs while maximizing the quality of treatment in the United States.
In the late 1980s, Tufts University nutrition professor Marian Zeitlin found that certain children in poor communities were better nourished than others--she referred to them as "Positive Deviants." Turning traditional problem-solving approaches on their heads, she and her colleagues sought to learn what was going right for those kids so they could help spread those conditions throughout the community.
Save the Children staffers Jerry and Monique Sternin began to apply Zeitlin's ideas to reduce malnutrition in impoverished Vietnamese villages. Instead of bringing in teams of experts to analyze the situation and make recommendations based on success in other settings, the Sternins asked mothers in the village to help them identify the healthiest children. The villagers then visited those families to learn what they did differently and emulated their practices, such as feeding their children sweet potato leaves. The results were astonishing--in two years, malnutrition dropped 65 to 80% in every village the Sternins had visited.
The Sternins and their colleagues have gone on to apply the Positive Deviance principles to other seemingly intractable social problems, including student retention, genital mutilation, and the spread of infections in hospitals. Likewise, numerous businesses have experimented with PD to make the most of the knowledge that already exists within the organization. The four basic steps in any setting are:
- Define the problem you want to solve.
- Determine if there are any individuals who exhibit exemplary results.
- Discover what uncommon practices or strategies these positive deviants use.
- Design an intervention that would enable others to grasp and practice the behavior.
In his commencement speech, Gawande talked about identifying the positive deviants when it comes to medical costs and quality. "We need an entire nationwide project to understand how they do what they do--how they make it possible to withstand incentives to either overtreat or undertreat--and spread those lessons. . . . One of [the] lessons is that, although the solutions to our health-cost problems are hard, there are solutions. They lie in producing creative ways to insure we serve our patients more than our revenues." So while the squeaky wheels seek to push through their own agendas during the healthcare debate, we might do well to focus our attention on the people who are steadily making a difference on the ground.
Janice Molloy is content director of Pegasus Communications and managing editor of The Systems Thinker.