1. Innovation U N L E A S H E D with Positive Deviance Keith McCandless, Social Invention Group January 2007

2. 2 Key Themes Drawing out innovations that has gone unnoticed in your organization or community; Improvising with the materials and imagination at hand - bricolage (not trying for perfection); Supporting communities-of-practice that sustain innovation; and, Recognizing that innovation is a social process that spreads peer-to-peer

3. What Is Innovation? Innovation is the act that endows resources with a new capacity to create value (Drucker) Getting a valuable new idea or technology or advance-in-practice adopted (Rogers) Innovations are non-linear shifts that change the rules and transform common practices (McCandless)

4. 4 Innovation, Not Improvement Changing the Rules in the High Jump Improvement Innovation …Meters…

5. 5 Continuum of Theories Let It Happen >> Make It Happen INNOVATION IS: Unpredictable, emergent, socially constructed adaptation INNOVATION IS: Socially-enabled progress through “lightly held” plans INNOVATION IS: Managerial, planned process of design and dissemination MEASUREMENT Support sense-making & direction shaping as goals emerge & evolve MEASUREMENT Capture movement toward goals as “vetting” work unfolds MEASUREMENT Predict and control movement toward a pre- determined aim Facilitate learning & alertness that informs ongoing innovation WHAT IS POSSIBLE NOW? Provide ongoing feedback regarding strengths & weaknesses IS IT PROGRESSING? Render evidence and definitive judgments of success or failure DOES IT WORK?

6. 6 Premise of Positive Deviance In every community there are certain individuals whose uncommon practices/ behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources.

7. 7 The Vietnam Story The future is already here… but it is not at all well distributed.

8. 8 Positive Deviance Process Define –the problem and what desired outcome would look like Discover –if there are individuals/units who already exhibit the desired behavior/outcome Determine –the uncommon, but demonstrably successful behaviors/strategies enabling the “positive deviants” to find an innovative solution to the problem Design –an intervention/program enabling others in the “community” to practice the new behaviors/strategies. (Note: focus on practice rather than knowledge!) Adapted from Jerry Sternin

9. 9 First Steps -- DEFINE Define the problem and desired outcome or innovation Determine data required to identify Positive Deviants (those already exhibiting desired status/behavior) if they exist Identify those to be involved in the inquiry… beyond the usual suspects Frame the inquiry in a way that the benefit is clear to those involved

10. 10 CONTRASTING APPROACHES I TRADITIONAL Externally Fueled (by “experts” or internal authority) Top-down, Outside-in Deficit Based “What’s wrong here?” Begins with analysis of underlying causes of PROBLEM Solution Space limited by perceived problem parameters Triggers Immune System “defense response ” POSITIVE DEVIANCE Internally Fueled (by “people like us”, same culture and resources) Down-up, Inside-out Asset Based “What’s right here?” Begins with analysis of demonstrably successful SOLUTIONS Solution Space enlarged through discovery of actual parameters Bypasses Immune System (solution shares same “DNA” as host) Adapted from Jerry Sternin

11. 11 Acting Your Way Into New Thinking … not thinking or designing your way into new acting Perceived Advantage Opportunity for practice Social Proof KNOWLEDGEKNOWLEDGE BEHAVIORCHANGEBEHAVIORCHANGE

12. 12 S P R E A D OF INNOVATIONS The tyranny of averages always conceals sparkling exceptions to the rule. JS Diffusion Attributes Relative advantage Compatibility Complexity Trial-ability Observability PD Behaviors identified as “advantageous” by peers created within cultural context requires no special resources opportunity to practice through PD participants and personal experience

13. 13 Awareness-to-Integration Development Efforts Focusing on Adoption & Integration in Communities DELIVERY APPROACH OBJECTIVE OR AIM Transformative thinking & innovating Skill & competency building Information transfer Expert Centered Individual or Patient Centered Community & Group Relationship Centered Awareness Clinician hears about innovation for the first time Agreement Clinician evaluates relative value of the innovation Adoption Clinician tries out the innovation Integration Innovation is a routine part of behavior 2. However, adoption occurs in communities- of-practice with interpersonal “peer” influence at play 1. Traditional change efforts focus on generating awareness & agreement with evidence or data © 2004, Keith McCandless

14. 14 Non-Linear, Bottom-up Fringe-In Learning Process Focusing on Self-Discovery and Social Proof Within the Community DELIVERY APPROACH OBJECTIVE OR AIM Transformative thinking & innovating Skill & competency building Information transfer Expert Centered Individual or Patient Centered Community & Group Relationship Centered Awareness People whose behavior needs to change discover PDs Agreement People see peers solving the problem with the same resources Adoption People practice & co-evolve behavior in their local context Integration Innovation is a routine-but-unseen part of behavior 2. However, adoption occurs in communities-of- practice with interpersonal “peer” influence at play 1. Traditional change efforts focus on generating awareness & agreement with evidence or data © 2004, Keith McCandless 3. Further, PD unleashes creativity adaptability and collective mindfulness among working groups, moving from explicit- to implicit- to tacit- know-how spontaneously

15. 15 Sources of Knowledge, Learning & Talent ExplicitTacitLatent ASK What your students or patients tell you they need when you ask (e.g., focus groups) OBSERVE What behaviors you see in their local context (e.g., ethnographic studies) CREATE & EXPERIENCE What you jointly develop with your students/patients (e.g., rapid prototyping efforts) ++ +++++ Telling Adapted from Alan Duncan, MD (Mayo Clinic)