Principles of the PD approach

The Positive Deviance approach is a strength-based approach which is applied to problems requiring behavior and social change. It is based on the following principles:^[6]

• Communities already have the solutions. They are the best experts to solve their problems.
• Communities self-organize and have the human resources and social assets to solve an agreed-upon problem.
• Collective intelligence. Intelligence and know-how is not concentrated in the leadership of a community alone or in external experts but is distributed throughout the community. Thus the PD process’s aim is to draw out the collective intelligence to apply it to a specific problem requiring behavior or social change.
• Sustainability as the cornerstone of the approach. The PD approach enables the community or organization to seek and discover sustainable solutions to a given problem because the demonstrably successful uncommon behaviors are already practiced in that community within the constraints and challenges of the current situation.
• It is easier to change behavior by practicing it rather than knowing about it. “It is easier to act your way into a new way of thinking than think your way into a new way of acting”.

The PD approach & process

The PD approach was first operationalized and applied in programming in the field by Jerry and Monique Sternin through their work with Save the Children inVietnam in the 1990s (Tuhus-Dubrow, Sternin, Sternin & Pascale).^[1][6][7]

At the start of the pilot 64% of children weighed in the pilot villages were malnourished. Through a PD inquiry, the villagers found poor peers in the community that through their uncommon but successful strategies, had well-nourished children. These families were collecting foods typically considered inappropriate for children (sweet potato greens, shrimp, and crabs) washed their children’s hands before meals, and actively fed them three to four times a day instead of the typical two meals a day provided to children.^[8][9]

Without knowing it, PDs had incorporated foods already found in their community that provided important nutrients: protein, iron, and calcium. A nutrition program based on these insights was created. Instead of simply telling participants what to do differently, they designed the program to help them act their way into a new way of thinking. To attend a feeding session, parents were required to bring one of the newly identified foods. They brought their children and while sharing nutritious meals, learned to cook the new foods.^[8]

At the end of the two year pilot, malnutrition fell by 85%.^[8] Results were sustained, and transferred to the younger siblings of participants.^[9]

This approach to programming was different in important ways. Based on a community's own assets, the Positive Deviance approach operates within the specific cultural context of a given community (village, business, schools, ministry, department, hospital) and is therefore always appropriate. It provides to community members the “social proof” that an uncommon behavior can be adopted by all because it is already practiced by a few within the community. The solutions come from the community, therefore avoid the “immune response” that can occur when outside experts enter a community with best practices that are often unsuccessful in promoting sustained change. (Sternin)

Since it was first applied in Vietnam, PD has been used to inform nutrition programs in over 40 countries by USAID, World Vision, Mercy Corps, Save the Children, CARE, Plan International, Indonesian Ministry of Health, Peace Corps, Food for the Hungry, among others.

Steps of the PD process^[6]

An invitation to change: A PD inquiry begins with an invitation from a community that wishes to address an important problem they face. This is an important first step of community ownership of a process that they will lead.

Define the problem: This process occurs with the community at the center of defining the problem for themselves. This will often lead to a problem definition that differs from the outside “expert” opinion of the situation. A quantitative baseline is established by the community. This baseline provides an opportunity for the community to reflect on the problem given the evidence at hand, and also measure the progress toward their goals. This is also the beginning of the process to identify stakeholder and decision-makers regarding the issue at hand. Additional stakeholders and decision-makers will be pulled in throughout the process as they are identified.

Determine the presence of PD individuals or groups: Through the use of data and observation, the community establishes that there are Positive Deviants in their midst.

Discover uncommon practices or behaviors: This is the Positive Deviance Inquiry. The community, having identified positive deviants, sets out to find the behaviors, attitudes, or beliefs that allow the PD to be successful. The focus is on the successful strategies of the PD, not on making a hero of the person using the strategy. This self-discovery of people/groups just like them who have found successful solutions provide “social proof” that this problem can be overcome now, without outside resources.

Program design: Now that the community has identified successful strategies, they decide what strategies they would like to adopt, and design activities to help others access and practice these uncommon and other beneficial. Program design is not focused on spreading “best practices” but helping community members “act their way into a new way of thinking” through hands-on activities.

Monitoring and evaluation: PD-informed projects are monitored their programs and evaluated through a participatory process. As the monitoring will be decided on and performed by the community, the tools they create will be appropriate to the setting. This can allow even illiterate community members to participate through pictorial monitoring forms or other appropriate tools. Evaluation allows the community to see the progress they are making towards their goals and reinforces the changes they are making in behaviors, attitudes, and beliefs.

A monitoring tool used by illiterate members of a community.

Scaling up: The scaling up of a PD project up may happen through many mechanisms: the “ripple effect” of other communities observing the success and engaging in a PD project of their own, through the coordination of NGOs, or organizational development consultants. However the project is scaled up, the process of community discovery of PDs in their midst remains vital to the acceptance of new behaviors, attitudes, and knowledge.

The application of positive deviance

PD approach in preventing hospital-acquired infections[edit]

The PD approach has been applied in hospitals in the U.S., Brazil, Canada, Mexico, Colombia, and England to stop the spread of hospital acquired infections such as c-diff and Methicillin resistant Staphylococcus aureus (MRSA). The Centers for Disease Control and Prevention (CDC) evaluated pilot programs in the U.S. and found units using the approach decreased their infections by 30-73%.^[10]

Additionally, it has been used in health care setting increase the incidence of hand washing, and improving care for patients immediately after a heart attack.^[11]

Public health applications

A PD project helped prisoners in a New South Wales prison stop smoking. Projects in Burkino Faso, Guatemala, Coite d’Ivoire, Rwanda addressed reproductive health in adolescents.^[12] PD maternal and newborn health projects in Myanmar, Pakistan,^[13] Egypt,^[14][15] and India^[16] have improved women’s access to prenatal care, delivery preparation, and antenatal care for mothers and babies.

PD projects to prevent the spread of HIV/AIDs took place in 2002 with motorbike taxi drivers in Vietnam^[17] and in 2004 with sex workers in Indonesia.^[18]

Child protection

A five-year PD project starting in 2003 to prevent girl trafficking in Indonesia with Save the Children and a local Indonesian NGO, helped them find viable economic options to stay in their communities.^[3]

A PD project to stop Female Genital Mutilation/Cutting in Egypt began in 1998 with CEDPA (Center for Development and Population Activities), COST (Coptic Organization for Services and Training), Caritas in Minya, Community Development Agency (CDA), Monshaat Nasser in Beni Suef governorate, and the Center for Women's Legal Assistance (CEWLA). Efforts have already shown a reduction in the practice.^[19]

In Uganda, a project with the Oak Foundation and Save the Children helped girls who were child soldiers with the Lords Resistance Army in Sudanreintegrate into their communities.^[3]

PD in education

PD projects in New Jersey, California, Argentina, Ethiopia, and Burkina Faso have addressed drop out rates and keeping girls in school.

Private sector

Proponents of PD within management science argue that in any population, even in such seemingly mundane groups as service personnel in a fast foodenvironment, the positive deviants have attitudes, cognitive processes and behavioral patterns that lead to significantly improved performance in key metrics such as speed-of-service and profitability. Studies claim that widespread adoption of the Positive Deviant approaches consistently leads to significant performance improvement.

PD had been significantly extended to the private sector, by William Seidman and Michael McCauley. Their extensions include methodologies and technologies for:

• Quickly identifying the Positive Deviants^[20]
• Efficiently gathering and organizing the Positive Deviant knowledge
• Motivating a willingness in others to adopt the Positive Deviant approaches^[21]
• Sustaining the change by others by integrating it into their pre-existing emotional and cognitive functions^[22]
• Scaling the positive deviant knowledge to large numbers of people simultaneously^[23]

Positive deviance was further extended to groups or organizations by Gary Hamel.^[24] Hamel looks to Positive Deviant companies to set the example for “management innovation.”