Sustainable results from hidden solutions

Not business as usual

I read Jane Bozarth’s excellent article on positive deviance (PD) in Learning Solutions Magazine with interest.  She succinctly highlights how PD uncovers hidden solutions and delivers sustainable results.  She points up the differences between PD and business as usual.  She sets out the usual scenario for solving problems:

“Organization has a problem.  Organization brings in “experts” to study the problem, devise a solution, run a pilot (which may mean a training program) and then leave.  Organisation members quickly revert back to old behaviors”.

Jane highlights the possibilities opened up by looking for what works.  A specific tool is the all-important “flip” or “somersault” question:

  • Not “why are staph infections so high across the hospital?” but “why are staph infections lower on the third floor?”
  • Not “why are sales down in regions 6 and 9, but “why are sales up in region 4?”

This helpful introduction highlights how simple the PD concept is, and how there are almost always hidden solutions.   On the face of it, it’s hard to understand why amplifying positive deviance, as practised by the Sternins, isn’t as common as many other improvement initiatives.  It’s about doing more with less, empowering and engaging people.  It spreads behaviours and practices that are already proven to be working, so the only resource needed is the time to find them.  It’s evidence based, teaches a lot about leadership and is fun to do.  What’s not to like?

A different way of leading and managing

A clue lies in Jane Bozarth’s introduction: the role of the expert, all-knowing leader or professional in fixing things.  Power and hierarchy.  The constant cry for more resources.  The immediate demand for cost-cutting, no matter what the longer term consequences.

However, as a recent Care Quality Commission report into an under-performing hospital stated, the problems are often as much about management as they are about money.  So much of an organisation’s success still depends on its people.  However brilliant technology, social media and big data are, they can only support what the organisation does, not HOW it does it.  And more money isn’t always the answer. The under-performing hospital in question has had many millions pumped into it in recent years, a huge redevelopment programme and the opportunity to be the health hub for a big urban area as other hospitals closed.

Positive deviance not only finds “free” solutions and releases other ways of doing more for less, it engages and energises people.  To use PD to best effect, for the success of the organisation and engagement of its people, a manager has to be an expert “non-expert” or team coach.  This is a very different way of working from the usual top-down, expert-driven quality and improvement initiative.  Yet it works very well alongside well-known methods such as Lean, as shown in the Veterans’ Administration Hospitals project that reduced MRSA infections by 63%.  PD delivers low-maintenance, sustainable results because people continue to own and evolve the solutions they find.

Building the right foundations

We’ve found that you have to do preparatory work with leaders and front-line staff, to get going with positive deviance. Leaders learn to listen, and to hold back on fixing things.  They need to challenge constructively and help people to understand all sides to a problem.  Through facilitation, groups learn to value each others’ differences and to believe that there can be solutions and opportunities without the need for financial investment.  They learn that data can be their friend, rather than a stick to hit them with.  Trust is established between groups and useful networks form.

So preparation is vital as part of the set-up of a positive deviance project.  Working with leaders is essential to create the “solution space”and permission to do things differently. Learning happens as part of the project rather than as a bolt-on training programme, and changes mind-sets.   Projects can be facilitated by peers, for peers, or by managers taking an adaptive leadership approach.  Key skills  for all include framing the “flip questions,” looking for and presenting evidence to show solutions work, and being open to there being more than one answer to a problem.  A very specific skill set is used in a kind of treasure hunt for solutions – observation and enquiry.  As well as being essential to uncover the hidden solutions, they are valuable skills in their own right.  They can be applied person-to-person or through social media.

Keeping the faith for sustainable results

However, we’ve noticed leaders lose confidence because the engagement process needs time.  If they don’t get the space to work on the project, front-line staff don’t have the confidence to collect data, to own the issues and their solutions.  If the projects are seen through (depending on the issue, they can be completed in weeks rather than months), solutions are sustainable.  People don’t turn their backs on what they create.

Two teams, with serious operational conflicts, discovered small instances where people had got round the barriers and collaborated.  In a morning, they discovered not only some better ways of working but also how much they could save if they changed behaviour.  They realised that just between the two teams (about 40 people) they could save thousands of pounds a week.   Three years on, they still use what they learned , despite restructuring, job cuts and increased workload, and celebrate joint success (pdf download pdf file.

This special morning, and the implementation of its discoveries, would not have happened without the relationship we had built with key leaders beforehand, and the special style of facilitation that PD requires.  The key thing was the willingness of the two team leaders to allow bottom-up discussion, discovery and design of solutions.

So positive deviance is both a way to achieve sustainable results through people, and a valuable way to learn leadership skills for the future – as long as it is allowed to happen.  Our recent “Changing Mindsets” workshop at the British Psychological Society showed how it can be used for business improvement, leadership development, talent management and culture change.

Our learning in implementing positive deviance in both communities and organisations has been turned into an enhanced process and learning programme.  It includes a useful range of simple tools and techniques for effective facilitation, group coaching and building trust.  In particular, we have evolved an approach to set the right foundations and environment for the work to be successful, to enable these sustainable results to emerge.

This includes support for leaders and professionals to let go (within boundaries) and allow teams and communities to learn.  Sustainable improvements and savings will take time to deliver, but even the short-term results can be astonishing, as seen in the case study above.   This happens especially in community projects,  where the longer-term payback to the public purse is hundreds of thousands of pounds, simply by helping people to help themselves.

So the other key to PD success is to support senior leaders who are not directly involved in the projects to keep the faith, to reinforce the need for measurement and evidence (which people may actively avoid in some cultures),  and wait for good things to happen, and keep happening..




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