Those deviants!

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I have a bookshelf that is filled with many books on leadership and management that I read while working on my Master of Public Administration degree. While each of them might have a kernel or two of unique insights, most of these books contain a great deal of fluff. The basic formula for these books is to take concepts that are often common sense, give them a new name, and create the illusion of a totally new discovery about human behavior.These books often focus on a magic number--7 principles, 10 milestones, 12 steps (wait, that's something else!), and they continue to be steadily churned out (just take a look at any airport bookstore). Of all of these books that I've read, one did stand out as different and important, and that was Robert Greenleaf's Servant Leadership.

One recent book in this genre caught my eye given it's potential application to HAI prevention: The Power of Positive Deviance: How Unlikely Innovators Solve the World's Toughest Problems. Positive deviance was a part of the interventions implemented in the Veteran Affairs initiative to reduce MRSA that was recently reported in the New England Journal of Medicine (see Dan's comments here and here). My colleague in Sao Paulo, Alex Marra, has published on his use of positive deviance to improve compliance with hand hygiene. You can read an interview with Alex focusing on the use of positive deviance here.

In a nutshell, the concept of positive deviance is to simply involve not just experts but everyone in identifying solutions to problems. And it recognizes that a few individuals (the positive deviants) devise solutions to problems that the vast majority of people never realize. The deviants then share their successes with others and in doing so previously intractable problems are solved. Importantly, change is driven bottom-up, not top-down. The book uses several case studies, including the Pittsburgh VA hospital MRSA initiative.

Like the overwhelming majority of leadership/management books, this is another one that essentially follows the same formula as many others--a relatively simple, commonsense concept is given a new name, and presto, problems appear to be solved. I have no doubt that positive deviance can be used successfully in infection prevention, but it's simply another way to achieve the outcomes we want. It's not magic and it's not the be-all, end-all. But it's another tool, and if it works for your organization, well, you go girl!


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