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