EIGHT

Nature’s Way

Invisible in Plain Sight

THIS BOOK MAKES NO CLAIM that the positive deviance process is the only, or indeed the best, approach for addressing intractable problems. To the contrary, our initial expectations following Vietnam were that its relevance was restricted and applications localized. Observing its ascendancy over two decades has left us a bit in awe. Popularization of the idea has been almost exclusively through word of mouth (save occasional mention in the media). There has been no marketing campaign, investment in branding, or orchestrated publicity. Launching a Web site and establishing the Positive Deviance Initiative at Tufts University, in Boston, was largely a defensive maneuver to cope with a growing flood of inquiries per month from around the world. (See the box “Virtual PD?” for some conjecture as to the future.)

Why the fuss? The simplest answer, given a world (and media) largely preoccupied with “what’s wrong” and “what’s missing,” is that the counterintuitive emphasis on “what’s working against all odds” is a breath of fresh air. The approach is a tonic for the change-weary. It distinguishes itself primarily by focusing attention on the variants that succeed against all odds. (While the process relies on bottom-up initiative, this is not a unique attribute. Other participative approaches tap into the same vector of influence.)

Another explanation is that PD is more than the additive combination of best practices (which capitalize on indigenous variations that work) with an overlay of participative methodology. It is multiplicative insofar as it is a powerful synthesis of the best of both traditions.

There is a third and deeper explanation, and it has been a consistent refrain touched on in every chapter: the PD process works within a social system in much the same way that evolutionary biology works in nature. It is radical across time but incremental in a moment of time. It is disruptive with respect to a narrowly targeted problem, yet overarchingly conservative. It leaves most of the genome intact, altering only those elements essential for successful adaptation.¹

Modularized Tweaks Versus Wholesale Reinvention

This last point warrants elaboration. Nature is selective in the way it innovates. It evolves piecemeal. A mutation that alters the size of the brain cavity does not require a change to the arms, legs, and torso. Computers exploit this concept. You can upgrade the hard drive without having to reengineer the microprocessor, server, or user interface. Positive deviance exploits this evolutionary pattern of modularization.²

In contrast, most human attempts at change disregard this principle. Organizations default to the big bang approach with wholesale reorganizations and new strategic initiatives. The debate over health care reform in the United States is a case in point. A nationwide reinvention of the entire system has dominated the discourse. Nature’s way would be different, addressing the need for adaptive change through many small experiments. States partnering with the federal government could test several plausible solutions: ending Cadillac programs in one state, eliminating the tax deduction in another, creating a multistate consortium to enable insurance companies to compete across state lines, coalescing individuals and small businesses into groups of sufficient diversity to spread actuarial insurance risks. Over time, possibly five to seven years, superior schemes would prevail. Unintended consequences would be identified and addressed while pilots would be small enough to make unpleasant surprises manageable.

Positive deviance modularizes in two important respects. First, it narrowly focuses on the specific itch the community wants to scratch. PD avoids grandiose aims such as eradicating poverty in Vietnamese villages, revolutionizing gender roles in Pakistan, or leveling the status hierarchy of hospitals. Second, each social entity is a module in its own right. Solutions are never exported wholesale. Each community, NGO, or business unit within a company is regarded as unique in its own way.

Reproduction and Variation

Positive deviance is predicated on diversity and variation. In nature, sexual reproduction serves this role. Natural selection favors a process that generates variety over one that generates too much continuity. Turns out, sex is best.³ The alternative, parthenogenesis (a rare process by which a few plants, ants, and worms conceive offspring through self-introduced combinations of identical genetic material), yields offspring identical to their single parent. Analogous to cloning, it is extraordinarily efficient in generating lots of progeny with few “defects.” The trouble is, cloning bets the house on “one size fits all.” It is far less likely to generate variations that thrive in new niche environments. In an organizational context, best practices are comparable to cloning.

Chromosome combinations from parents with different DNA generate variety in offspring. Sexual reproduction is nature’s risk-mitigation function: variety increases the odds that species will find a way to survive in the face of disease or abrupt changes in the environment. Nature runs a prolific but indifferent R&D lab. Mutations too far from the norm (usually as the result of too many big changes at once) are aborted.⁴ As many as one-third of pregnancies spontaneously miscarry within weeks of fertilization because the embryo is too radical to survive.⁵

These two intersecting properties of selectivity and variety give nature its potency and the positive deviance process its power. Both are predicated on arrangements that cultivate variety in moderation. (That’s why it is important to reach beyond the usual suspects in embarking on the PD process.) Less obvious, variation is exquisitely sensitive to local conditions. (We observed this in the work with Jakarta’s transvestites, in sales practices at Genentech and Merck Mexico, and in the essential adaptations of the PD process to the time constraints of hospitals.) Small details in the organism’s ecology matter a lot as to whether a variant (positive deviant) flourishes or fails. Sometimes a peripheral development out of the corner of the eye turns out to be the main point. All-purpose solutions lose out because small variations in a particular environment require parallel minor adaptations for a species to flourish within it. Large scale, top-down change programs or lock-step generic techniques such as reengineering or Six Sigma often experience high failure rates because they ignore these essential truths. The PD process doesn’t. A novel solution is disseminated through an infinite number of small adjustments. That is the way of nature—and it works in villages, corporations, and communities of every kind.

Preserving Cultural DNA

Social systems are natural extensions of the human genome. From the natural science perspective, Homo sapiens (and other advanced species) evolved a social repertoire to outcompete rivals for the same resources. Approximately twelve thousand years ago, hunter-gatherers discovered it was easier to raise plants than endure the nomadic life of searching for them. Remaining in one place favored the domestication of animals. This led to larger permanent communities and gave rise to more evolved cultures, which necessitated mechanisms of governance.⁶ Accordingly, social arrangements became an important determinant of ascendancy or extinction. What we call “culture” is the name given to these unique properties—the social DNA important to a community’s success and worthy of preservation. Variation serves to modify cultural DNA as it does with genetic DNA. Successful species discard that which no longer serves and preserve the rest.

The positive deviance process pays attention to balancing variation and preservation. This was of decisive importance in the progress made in reducing infant mortality in Pakistan. First, it turns to the intact community, not to experts, authorities, or an infusion of external resources. Second, it embraces the social system as central to deep human learning. Biological cognition and social learning are not separate and distinct. The mantra of the PD process is to leave as much cultural DNA intact as possible.

Phases of Change and Four Laws of Nature

Throughout this book, each story begins with an intractable problem regarded as “just the way it is.” Equilibrium conditions accepted that 63 percent of Vietnamese village children under three were malnourished; stunting was the norm in the Altiplano of Bolivia; nineteen thousand Americans would die each year of MRSA infections; and nearly half of all children in Misiones Province, Argentina, dropped out before completing sixth grade. In nature, as in these situations, equilibrium over the long haul is a precursor to failure, not just figuratively but literally.

There is a natural progression of change within evolutionary systems.⁷ These are incorporated into the positive deviance approach:

Prolonged equilibrium is a precursor to death or stagnation: when a living system is in a state of equilibrium, it is less responsive to changes occurring around it (e.g., complacent, resigned, ignoring or suppressing successful variants). Change entails disturbing this equilibrium (e.g., in the PD context, questioning fatalistic assumptions that “this is just the way it is” perturbs the status quo).

Somewhere near the edge of chaos is a sweet spot. Movement toward (but not over) that edge is propelled by threat or galvanized by a compelling opportunity. The invitation at the onset of a PD process provides the group with a choice to move out of its comfort zone. The somersault question evokes turbulence by challenging orthodoxies and focuses attention on the counterintuitive successes of outliers. This opens minds to experimentation and innovation.

Self-organization, as witnessed in every example in this book, occurs when this perturbation takes place. New forms and solutions often emerge from the turmoil. The most dramatic examples of these two phenomena took place in Pittsburgh and Pakistan. Emergence within the VA hospital revealed itself as patients, orderlies, and nurses were empowered to challenge the hierarchy and remind doctors to wash their hands. In Pakistan it altered the relationships between wives and husbands.

It is an empirical fact that most of the world’s cities live forever.⁸ Corporations, on the other hand, live half as long as the average human being. The explanation has to do with the self-organizing and emergent nature of cities as contrasted with companies. True, cities may cycle between decline and ascendance. But the complex interplay between a city’s heterogeneous elements fosters continuing variation and adaptation. Corporations, in the name of efficiency, suppress variation by “getting all the ducks in line.” To optimize productivity, they evolve highly refined and internally consistent operating systems. Payoff results—as long as the music lasts. But in the face of nontraditional competitors or major environmental discontinuities, all that streamlining and reengineering limits diversity, suppresses self-organization by those closest to the disruptive change, and curtails a bottom-up emergent response to cope more effectively. We witnessed this at Genentech and Merck. Nothing fails like success. Overadaptive organizations become inflexible. Disruptive change leaves them as helpless as a beached whale.

Unintended consequences are an inescapable feature of life. Living systems do not follow a linear path. One can disturb them in a manner that approximates a desired outcome—but never fully direct them. Leveling the status hierarchy at the Pittsburgh VA, strengthening the partnership between teachers and parents in Argentina, and bridging the gender divide in Pakistan exemplify outcomes that extended well beyond those that were originally sought or foreseen.

The positive deviance process traverses through all four phases. A non-conforming variant experiences an equilibrium condition as unsatisfactory and expresses its emergent potential to ferret out a winning formula. Then comes the kickoff to the PD approach, which not only perturbs the community’s orthodoxies (e.g., upsets equilibrium) by causing stakeholders to reconsider whether the “undesirable” is “inevitable”—it also mobilizes its members in search of the variant in its midst. They self-organize to ferret out common practices and exceptions to the rule that are outperforming the norm. Emergence of preexisting and (as in the case of the Pittsburgh VA) yet-to-be-discovered solutions can occur. Emergence yields unpredictable, sometimes truly astonishing ways forward. Innovation is accelerated near chaos and emergence invites unintended consequences.

Let’s zoom in on the term chaos. It evokes all manner of unpalatable images—pandemics, the stock market crash of 1932, cataclysmic meteor showers, even the wrong party winning the presidential election.⁹ But “chaos” is all in the eyes of the beholder. Events that evoke one man’s coronary arrest stimulate another’s adrenalin rush. When we strive to catalyze disequilibrium and surf its edge in the positive deviance process, the question is always how much is enough. The group is the wisest guide in determining the productive threshold near chaos where minds are open and learning occurs. Beyond the upper threshold lies chaos itself. Trespass this boundary and the group may disintegrate. Learning shuts down. (Note how the groups in Uganda and Indonesia tiptoed up to the sensitive topics of menstruation and girl trafficking.)

The potential for unintended consequences is ever-present when tampering with a living system. It played out for the good in Pakistan where a narrow quest to improve infant survival bridged the gender gap and increased communication between wives and husbands. At Merck and Genentech, unintended consequences manifested as the corporate immune defense response mobilized itself to thwart further inroads of consultative selling.

Unintended consequences get to the heart of why you never really understand an adaptive problem until you’ve solved it. Problems morph and “solutions” often point to deeper problems. In social life, as in nature, we are walking on a trampoline. Every inroad reconfigures the environment we tread on.

Minimalist Leadership

Understanding nature’s way—modularization, selective variation, preservation of cultural and biological DNA, and the natural progression of change—has clear implications for those in positions of authority. It calls for nothing less than a role reversal in which experts become learners, teachers become students, and authority figures become catalysts for bottom-up change. This isn’t easy. It requires leaders to set aside their egos and habitual identities (being the go-to guy, the decision maker who knows what to do). What, then, becomes of the leader?

Notwithstanding nature’s minimalist approach, important work still remains to be done. Specifically, the new work includes four primary tasks: management of attention, mobilizing those below to engage in discovery, reinforcement to sustain the momentum of inquiry, and the application of means to track progress toward goals. Instead of the “CEO” (chief expert officer), the leader becomes the “CFO” (chief facilitation officer). The job is to guide the PD process as it unfolds. This is as radically different from the traditional model of leadership as the positive deviance process is from the standard model.

Leadership begins with framing the challenge in a compelling way so as to engage others in generating an alternative future. Next, the task is to catalyze a conversation, paying attention to the social architecture to reach beyond the usual suspects and ensure the group takes ownership of its quest. The hardest part is to listen, pay attention, trust the process and the “wisdom of crowds,” and permit the emergent potential of the community to express itself. A weathered marble tablet in Xian, China, commemorates the wisdom of Taoist sage, Lao-Tzu. A loose translation “reflecting our Chinese guide’s best efforts and author interpretation” captures the essence of leadership in the positive deviance context with eloquent simplicity:

Learn from the people

Plan with the people

Begin with what they have

Build on what they know

Of the best leaders

When the task is accomplished

The people all remark

We have done it ourselves