10 Frequently Asked Questions on Positive Deviance

Authors: Monique Sternin, Co-Founder of Positive Deviance Approach and Lars Thuesen, Change Leader and Positive Deviance Facilitator

1. What attracted you to the Positive Deviance Concept?

Like many other PD practitioners, it is the opportunity to tackle seemingly intractable problems in a total different way: A departure from the standard way of addressing problems from an expert and need based position, by letting the community affected by the problem to find existing solutions within its peers, and innovating in the process.

2. What does “acting your way into a new way of thinking” mean?

In PD parlance, it means that for people to change they need to discover what works for themselves, and adopt & practice the uncommon behavior or strategy that some of their peers have used to solve a specific problem. This very action promotes change. Knowledge alone does not bring about behavior change. 

3. What does it mean to be a “non-expert?”

To approach a community with a very complex problem with no tips, suggestions or  advice to help them solve the problem. To come as a neutral facilitator. To invite the local experts to come forth with their own solutions and leverage them to the entire community.

4. What is different about the PD approach compared to other behavior & social change methodologies?

PD shares some DNA with other asset-based approaches: The focus on what works well. PD is very different, because it focuses on behaviors that already are being practiced – with success in the communities. The focus on co-creation with and in the communities is also unique: if it is about me not without me. Finally, the combined focus on both hard, quantitative and behavioral data that are owned and monitored by communities both when defining the right problems, discovering PD solutions and dissemination and scaling is an importance feature. 

5. What does it mean for PD to not be a “program” to be manualized and replicated, but to be grown within each community?

It is a not a very popular feature of PD that requires that it be always context specific, whereas most pilot projects can be replicated in a “roll out” fashion. What needs to be replicated is not the fidelity to the method (by definition adaptable) but the integrity of the principles.

6. How do you “scale up” a PD informed project?

There are many ways to scale up a PD pilot project: ripple effect from a successful pilot, geographical expansion via training center, entertainment education, etc. A PD informed project, if successful, is doomed for extinction, but its impact is sustained because of the social change that happens during the life of the project.

7. What is the role of a facilitator? What are the most important skills needed?

The role of the facilitator is to be a catalyst for the community to come together, to provide the unique opportunity for the community to uncover solutions and innovate to solve their problem. The most important skills required include: ask open-ended questions, be a good listener, be curious, and most importantly, be humble.

8. How do you get trained in Positive Deviance work?

You need to learn by doing it. You cannot be trained in a vacuum. The best way to learn is by trials and errors, to experiment with the PD approach basic method and process, and apply its principles. There is a generic guide available on the PD website which needs to be adapted to the type of problem and the context in which PD will be applied.

9. What is the most challenging aspect of the PD approach?

The paradigm shift or different mindset from the part of donors, organizations and governments: which is for experts to become learners, for teachers to become students and for leaders to remove barriers for bottom up change

10. Why is the PD approach not better known and widely applied given its positive record?

The PD approach defies standard ways of solving problems. It is a belief in the community agency and people’s capacity for goodness and for solving their own problems. In our expert-driven world, the suggestion that the community can harness its own wisdom and “know-how” is unfamiliar and slightly threatening.

Click here to hear more Voices from the Field.

Maha Abusamra: PD for Gender Equality

Maha Abusamra is a consultant/trainer with over 20 years of experience in gender and programme management. She applied the Positive Deviance approach in the areas of gender equality in the Middle East and is one of the founders of the Palestine UN Gender Innovation Lab. She worked with UNDP, UNRWA and Catholic Relief Services on Gender, Governance, Social Development programmes, as well as in the private sector.

In this short video, Maha Abusamra shares her experiences using the Positive Deviance approach at a project level as a PD facilitator and one of the founders of the Palestine UN Gender Innovation Lab.

Merck: Improving Marketing Strategies

Sector: Business (Improving marketing strategies)
Organization: Merck
PD Practitioner: Sales Representative
Location: Mexico City area, Mexico

"Let me tell you that, in the process of positive deviance, when the time came  to communicate the message to our coworkers, it was not easy to 'infect' them with this concept. However, most of the people felt an atmosphere of trust and harmony, and we discovered that, one way or the other, we all are positive deviants."

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Sector: Business (Improving marketing strategies)
Organization: Merck
PD Practitioner: Merck Director. Andreas Bruzal 
Location: Mexico City area, Mexico

“For me, as head and mentor of the process, it was a great experience, not only because of the results seen in our people, but because I feel that I also underwent a gradual change in some of my behaviors in terms of trusting, delegating more, letting people self-organize so things happen, and letting them be the ones to carry out the processes.” 

“For the first time in a process in which I have participated, we left aside the rank and the top-down approach and worked side by side as colleagues and coworkers. If I could summarize my role throughout all this process, I would do so with just one word: facilitation.

In the end, all I did was creating a space where people could self-organize and learn from one another. However, the most important thing is not that I say it, but that the community says it.”

Waterbury Hospital: Medication Management

Sector: Other (Medication management)
Organization: Waterbury hospital
PD Practitioner: Tony Cusano, MD and PD team coordinator at Waterbury hospital and assistant professor, Yale school of medicine.
Location: Waterbury, CT, USA 

“Many quality improvement processes, particularly those that attempt to teach evidence-based best practices by simply disseminating information regarding their use, or mandating their use, have been ineffective in sustaining change in professional performance.   

While groups have developed and introduced “Best Practices” that they consider likely to improve the performance of health care professionals, these processes have often suffered from a lack of sustainability due to their focus on technical solutions rather than on engaging professionals in a way that motivates them to change their behavior and adopt those solutions.  The top-down approach of introducing “answers” to complex problems that come from outside of a medical community often fails to inspire change in professionals who have spent much of their lives developing effective work habits and confidence in their own ability to solve problems.

We believe that the respectful manner through which Positive Deviance seeks to instill change in groups of people dealing with particular problems led to the successful and sustainable improvement in medication management during the transition out of hospital care.

Indian Health Services: Conflict Resolution

Sector: Other (Conflict resolution)
Organization: Indian Health Services 
PD Practitioner: Doctor Diane Pitman 
Location: Cass Lake Reservation, Minnesota USA
Date: February 2007

“The PD initiative at Cass Lake has brought about several small, tangible improvements at CLIHS.  More importantly it has made significant changes in the way employees at the hospital communicate with each other and approach problems.  We are moving from strategies that have not worked (name and blame, waiting for outside help to solve problems) to experimenting with new ones.  Our mantra has become “If you do what always did you get what you always got.”

Ethiopian Elders: Pastoral Communities in Conflict

Sector: Other (Pastoral communities in conflict)
Location: Afar Region, Ethiopia 

In Ethiopia, Afar Region, nomadic pastoral communities were in conflict with each other because of impending famine and tremendous loss of cattle .

After a few days of camping in the desert, Abdulkadir the translator, confided to the PD INGO team what he overheard from a conversation among several of the elders. They were amazed at the fact that the outsiders had come 3 times to the water hole to “sit at our feet, and listen to us!”  “Not even our own children pay us that kind of respect,” one man added.

Egyptian NGO Staff: Advocacy against Female Genital Mutilation

Sector: Advocacy against FGM (Female Genital Mutilation) 
Organization: Local NGO
PD Practitioner: Staff Member of Local NGO
Location: Assiut, Egypt

“The PDs have credibility and help us a lot with our advocacy. When we just use our knowledge, people don’t believe us. They say: “You are just saying these things because it is your job and you are being paid. Show us someone we know who is circumcised, and still a virtuous woman!” When we can get the PD to talk with them, it changes all of that, and they do believe.”

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Sector: Advocacy against FGM (Female Genital Mutilation) 
Location: Egypt

“When I’m successful in convincing people, it is because they see how enthusiastic I am.  Also I have them re-live the moment  – I put my hand on the wound!”

Indonesian Kadar: Advocacy against Girl Trafficking

Sector: Advocacy against Girl Trafficking 
PD Practitioner: A Kader 
Location: Kedoyo, Java, Indonesia

“PD is like a flashlight. It helps to shine light and illuminate what hides behind the darkness. It helps us discover what already exists. For example, it helps us discover our existing strengths we had not realized or utilized.”

Peace Corps Volunteer: Public Health

Sector: Public Health
PD Practitioner: Peace Corps Volunteer
Location: Mali

The Positive Deviance approach is perfect for Peace Corps Volunteers. Not only does it correspond with Peace Corps' philosophy, but volunteers have a whole two years to get to know and understand a community. We were told consistently how important the first year is, to have patience and learn about our community. However, as Americans, we are eager and feel restless when we are not doing. If we could only come up with a way to get volunteers to truly embrace that first year! My Health APCD (Assistant Peace Corps Director) gave us an "etude de milieux" to complete during the first 3 months. This was extremely helpful as it gave us work to do, a task to complete, as well as facilitating in our getting to know the community.

Positive Deviance and local practices

Reflecting on my experiences, the one thing that we must be mindful of is to not forget to look for local practices, which seems ridiculous as this is the whole point. But PCV's arrive in their village fresh from training where we are taught best practices and eager to share them all. Often, I got so caught up in trying to find the women that were immediately and exclusively breastfeeding, introducing foods at 6 months, washing their hands before eating, etc. that I often forgot to look for other solutions, local solutions. For example, there were many women who reported to me that they had exclusively breast-fed for anywhere between 9-18 months. I did observe a high number of these cases and even more interesting, these children were often the healthier ones. I still do not know why these children were healthier because I did not dig deep enough to search out the answers, instead I was looking for women doing what I already deemed to be a healthier behavior.

An agricultural volunteer may be looking for the person who is using the techniques the volunteer learned in training, when there may be someone who is using a technique that is even better suited to the community. I started planting Moringa trees and a few months later found several compounds that already had healthy and vibrant Moringa. One man was using it as live fencing. Here was a Positive Deviant, whom I could have worked with to multiply the number of Moringa trees that existed in the community.

A volunteer may be working with a very talented tailor. He wants to export his work, however he does not even keep records of what he has bought and sold. He does not understand that to begin exporting will take time and is a process. The volunteer could take him to visit with someone who is already exporting, someone who has done it from the beginning on their own.

For many PCV's, behavior change is all they do whether it is agriculture, health or business related. If we gave behavior change more focus during training, perhaps volunteers would not get as discouraged because they would start with more realistic expectations. It would also help give volunteers perspective. 


Positive Deviance and Volunteer Satisfaction

I was in a health center one day that was implementing a supplementary feeding program. Nothing they were doing made sense. It was a combination of motivation and misunderstanding. I was starting to get visibly frustrated and then I remembered positive deviance. I thought to myself, 'Wait a minute, instead of continuing to tell them how they are doing it wrong, why don't I take them and show them someone who is doing it right?' Someone who is on their level, i.e., someone who has had the same training, receives the same salary, and has the same demands placed on them every day. There is one health center worker, Madame Cherif, who is exceptional. She is enthusiastic, she does everything correctly, she gives nutritional advice to women that come to the health center and she always goes the extra mile even if it is out of her way. I took the two health center staff that did not understand protocol to see Madame Cherif in action. It worked out wonderfully! I avoided being discouraged with the staff, the staff learned a whole lot and Madame Cherif felt a huge sense of pride in her work.

Finally, using the Positive Deviance approach can be highly rewarding for a volunteer. During my service, I have worked both with supplementary feeding programs and the PD/Hearth approach. I enjoy my work with the supplementary feeding programs and I do think that the supplementary feeding programs help in the moment, the more amount of time that a child is healthy in her developmental years is important. However, it is my work with PD/Hearth that makes me really proud of my service. I know that through my PD/Hearth work I left something truly lasting: knowledge, knowledge that built upon what already existed. There were many mothers who were really proud after the Hearth, they could see the change it made in their child and they knew they (and their local ingredients!) made it happen. I am certain that those same mothers are passing on that knowledge to other mothers and it makes me happy to know that our (The community members who made the Hearth happen, Catholic Relief Services' staff, and myself) work continues. 

Garamthone Villagers: Maternal & Newborn Care

Sector: Maternal & Newborn Care
PD Practitioner: Mother from Garamthone Village
Location: Garamthone village, North West Frontiere province, Pakistan

“Jo loog bahir say aatay hain un se farq nahi parta jab kay ankhian naal takia par ziada umaal kartay hain. Dekha Deeiakhe ziada assar hota hai”.

 “When people come from outside, it does not feel good. But if we see the things with our eyes, and try them practically, and see some people practicing them, this has a good effect on people.”

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Sector: Maternal & newborn care
PD Practitioner: Activist from Garamthone village
Location: Garamthone village, North West Frontiere province, Pakistan

“The NGO has gone. Today we are on our own. We are still sharing the information. A few days ago there was a birth in my neighborhood. The father came to me at 11 o’clock at night and asked me for a new blade to cut the cord. Whatever we have learned from these PD sessions we are acting upon it, and guiding others to do so.”

Peace Corps Volunteers: Nutrition

Sector: Nutrition
Organization: Peace Corps
PD Practitioner: Peace Corps Volunteer 
Location: Guinea

“I was in one health center one day and nothing they did made sense, it was a combination of motivation and misunderstanding.  I was starting to get visibly frustrated and then I remembered positive deviance.  I thought to myself, “Wait a minute, instead of continuing to tell them how they are doing it wrong, why don’t I take them and show them someone who is doing it right?”  Someone who is on their level, i.e., someone who has had the same training, receives the same salary, and has the same demands placed on them every day.  There is one health center worker, Madame Cherif, who is exceptional.  She is enthusiastic, she does everything correctly, she gives nutritional advice to women that come to the health center and she always goes the extra mile even if it is out of her way.  I took the two health center staff that did not understand protocol to see Madame Cherif in action.  It worked out wonderfully!  I avoided being discouraged with the staff, the staff learned a whole lot and Madame Cherif felt a huge sense of pride in her work.”

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Sector: Nutrition
Organization: Peace Corps
PD Practitioner: Peace Corps Volunteer 

“Finally, using the Positive Deviance approach can be highly rewarding for a volunteer.  During my service, I have worked both with supplementary feeding programs and the PD/Hearth approach.  I enjoy my work with the supplementary feeding programs and I do think that the supplementary feeding programs help in the moment, the more amount of time that a child is healthy in her development years is important.  However, it is my work with PD/Hearth that makes me really proud of my service.  I know that through my PD/Hearth work I left something truly lasting: knowledge, knowledge that built upon what already existed.  There were many mothers who were really proud after the Hearth, they could see the change it made in their child and they knew they (and their local ingredients!) made it happen.  I am certain that those same mothers are passing on that knowledge to other mothers and it makes me happy to know that our (The community members who made the Hearth happen, CRS staff, and myself) work continues.” 

Director of Patient Safety and Infection Control: MRSA

Sector: MRSA
Organization: Billings Clinic
PD Practitioner: Nancy Iversen (RN, Director of Patient Safety and Infection Control) 
Location: Billings, MT, USA

“There is more dialogue, more discussion, and people ask questions of each other. When I round now, there is different bonding, because we have learned together. The conversations are different. This is especially good for us in infection control because sometimes we have felt like police. Now we feel like partners.”

Infection Disease Control Nurse: MRSA

PD Practitioner: Ms. Borton (Infection Disease Control Nurse) 
Location: Pittsburgh, PA

“If you asked staff two years ago who is in charge of infection control, they would say it’s the infection control professionals. If you ask now, they’ll say they are, and they are comfortable making suggestions and asking how to fix things. They have truly taken ownership of this effort.”

Virginia Health Services: MRSA

Sector: MRSA
Organization: Virginia Health Services
PD Practitioner: Jon Lloyd (MRSA Prevention Coordinator)
Location: Pittsburgh PA, USA

“PD has contributed two additions* to the old adage: "What I hear, I forget. What I see, I remember. What I do, I understand."  (PD additions) *What I do, I own and I use it and improve on it. *What WE co-create, WE own and the process builds trustful relationships that foster learning together and self-sustaining improvements because WE own them”.