Positive Deviance

Definition

Positive deviance, developed by Monique and Jerry Sternin, is a discovery method that inverts the usual diagnostic move: instead of studying what's failing and importing best practices from elsewhere, it looks inside the struggling community itself for the rare people who — working with the exact same resources and constraints as everyone else — have already solved the problem, usually without realizing they've done anything unusual. The consultant's job shifts from analyzing failure to locating, observing, and helping those solutions spread by practice rather than instruction.

In the Book

Block introduces the method through the Sternins' work on child undernutrition in Vietnamese villages, the curtailment of female genital surgery in Egypt, and MRSA infection control in hospitals — "problems that have almost [been] unsolvable by traditional means." Their question was never "why are these children malnourished" but "are there any children in this village who are healthy?" — treating the healthy exceptions, not the failing norm, as the object of study. The method proceeds through strict invitation (only people who show up voluntarily, twice, are worked with — "no mandates allowed"), then observation rather than interview, since positive deviants "usually do not even know what they know." Crucially, the Sternins found that the failure point in most change efforts is the moment right after discovering the answer, when the reflexive move is to "go out and spread the word: teach people, tell them, educate them" — which doesn't work, because knowing something doesn't produce doing it. Instead they had mothers bring malnourished children to a neighbor's house to jointly cook and feed a supplemental meal using foods already available locally, and had community health volunteers track and record progress themselves rather than relying on third-party evaluators. Block links this directly to Paul Uhlig's cardiac surgery team, whose outcomes improved once care decisions moved from individual physician authority to a self-organized partnership with patients and families.

Why It Matters

This displaces the default diagnostic instinct — study the failure, import an outside best practice — with a cheaper and more locally credible alternative: assume a working solution already exists somewhere inside the constrained system, because someone facing identical limits has likely already found a workaround. It also names a specific reason knowledge-transfer initiatives fail: teaching and telling do not reliably convert into doing, so change has to be learned by practicing alongside people already living it, not by absorbing a briefing about it.