Atul Gawande on the importance of a “positive deviant”

In “The Bell Curve,” an article written for The New Yorker (December 6, 2004), Atul Gawande uses the term “positive deviant” to describe unusually effective performers in the field of medicine. In fact, there are outliers in all fields. To Gawande, it is highly advisable to study outliers and learn from them to improve our own performance.

(Note: To the best of my knowledge, the term “outliers” was first used by Frank E. Grubbs in his article, “Procedures for Detecting Outlying Observations in Samples,” published by Technometrics magazine in 1969.)

In his book, Better: A Surgeon’s Notes on Performance, Gawande describes and defines the concept of “positive deviance” as it relates to improving outcomes in the medical profession. He tells a story about a Save the Children program designed to address malnutrition among children in poor, outlying villages in Vietnam shortly after the Vietnam War:

“The anti-starvation program run by Tufts University professor Jerry Sternin and his wife, Monique, had given up on bringing outside solutions to villages with malnourished children. Over and over, that strategy had failed. Although the know-how to reduce malnutrition was long established—methods to raise more nourishing foods and effectively feed hungry children –most people proved reluctant to change…”

Does this remind of us of anyone?

Gawande goes on:

“The Sternins therefore focused on finding solutions from insiders. They asked small groups of poor villagers to identify who among them had the best nourished children—who among them had demonstrated what the Sternins termed a ‘positive deviance’ from the norm. …The villagers discovered that there were well nourished children among them, despite the poverty, and that those children’s mothers were breaking with locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea, for example, or giving them several small feedings each day rather than one or two big ones; adding sweet potato greens to the children’s rice despite it being considered a low class food. And the ideas began to spread. They took hold ….In two years malnutrition dropped 65-85% in every village the Sternins visited.” (Page 25)

Given all the problems we human beings face today, the need for positive deviance is greater now than ever before.

o   It all begins with an unshakable faith in what can be accomplished.
o   Next is some highly unorthodox collaborative thinking that generates lots of possible solutions.
o   Finally, selection of what seems to be the best solution and then APPLY IT.

I agree with Albert Einstein: “We cannot solve our problems with the same thinking we used when we created them.”



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  1. […] of ‘typical’ project beneficiaries. (This echoes Atul Gawande’s emphasis on learning from “positive deviants” – or what Chris Roche calls “exceptional responders”). The priority attached to formative […]

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