Have you ever been excited to start something new, but not sure how or where to start?
That’s what we call the “failure-to-launch”-syndrome.
In this article I will provide you with a fail safe way to get Positive Deviance (PD) started in your community/unit or group.
It will help you fast-forward past the initial “failure-to-launch”-phase.

I’ll draw parallels from my experience when Positive Deviance was first introduced to my hospital and more specifically my unit, so you will have a smooth transition with implementing this great initiative. This article will provide you with the basics to getting started, challenges that you may encounter when implementing PD and how to over come those barriers.
I will also give you some hints on running a PD meeting, the power of self reflection to enhance your PD skills and finally how PD translates to success.

Before you Start

The guiding principle of Positive Deviance is based upon recognizing that the community has the answers to their problems. Your job as a facilitator is to guide the community though exercises that enable them to unravel those ideas and solutions.

But how do you successfully unravel the solutions, in the web of problems? First you need to acknowledge that your role is to facilitate a discussion in a way that allows you to listen more that your speak. You will find that everyone appreciates being listened to. Becoming proficient in listening will make your experience with PD a rewarding one.

Positive Deviance is about asking questions, being curious and guiding the group through self-actualization.  In order to accomplish this, you must let go of your need to control the discussion and accept that the answer or solutions that you’ll receive may not be on your personal recommendation list. If you are able to let go of your agenda and expectations and allow yourself to enter the discussion with an open mind, you will be able to capture the unique and inventive ideas that will erupt out of the discussions.

Getting Started

Pick a community/unit/group to introduce Positive Deviance to.
Plan an introduction both large scale and small scale, we call this the ‘Kick off.’ 

The large-scale approach.
For your large Kick Off invite everyone you can think of, from CEO to maintenance, as this is your chance to introduce PD to the hospital or facility. Think of this as a movie trailer, “coming to a theater near you.”  Your movie trailer needs to tantalize them with the benefits of PD, introduce them to the story line with the history and reel them in with the cost the effectiveness of Positive Deviance. By the end of the large kickoff people will be on the edge of their seats with anticipation as they wait for PD to role out in their area.

The not-so-large-scale approach
For the smaller scale or ‘mini kick off’ it will include an intimate gathering of the community or area that you will begin the Positive Deviance journey with. Discuss with the group the history of Positive Deviance, as well as provide them with real life examples that are pertinent to the group. Be aware that you may be met with some skepticism as in many healthcare areas the traditional top down approach has been the norm when changes have been implemented. 

You will now be asking the group/community to come up with the recommendations for change and this in itself is a change in culture and behavior. However, in order for sustainable changes to happen the community needs to take ownership of their challenges and problems and feel supported by their leaders.
Once the group trusts you as a facilitator and their voice is heard, beliefs validated and ideas implemented, you will recognize a shift in behavior and change in culture.

First Positive Deviance Meeting

Before you facilitate your first PD meeting find out from the community/group what is that best time to meet and be on time. Be honest with the group that this is your first time facilitating a PD meeting and the first time leading a Discover Action Dialogue (DAD). Being honest and vulnerable with the group may allow them to open up and disclose their ideas and feelings more readily, as well as create an environment where they feel safe to make mistakes, express their feeling and take chances with ideas.

Ask the DAD questions and wait for the group to respond, silence is ok and eventually someone will speak up. Thank the group member for their comment, validate it and ask questions, but most of all be curious and praise ideas. Your interest in what they have to say will help evoke more conversation and others will join in.
Listen carefully to your community’s comments and write down what you hear, ask questions about the behaviors and emotions behind the comment.

The world is just a great big onion
Think of Positive Deviance as an onion, as it has many layers of behaviors and feelings on the surface, but as you ask questions you are able to expose the true feelings and behaviors that are underneath. When those behaviors are validated and understood you will find change will fall into place.

At the end of your PD session, summarize the key points, ask for volunteers when suggestions for changes arise and thank the group for their time. Praise their abilities to come up with inventive ideas, congratulate changes and unique ideas and most of all celebrate achievements. Since you have taken notes, send them to the group so their ideas are recorded. Before you leave, let the group know what frequency you will be meeting, on our unit we meet bimonthly which helps to ensure the momentum is maintained and changes are carried out.

When you get proficient and comfortable with Discovery Action Dialogues shake it up with new methods like Triz, Improvisation and Fish bowls.

Self reflection

After each PD meeting I find it helpful to journal my thoughts, feelings and personal goals. I have found it beneficial especially in the beginning of the Positive Deviance journey because it provided me with a tool to channel the emotions I felt after each meeting. You will hear in PD literature the term “catching butterflies,” which means capturing the unique and unconventional ideas.

I didn’t truly understand what people were referring to when I first heard the term and I was privileged enough when I started PD to have a mentor who would debrief with me after each meeting. These regular meetings with my mentor allowed for personal growth. She would ask me general questions about how the session went, but the most beneficial interactions we had was when she would ask me if I heard a specific comment from the group and would challenge me to have further explored those ideas with the group.

My greatest learning was not to dismiss those “crazy or over the top suggestions” but to embrace them and get the group to dive into them. I had to learn to open my mind and take the blinders off, and the easiest way to do that was by asking questions and peel off the layers of the onion.

Final thoughts

The PD journey will not only been beneficial for the community that you are partnered with, but I have found the personal journey through facilitation is truly rewarding. Personal growth is seen by all that participate in PD and I will share a few cultural changes.

• Staff now take ownership of their unit problems and challenges whereby regaining their independence. They no longer approach me with problems because they now come to me with solutions.
• Staff have become more confident and are able to approach both staff and families when they witness things that are not inline with their protocol. In other words, they have gained confidence to approach, teach and lead.
• The unit has the 3^rd highest hand hygiene percentage in the hospital at 85% and when asked what would be a realistic rate by a staff member, the group told them 100% is what they strive for.
• Staff are now able to self reflect when problems arise.

When an outbreak occurred the staff had a group session where they problem solved what factors could have lead to this outbreak if meticulous hand washing was completed. They systematically went through modes of transmission to determine what needed to be implemented to eradicate the problem.
Another great example is the situation where a patient “X” was readmitted to the hospital and according to infection control C-diff had acquired on the unit. Staff discussed that they did not understand how it could have been acquired since the patient was in a ward room, no other patients had c-diff and no symptoms were exhibited while in hospital. Once again staff spent time analyzing and thinking about unit issues.

Just the tip of the iceberg
These are only a few examples of the transformation that is now exhibited by the group.
Their ability to think critically, problem solve and feel supported when doing so has increased. The personal growth of the unit as a community translates to cultural changes and is evident today.
Bear in mind these changes happen slowly and over time.

My advice to you as a new comer to Positive Deviance is first and for most:
congratulations for taking the steps to sustainable change.
It is not an easy road but a rewarding one.

“Go forward with an open mind and remember:
you can only fail to launch if you fail to try.”

This user-generated content was contributed by our Stopsuperbugs.com – member:

Melissa Crump: RN, MSN
Patient Care Coordinator
Sub acute Medicine/Acute Medicine
Vancouver

What are you running into while getting ready for the Launch?

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