Just over a year ago, CAP hosted seminars in a new method of social change called “positive deviance.” The basic idea of positive deviance is that, within any given community possessing any given problem, some members through their own actions will fare better than others given equal resources. Observing what makes these “deviants” positive can unlock the secret to solving the challenges facing the community.
Recently the New Yorker ran a widely-praised article by Atul Gawande about the problem of health care costs in the U.S., focusing on the unlikely town of McAllen, Texas. As a follow up, the New Yorker posted a transcript of his commencement address to Northwestern University the Pritzker School of Medicine at the University of Chicago, in which Gawande explains the concept of positive deviance and suggests applying a positive deviance approach to the national health care crisis:
Jerry Sternin was for awhile the director of a Save the Children program to reduce malnutrition in poor Vietnamese villages. The usual methods involved bringing in outside experts to analyze the situation followed by food and agriculture techniques from elsewhere.
The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.
So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.
Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.
If you attended our positive deviance seminars, led by a friend of the Sternins, you know this story by heart. Positive deviance has gone on to a distinguished history of discovering innovative, community-based solutions, particularly in healthcare. It’s shown success in reducing hospital infection rates by, gasp, encouraging medical staff to wash their hands thoroughly.
Gawande looks through this lens of positive deviance and sees solutions to today’s runaway health care costs that go unaccompanied with improved health:
Like the malnourished villagers, we are in trouble. But the public doesn’t know what do about it. The government doesn’t know. The insurance companies don’t know. …
Well, let us think about this problem the way Jerry Sternin thought about that starving village in Vietnam. Let us look for the positive deviants. (more…)
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