The Power of Positive Deviance
Richard Pascale, Jerry Sternin, Monique Sternin
Some problems are “technical” and can be solved by application of expertise. Some problems are “adaptive” and can only be solved when the “participants” in the problem change their behaviors. This book describes a method called “positive deviance” to uncover and diffuse solutions to adaptive problems. The book focuses on social problems, because it is people that must adapt.
The method is explained through a series of stories based on the author’s own consulting experiences and range from decreasing infant malnutrition in rural Vietnam, to improving the sales of Fosamax™ in Mexico or wealth management in the United States. In each case, the community (whether farmers or salesmen) had a seemingly intractable problem. Asked about the problem, it was easy to explain how some lack of resources (money, materials, or permission) was the root cause of the problem. The method described in the book has its basis in the question “Is there somebody in the community that does not have the problem?” For example, are there infants in the community that are not stunted? Are there salesmen in the country who regularly exceed their targets? Are there hospital wards with no MRSA infections? This is a very positive perspective; it focuses on what is working rather than what is missing.
Although it is simplest to describe this as a method, I will continue to do so; it is closer to a philosophy of emergent social change. The process may be facilitated or catalyzed by an “expert”, but it is lead by community members. The community sets the actual agenda for change and carries out the agenda. This is a central piece of the philosophy. …the community must make the discovery itself. It alone determines how change can be disseminated through the practice of new behavior – not through explanation or edict.* Education can be a solution to a technical problem, but it is not a solution to most socially-embedded problems. In many cases, you don’t want people to accept a valid solution, but to discover, test, validate and accept a solution. The book uses the term ‘enactment’ for this process as a short hand for the idea of acting oneself into a new way of thinking and believing. The concept of enactment’s role in this came from a Vietnamese farmer who said “a thousand hearings aren’t worth one seeing, and a thousand seeing aren’t worth one doing.”
The method itself is quite simple to describe, but it must be much more adaptable than what I describe here.
- Identify the challenge
- Invite community members to engage the challenge. Insure they understand the possibility for opting in or out.
- Allow the group to frame or reframe the problem (expect a reframing based on their superior knowledge of the issues).
- Seek out people or situations where the challenge has been resolved, and determine what behaviors and practices prevent or resolve the challenge.
- Design ways to practice the behavior/practice, and then to share that practice more widely.
- Design measures that illustrate that success is taking place.
- Review progress with the whole community.
The book uses a series of cases studies to illustrate principles learned over the years across a wide range of situations. Some of these principles are condensed into sayings, but not all.
- Don’t do anything about me without me.
- Progress is local. You can’t transplant the solution to an adjacent community, but must start over. It is the process of discovery & enactment that creates change – not the technical facts.
- Learning and change take place in a social context. Every community has unique features. “Social proof” enables people to challenge their own mental models knowing that other community members have challenged theirs too.
- Positive deviants are not best practices. They are examples that prove that a solution is possible. Positive deviants are the seeds of a overall solution.
In the 1970s, Japanese companies (Toyota, Honda, Sony, etc.) were quite happy to host western business consultants interested in their quality systems. They were not concerned about loss of competitive advantage because “The visitors on focus on the what. They either overlook or are culturally incapable of grasping the how.” Most modern organizations embrace what the authors call the standard model. Simplistically, in the standard model; higher ranking people have greater expertise and authority to impose change, when senior managers initiate a change – they assume it will be executed as expressed, and they assume the change will create the desired results. One of the reasons that so many organizational change initiatives fail is that social systems are not as mechanical as the standard model supposes. The book describes a campaign in a hospital to control MRSA infections. The hospital had people whose job was to develop plans to control infection, but they were unsuccessful. They had tried all sorts of approaches before trying positive deviance. Through the process, everybody became involved and a wide range of actions taken to prevent spread of bacteria. Some might seem inefficient, but they engaged everyone and the system showed a huge improvement. There was never an lack of information on how to control infection, but there was a lack of enactment on that information. One of the major consequences of the effort was a reconfiguration of “authority”. Patients, nurses, cleaners, volunteers all “gained” the authority to speak to doctors and administrators about hand sanitation. When it came to MRSA control, everybody had similar rank and authority. Each ward developed their own local practices, and people from different wards learned and practiced improvements. Staff began reporting successes and failure to managers – rather than managers reporting failures to staff. Because the staff was in charge and they knew that success was behavioral, they no longer had conversations about external barriers to success. Authority and expertise was NOT located at the top. Changes were NOT mandated with execution by compliance. Ideas were converted to experiments by staff, and staff chose which ideas to implement based on what the experiments taught. For this particular problem, the standard model no longer applied. This cultural change did have a knock-on effect, but parts of the system where greater hierarchal control were effective, retained the standard model.
While the normal practice is to seek existing solutions to the challenge, the MRSA cases also revealed the potential for latent positive deviants. These are solutions for problems that are “almost” known to the community. There was intuition about potential solutions, but no avenue to share or test those intuitions. The cultural change allowed these ideas to be expressed, tested, and put into practice. These ideas would have remained latent in the standard model because these ideas did not come from “experts”.
The book highlighted three business examples of positive deviance and the interaction with the standard model. Genentech brought out a new drug and had high hopes for their sales. In fact, sales were disappointing and this lead to considerable analysis of what was going wrong. Along the way, two sales people in Texas were found to have no problems selling the drug, but their success was not copied by other sales people. In effect, they had discovered that the doctors who needed to administer this drug rarely did this sort of procedure and did not know how to deal with the insurance aspects of it. The sales people became trainers on these aspects of procedure. They taught office staff how to complete insurance paperwork. They taught nurses how to prepare the drug and administer it to patients. This was well beyond the normal role of selling and inconsistent with the marketing plan devised by management. But management hired a third party and investigated the novel practices and endorsed them. After a briefing with management, management broadcast this approach to the whole sales force as a best practice. There was no effect on overall product sales. This organization attempted to educate their staff, but it did not take.
Merck had a similar problem with sales of Fosamax in Mexico. While sales were good elsewhere, in Mexico they were not. The national sales manager decided to use positive deviance to seek ideas for improvement. He called a meeting of his regional sales directors and some sales people to discuss the challenge. At first, the regional directors did not believe that they were really being asked for their ideas or that they would be accepted. Over time, they realized that it really was being left to them to discover and test improvements. There were sales people who had very good sales surrounded by people who did not. Merck had a set of rules for operating a dispersed sales effort, and this was part of a very systematic top-down system of directing sales. The sales people who were having the best results violated many of the main rules in small ways. Sales people were to make 7 calls on doctors each day; the deviants did 3 and spent more time on each call. Merck placed a lot of faith in data entered into handheld computers, but tops sales people rarely entered their data. “We don’t use them. It’s just a reporting device to headquarters”. “Time spent entering data into handhelds takes times from working with doctors.” As sales managers and representatives learned more, they began experimenting and sales began to rise. Soon sales were very good and representatives engaged with customers in a new more productive way (and without handhelds). This effort was done with the full knowledge and support of the Latin American sales manager, but the effort was never replicated in any other country. Even the manager who lead the effort in Mexico did not replicate it when he was transferred to Chile. Within the company, it took a lot of energy and political effort to support the effort. Travel budgets, time away from sales, and supervisory time all had to be approved. As one participant noted, for one moment – the stars aligned and they got to do this. These two stories point out one issue with the approach – it does not scale well. The process works because it directly engages people’s behavior directly. It is not a learning process as much as a discovery and enactment process. You can’t have a “pilot” group do this and transmit the results. Every group must do it for themselves – remembering that opting out must be a viable option.
One final organizational story amplifies this aspect. Goldman Sachs wealth management group earned the bulk of its money from brokerage fees. Headquarters recognized that a shift was coming; brokerage fees would decline and needed to be replaced by a fee-for-service model. Account representatives rebelled against this. It was quite common for customers to follow account reps when they changed jobs, so Goldman could not force through this change; they might loses both their valuable reps and clients. Instead, they introduced a positive deviance approach in a few regions and allowed representatives to discover for themselves that there was issue. They allowed the representatives to develop and test solutions. When representatives in other regions learned of this, they asked to start their own similar efforts. Within a year, almost the entire sales force had re-focused on fee-for-service. The account representatives were very independent, so the possibility of opting in was critical. The book mentions that almost like Newton’s law, when the top tries to push a change down into the organization, it meets an equal and opposite force. When the system changes from inside, there is no resistance as normally understood.
One of the hardest barriers to overcome is that of leadership. The standard model expects that leaders are the experts and direct the change. This model expects the leaders to catalyze change, but not to create or direct it. This can be very hard. The book relates a number of cases where facilitators knew the answer to a problem, but needed to say nothing. Saying something might deprive participants of the change to discover a solution and make it theirs. The other main barrier to progress may lie in the participants themselves. In many organizations, their role has been made passive. If the senior people are the experts, then the rank-and-file are not. Senior people are paid more to use their knowledge and make decisions – the rank-and-file are not. Senior people have authority – the rank-and-file does not. The combination of these factors embeds submission in a culture. This process may undermine the aura of management omniscience and build a much wider more active acceptance of common sense. Recall the comments about western companies visiting Japanese manufacturers – they were culturally incapable of seeing what was in plain sight. Positive deviancy requires a much more diffuse application of power, and that may upset people at every level of the organization.
Change of this type much more evolutionary than revolutionary, but the results can seem revolutionary. A decrease from 60% malnutrition to less than 10% malnutrition is revolutionary. A 50% reduction in MRSA over 15 months is revolutionary. But the actual practices used to achieve these results were not revolutionary. Hand washing, feeding children some meat and vegetables (already present in the environment), and spending more time with customers to really understand their needs is not revolutionary stuff. The revolution is in the way that participants relate to these behaviors and practices. The revolution is in the empowerment that the philosophy requires. Once in motion, the participants may continue to drive change even after significant progress is made. A 50% reduction in MRSA infections is great, but that does not mean that the hospital quit – groups continue to seek ways to reduce infections to zero.
My reactions and interpretations
- I am reminded that it is well established that adults learn by doing – not by hearing/reading. If cultural change has a learning element, then it makes sense that adults may be more open to change by doing than hearing. However, when I hear about organizational changes – there is a real emphasis on communication plans. These plans are about how the message/demand for change with be sent. If there is any intention to engage those effected, it is to just allow them to vent before getting on with the change. This book observes that most such change initiatives fail - and I no longer wonder why. I love the phrase “Don’t do anything about me without me.” This captures my own reaction pretty well. If nobody asks me (or anybody else) if I want to change, why would they expect my compliance? This book makes clear that the source of culture change should be the grass roots; this approach challenges the standard model of who gets to choose to initiate change, much less what direction to take.
- This approach is also a real challenge to people with expertise. How do you behave when you really do know the answer already? It seems so efficient to tell people what you know, but maybe that efficiency is an illusion because it is not that effective. Efficient and effective may not require the same behaviors.
- This is another book that drives home the thought that the most important part of innovation is cultural. Solving the problems outlined in the book required social innovation to allow any technical innovation to succeed. This must be true in commercial organizations as well. For sustainable innovation to succeed there must be social innovation paving the way. And the people inside the culture must be given a chance to create the change. This may have unexpected effects. This book shows that the social innovation is not the process itself (e.g., an innovation process, Six sigma, etc.) – but the ways that people relate to each other and to their own behaviors and beliefs.
- There are a number of books that talk about social/cultural communication that originated with the systems thinking efforts of Peter Senge. For people contemplating a social innovation, these books might be worth consulting. This sort of communication is not at all like standard corporate communication. Three titles to consider are Theory U, Solving Tough Problems, and Dialogue.
Learn from the people
Plan with the people
Begin with what they have
Build on what they know
Of the best leaders
When the task is accomplished
The people all remark
We have done it ourselves
Lao-Tzu
*text in italics is directly quoted from the book
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