When Deviance is Positive!

Speaking of Handwashing in Health Care Settings… Have you heard about Positive Deviance? Deviance in this case means going against the norm and achieving positive results. Sometimes, if things aren’t going well in some departments, you can look around to see if anyone in the organization is having success with that one issue. If they are, they must be doing something right! You want to figure out what they’re doing, and then you want to get other people to imitate that.

Atul Gawande is a surgeon in a Boston hospital, and he’s written 2 fabulous books on learning in health care institutions: Complications and Better. He describes how doctors, nurses, and administrators can learn – from their mistakes, from surgical errors, from places in the hospital where things are going right.

As I mentioned hand-washing in my last post, I thought I’d make this connection. Gawande talks about this in his book Better. It’s been difficult for hospitals and clinics to get doctors to wash their hands between patients – they claim that they don’t have time because they’re so rushed, or that they don’t like to wear gloves. But patients are still getting infected, and one cause is the spreading of germs by doctors who go from one patient to the next without washing their hands or without wearing gloves.

So they searched for departments in the hospital with low infection rates, and they asked, “What are people doing here that makes this successful? What are the conditions for that success?” They found departments where the nurses felt comfortable asking the doctors, and where cleaning dispensers were in convenient locations – and they had their answer. Turns out that when they asked the staff to help figure it out, the staff easily identified various problems, and they became invested in solving the problem. The solutions ranged from operational: installing more dispensers (easy fix) – to training and development (longer term): when the reluctant nurses saw that other nurses were asking the doctors about washing their hands, they began to ask also. Just the fact of asking the staff to help figure it out got them engaged in the problem, and their suggestions were taken seriously – and they began to replicate this across the hospital, and reduced the rate of infections!

Where else could we apply Positive Deviance?


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