Richard Pascale is coauthor of The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest Problems.
Richard Pascale is a writer, a global business consultant, and an Associate Fellow of Said Business School, Oxford University.
Jerry Sternin (1938-2008) and Monique Sternin pioneered and have successfully applied the positive deviance approach in many organizations and countries worldwide. Monique Sternin is the Director of the Positive Deviance Institute at Tufts University.
What is positive deviance?
RP: It's an oxymoronic term, in a way, but it's a very simple observation that in many situations—both in companies and in societies—there are problems that seem absolutely intractable, where you tried everything and you can't get anything to work, and you just end up accepting things by saying, "that's just the way it is." Yet in almost every one of those situations there usually are a few people with the same resources as everyone else, who, against all odds, are succeeding when everyone else is not.
So the simple idea is to look at those people who are deviant in a positive direction, and who are prevailing when the conventional wisdom says you can't.
How is this idea being applied in the world?
RP: The first application, which has been written about quite a bit, was our initial experiment in Vietnam in 1990 where the two other coauthors (Jerry and Monique Sternin) were invited by the Ministry of Health to deal with malnourishment among rural children. Something on the order of 80-85 percent of all rural children were malnourished. This isn't just kids being hungry. Second, third stage malnutrition is a serious matter because you can be stunted for life and your brain is impaired. So if it goes on very long it really cripples an economy that's heavily reliant on human labor.
The officials said, "Look, we've had lots of people coming in here with money and food. And we know if you go into a village and throw resources at it you can get kids to be up to normal weight rather quickly. But as soon as you no longer can sustain that, they go back to where they were. So we're looking for something that will stick and is sustainable. And by the way, owing to the fact that having Americans around is not a lot of people's favorite idea, you only have six months to show that you can do something."
This is in 1990, so it's only 15 years after the end of the Vietnam War.
RP: Necessity being the mother of invention and all that caused Jerry and Monique and the Save the Children folks to say look, we ran across an idea when we were at Harvard University. It was just a research idea at the time, which was this concept of people who succeed against all odds. So let's take these three pilot hamlets we've been told to work in, and invite the mothers to weigh their children to determine if they're normal for their age and sex. And that is a pretty compelling offer, as most parents want to know that. So using those hand-held fulcrums that you see in third world for weighing rice and chickens, they weighed the kids. They scratched their names on this very crude black painted piece of wood that served as a blackboard using a soft rock as chalk. You had all these kids' names and their sex and their weight. The whole community assembled to see what this all added up to.
The first question was, "So how would you classify these people economically?" And the answer was, "Poor, very poor, and very, very poor." And then the question was, "So are there any kids here on this list who are normal for their age and sex who are one of these poor, very poor, or very, very poor families?" As they looked down this list, there was this sort of surprise that there were actually a few kids from very, very poor families who were fine.
A key part of this—you'll hear this throughout this conversation—is not that the experts figure out the great insight, but that the community gets interested and curious. Of course, when folks saw that others just like them somehow had healthy kids, it mobilized teams of community members to go out and visit these families and find out what they were doing. In the first three hamlets the what and the how of that inquiry was that they were going out into the rice patties in the morning and getting freely available shrimps and crabs. Now this may sound exotic, but it would be regarded as inappropriate to feed a kid shrimps and crabs in Vietnam—the equivalent of parents in the U.S. giving their kids earth worms and snails. So if you were doing that you might not be telling your neighbors you were doing it.
RP: It's kind of a screwy thing to do, but you're obviously getting extra protein that way. Plus they were putting weeds in there, whatever the Vietnamese equivalent is of something like dandelions.
They were getting free resources and adding these things to the kids' rice. These parents were also getting their older siblings to feed these young kids more often than twice a day. As a result of that, they had healthy kids.
The first insight was "this stuff that we could all be doing is being done by our neighbors." And it seemed to be somewhat correlated to their kids being healthy. Then the next question, which was a big breakthrough, came as they were discussing how to take this idea forward and really get it into the bloodstream of the communities. One of the older volunteers said, "A thousand hearings aren't worth one seeing, and a thousand seeings aren't worth one doing."
Meaning if you do it, you get it. Some folks in that community took that to heart, then said, "If you guys can give us an egg or tofu for each kid for two weeks, we will create these seeding workshops around the community where parents will bring their children." The bribe of course is the egg and the tofu. But the price of admission was they had to show up with a handful of crabs and add them to the greens to get their kids to eat it. If you've had young children, you know getting them to eat stuff is not necessarily the simplest job. Not to mention the parents having to get in the habit of collecting these things every day.
But the effect of this was that they had these workshops. They weighed a kid at the beginning. Then they'd weigh them after two weeks, plus another two weeks on their own. A very high percentage would "graduate," meaning achieving a normal weight for kids of their age, because kids bounce back quickly when they're getting nourishment.
If you failed, meaning you didn't put on the weight, you had to do it again except next time you just have to come to the workshop without the egg and the tofu.
Six months later, just before the visas ran out, the health officials all show up, and something like 80 to 90 percent of the kids graduate, and are now normal in these villages. Of course the initial reaction of any hierarchical organization is, "this is a best practice, let's do it everywhere."
The strong counsel of both the villagers and Jerry and Monique Sternin was, "Absolutely not. Every community has to be curious about the question. They have to accept the invitation, if you will, to do something about a problem they regard as really essential.
"They've got to be at the front end to figure out what's going on, what's working. Then they've got to find the other positive deviants and learn what they're doing. Then they have to figure out to disperse this information within their community. But if you go out and say to people in another village, 'Gather and eat shrimps, crabs, and greens,' they're going to say something like, 'You know, we're different. Those guys eat weird things.' You've got to get the community to own it."
They need to own it themselves, even if they come up with the same solution.
RP: Right. So what differentiates this from best practices in most applications is that there is always this invitation, an authentic invitation, that has to be accepted by the target group.
Who extends that invitation?
RP: In our case it's usually facilitators who are working on behalf of an agency or agent. They interact with someone, whether it's a CEO in a company, or someone at a government ministry that has perceived some kind of issue that they need to deal with. For instance, we did work in Pakistan with neo-natal mortality, the high death rates of young children in the northeast corner of Pakistan, which is that place we're reading about every day as one of the most obdurate and isolated places on earth. The thing is, Ministry officials don't have much influence there.
The only way to address the problem was to send in a couple of people familiar with the positive deviance method. A couple of these folks go in, talk to some of the tribal elders, and say, "We certainly know a lot more of your young children are dying here than anywhere else. Is that just Allah's will, or is that an issue you'd actually be curious to see if we could do something about?" They replied, "Well, let's get some folks together as we drink tea every evening and talk about it." It was an extraordinary occurrence, because the men, who are the extremely dominant force in all matters, and saw this as completely irrelevant to their concerns, started using stones and the ground to make mockups of their town, and coloring the stones to indicate which houses had kids, and which houses had kids who had died. In this very rudimentary way, they started to create an epidemiological map. Then they started looking at it again, finding the positive deviants, the families that had had births and the kids who were doing fine.
I just want to interrupt for one second because when you talk about putting the stones on the ground as a way to visualize the problem, that seems to be a common theme in all these stories you tell in the book about positive deviance (PD). Someone has to create a visual representation of the issue. There's the one about the hospital-acquired infection methicillin-resistant Staphylococcus aureus (MRSA) and the woman who goes out and gets 100,000 pieces of macaroni and puts them in a huge clear bowl, and they're standing up at the front of this room and basically saying each piece of macaroni is a person who is infected with MRSA each year in a hospital.
There are two elements that always seem to exist here. It's this thing about visualizing the problem, and then everybody starts telling stories. And once they start sharing stories, the community gets energized.
RP: Let me put it this way. However it's done, you make the data real and you make the data accessible to the community. So obviously weighing the malnourished kids in Vietnam, then scratching their names up on the board and seeing their weights, that made the situation more real. It went from being one family's issue to being a community issue.
Then in the hospitals, when that person collected 100,000 pieces of macaroni and put them in a glass bowl, then you could start to envision each one of those as a person. You try to whet the community's appetite to take on something that is regarded fatalistically as just the way it is.
If you talk to nurses or doctors around MRSA, most often they will say to you, "Hey, I'm sorry, this is a hospital. It's the way it is. You just have to put up with this because we do our best, but this is just something that happens."
You say that positive deviance is the remedy of last resort. Why is that?
RP: Well, it need not be. But the problem is what I call the standard model, which is this hierarchical principle of experts and people in authority having the answers to our problems. That notion seems to be baked into the human psyche. It's just generally true throughout the world. You always begin, and not wrongly, with looking for a technical solution. So the Salk vaccine is a great answer, and you don't really need a lot of community mobilization if you've come up with a silver bullet and can prove that it works—that's not a particularly hard sell.
But really hard problems—what we call adaptive problems—are imbedded in a complex social system. They require behavioral change, and they're rife with unintended consequences. These kinds of problems, like the ones that we're facing all around the world: developed societies with governments that can no longer afford the social safety net, the healthcare problems in the United States, and any number of issues like that, are not just technical problems. They're really adaptive problems.
You try the technical solutions. For reasons that are imbedded in the complex social system and behavior, they don't work. When you impose them—and I would assert that Obama's healthcare legislation is a good example of this—in a top-down fashion, you don't get closer to anticipating all the unintended consequences. So they don't work. Once you have exhausted yourself trying to do that, and you've heard about PD, then you say, "Well, it sounds crazy and it's a strange term, but what the hell."
That raises an issue. This idea isn't new. You first wrote about it in 2000 in the Harvard Business Review. And the positive deviant work in Vietnam was done in the early 1990s. So this idea has been out there for a long time. But it seems that it hasn't caught on in a big way.
RP: You hit a very sensitive nerve here. I have to say, though, that because of the work that we've done in hospitals, there's a lot more awareness of MRSA. There's an increasing mention of this incredibly risky proposition anytime you go into a hospital for any reason whatsoever. And 20,000 people is a lot of people to die each year in the United States, not to mention 100,000 infected.
So that's starting to get attention. And the work we've done in the Veterans Administration (VA) hospitals is now spreading into other hospitals. The one little piece of good news is a lot of stuff is happening in the hospital world and people are going around and running workshops with hundreds of people signing up from different hospitals to figure out how to apply this in their system. That's the one place in the U.S. where we've gotten some traction. Also, the Positive Deviance Initiative (PDI) website gets a couple of thousand hits a month from around the world. And because the work that's been done has been in so many different fields—trafficking, condom use, and many health-related issues—it's a known thing within the non-governmental organizations (NGO) around the world.
But for an idea that's really affected the lives of probably three million people, it's a bit under the radar.
At the very back of this book, in the last chapter, I get into what I think is probably the most important aspect of this idea. This process works like nature works. Nature is incremental, it's modular, it relies heavily on diversity and variation. It goes about change in a way that you work with the whole ecosystem and you get that tiny mutation of the positive deviant that's actually got a superior survival strategy. Then you get the rest of the organism to be aware that this mutation is a winner through human awareness. And it starts to spread and it starts to build.
When nature changes things it doesn't do it by changing the whole genome. It may mess around with the size of your brain, but it doesn't take away your five fingers and five toes and change your legs and your torso. And that's how the positive deviance process works. It keeps the community intact, and only gets the community to engage the parts that are material to a better survival strategy through natural selection in its own human kind of form, without messing around with everything else. And without the gross collateral damage that often occurs with top-down change.
The problem is, compared to the way most people think about change, it seems slow and imprecise, and you don't know what's going to happen. You have to rely on regular people to come up with stuff. These ideas get into the hands of the experts and then they want to turn them into "best practices" and put together a PowerPoint presentation and get everyone else to do it. There again, this is not how positive deviance works.
I'd love to hear you talk a little bit more about experts. We seem to live in a "call the expert" society. You turn on the news every night and the reporters are interviewing the expert on the subject. Then in court cases there's expert testimony. It's always, "let's bring in the expert." As you said, it seems that's ingrained in the human psyche. I thought maybe it was more just a product of a corporate culture. But perhaps it is deep down in our lizard brain.
RP: I was in China, because The World Economic Forum has its summer meeting in China. It complements the one in January in Davos, Switzerland. On the closing panel with Tom Friedman as the moderator, my colleagues on the podium were an esteemed professor from one of the major engineering universities in Beijing, and a professor from Massachusetts Institute of Technology (MIT). These two guys were making a lot of sense in their opening remarks about the need to get more innovation in engineering and the education process and the MIT professor's thesis was that we need a new consciousness about how to work collaboratively together.
This all sounded reasonable to me. Then Friedman asks both of them the question, what would they do to fix it? The guy from MIT said, "I would abolish all MBA programs." The Beijing University professor said, "I would completely reinvent engineering education and get rid of all the rote memorization that goes on, which destroys the ability of minds to think freely."
I was shaking my head. Friedman asked me, "What's wrong?" I said, "I was completely with these two folks until they got to their solution. But both of these solutions have just defaulted to the classic big-bang, top-down, radical-surgery approach, which even if you could do it doesn't solve anything. There's no input from the institutions or the students. You need to begin with some experiments. Maybe there are some positive deviant schools, they're doing stuff different than just all rote. Maybe there are some MBA programs, or ways of educating managers that go about doing it in a way that doesn't reinforce command and control."
The other thing about experts is that this positive deviance process is like water boarding for them. It is hell for someone with all that expertise. It's not that their expertise is irrelevant, because it expertise informs the right question, if they really know how to manage their knowledge. But that water boarding part is they want to fix the problem, rather than engage people in a conversation where they, the community, starts to be interested in fixing the problem. And that transition, once you've made it, it's like, "Oh, I'm actually more effective." But getting them over that hump is really torture.
So you need PD coaches for the experts.
RP: [Laughter] Well, a lot of training. All that's required is actually just doing it once or twice and seeing that it works. Once you've seen it, you say, "Oh, it's actually a better way." But until you've been there, it's a leap of faith.
Thank you, Richard.
RP: Thank you.
Email: rtpascale (at) aol (dot) com