Voices from the Field

Other

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.

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."

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.”

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.”

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.

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