Positive Deviance as an approach to delivering sustainable change NHS Employers 17 th June 2014

About me Antonio Belgrave BSc (Hon), MSc, NTL Managing Director Positive Deviant LTD

In Collaboration with Sapphire Projects Ltd Keith Morss Director, Sapphire Projects Ltd

A useful approach to deliver change

Positive Deviants Ordinary people/institutions who have found better (or even extraordinary) solutions to existing problems – without access to any extra resources. Definition

Small things people do that most others do not do that make a BIG difference The Magic Formula

do *Round 1: Find a partner whom you do not know 2 minutes total sharing time (1 minutes each) *Then find another partner… (2 minutes) *Then find another…(2 minutes) What is your secret behavioral magic formula? A small little thing you do [that most other people do not do] that makes a big difference? THREE ROUNDS Group Exercise

PD vs Holy Grail of Change management 1.We Can Solve Problems by Unpacking Problems (i.e. what is not working) 2.Deductive Reasoning about What Works for Whom (i.e. the logic of regression, the normal curve) 3.Push Standardized Solutions (i.e. no variability; high reliability) 4.Scientific Proof (Evidence-Based Practice) 5.Buy-In Compliance (I know best). 6.Thinking One’s Way Into a New Way of Acting (Cognitive information-processing and stages of behavior change): KAP Problem Solving by finding hidden solutions (i.e. what is working) Abductive Reasoning (“It is elementary”) (Solutions lie with unusual suspects in surprising places) Solutions are distributed widely: They are everywhere Social Proof (Practice-based Evidence) Invitation and Ownership (We care) Acting One’s Way Into a New Way of Thinking: PAK Holy Grail for Change Management PD approach to change management

Solving malnutrition by finding the magic formula Vietnam 1990

A reframed PD question : Are there children from very very poor households that are well-nourished? PD starts with an Improbable Question about “What is Working?” against all odds? Reframing

Positive Deviant 5 step process DefineDetermineDiscoverDesignMonitor

Principles of the PD Approach The community owns the process All individuals or groups who are part of the problem are also part of the solution The community discovers existing uncommon, successful behaviours Community designs ways to practice and amplify behaviours and strategies that unleash innovation Community recognises that some like me can do Focuses on how in stead of what and why Community creates its own bench marks and monitors Honour and respect of the community we are serving Expands existing networks and creates new ones.

So What?

Health Care example of the Positive Deviance approach in action Reducing MRSA infection rates

Positive deviance applied to MRSA in US healthcare RJWF Final Report PD MRSA 2008

What is the ONE complex challenge that you are trying to solve for which you believe the positive deviance approach can be useful? What is the reframed PD question?

Where are my positive deviants hiding?

Questions??

Miscellaneous

Finding Positive Deviants Using discovery action dialogues Ask seven progressive questions: 1. How do you know when problem X is present? 2. How do you contribute effectively to solving problem X? 3. What prevents you from taking these actions all the time? 4. Do you know anybody who is able to frequently solve problem X and overcome barriers? What behaviors or practices made their success possible? 5. Do you have any other ideas to solve the problem? 6. What needs to be done to make it happen? Any volunteers? 7. Who else needs to be involved?