Excerpt from Nurse Leader, April 2008

Innovation has become a buzzword.  Commercials shout it, magazines bold it, and leaders attempt to sustain it. Innovation by definition is the introduction of something new. ¹  All new ideas start out as different or deviant ideas.  Deviant ideas have spawned healthcare innovation throughout history and are needed to continue the evolution of healthcare.  Consider the positive deviant, Ignaz Phillip Semmelweis, a Hungarian Physician working in Vienna in the mid-1800s.  He researched the higher morality rate for women who were delivered by physicians verses midwives.  He concluded it had something to do with the cleanliness of the physicians' hands.  When Semmelweis implemented a rigorous hand washing and scrubbing procedure in the doctors' ward with chloride-of-lime solutions, a powerful antiseptic, the incidence of puerperal fever dropped from 17% to 1%.  This deviant made a great difference to the women in that hospital, but others did not accept his ideas or behavior until 4 decades later.  Imagine the lives saved if a positive deviance leader could have recognized him for what he was and been able to facilitate the sharing among peers necessary for others to adopt his strange new idea.²

Although positive deviance has always existed, nurse leaders are beginning to actively use the concepts of positive deviance as part of their problem-solving tool set to address and manage the challenges of contemporary healthcare organizations.  We will describe positive deviance theory and how it relates to innovation; an ever-present need for transformational leaders.  In addition, positive deviance strategies for nurse leaders will be explored as a means to describe tangible approaches to encourage development of sustainable, innovative ideas from inside the organization.  Nurse leasers can use this information not only for personal development, but also to more actively engage staff in the work of innovation without the historic fear associated with change.

DEVIANCE

All too often, nurse leaders encounter the behaviors of deviants, those who stray from the norm.  In most cases, deviants are perceived as troubling disruptors.  The dictionary defines a deviant as one who differs from a norm, especially a person whose behavior and attitudes differ from accepted social standards.¹   traditionally, this type of person is typecast as a trouble maker.  They may see the world and the work they do from a different perspective than their peers; they ask more questions, they need more explanations, and they are not afraid to try something that others view as risky.  

In contrast to the troubling disruptor, a positive deviant is an individual who exhibits the characteristics of a deviant, but whose exceptional behaviors enable her to get better results than her coworkers with the exact same resources.³  Transformational leaders will recognize the power of positive deviants to creatively solve different problems in ways that optimize the limited resources of the organization.

It is interesting to note that innovative cultures are in fact deviant cultures.  Furthermore, the most innovative member of an organization may very well be perceived as the most deviant.  A culture that fosters creativity and experimentation is necessary for both innovations and positive deviants to thrive.  In healthcare, there is a dearth of innovative cultures because the nature of healthcare inherently requires behaviors that seek stability and safety.  To achieve the best patient outcomes, healthcare workers are expected to follow the rules and maintain the traditional, conservative status quo.  Behaviors that epitomize compliance and conformity are rewarded and reinforced.  Many positive deviants are told to become more like their peers without investigation of the results obtained by either.   There are seven strategies for optimizing innovation through the encouragement of positive deviance.  The following strategies are particularly useful for organizations considering or already engaged in the Magnet journey to excellence. 

Strategy #1:  Look to the inside for change management resources

Strategy #2:  Accept that leaders cannot possibly have all the solutions and be willing to look inward first for answers.

Strategy #3:  Ask the best question

Strategy #4:  Nurture and encourage positive deviance and innovation

Strategy #5:  Recognize the value of team

Strategy #6:  Look with a different lens at the people in your organization who are different.

Strategy #7:  Be present

References

Random House Webster's College Dictionary,  New York: Random House, 2005:639

Sinclair WJ, Greiner K. When the task is completed, can we say we did it ourselves?  A quest to eliminate MRSA in the Veteran's Health Administration's hospitals in Pittsburgh.  2007

Morris N.  A comparative analysis of the diffusion and participatory models in development communication.  Commun Theory 2003; 13:225-248