You are on page 1of 3

This article was downloaded by: [University of Oklahoma Libraries]

On: 30 March 2015, At: 03:11


Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK

Health Communication
Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/hhth20

Communicating What Works! Applying the Positive


Deviance Approach in Health Communication
a
Arvind Singhal
a
Department of Communication , University of Texas , El Paso
Published online: 13 Sep 2010.

To cite this article: Arvind Singhal (2010) Communicating What Works! Applying the Positive Deviance Approach in Health
Communication, Health Communication, 25:6-7, 605-606, DOI: 10.1080/10410236.2010.496835

To link to this article: http://dx.doi.org/10.1080/10410236.2010.496835

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained
in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the
Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and
are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and
should be independently verified with primary sources of information. Taylor and Francis shall not be liable for
any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever
or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of
the Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://
www.tandfonline.com/page/terms-and-conditions
Health Communication, 25: 605–606, 2010
Copyright © Taylor & Francis Group, LLC
ISSN: 1041-0236 print / 1532-7027 online
DOI: 10.1080/10410236.2010.496835

Communicating What Works! Applying the Positive Deviance


Approach in Health Communication
Arvind Singhal
Department of Communication
University of Texas, El Paso
Downloaded by [University of Oklahoma Libraries] at 03:11 30 March 2015

It [positive deviance] is the most fascinating idea anyone has in U.S. hospitals is pitifully low—averaging between 35 and
had to solve the problem [of hospital-acquired infections] in 40% (Singhal & Greiner, 2008). That means an interaction
a century. (Gawande, 2007, p. 27) between a health care worker and a patient in a U.S. hos-
Most health communication campaigns, especially those pital, more than likely, carries the risk of infection transfer.
A leading bacterial source of HAIs is methicillin-resistant
that draw upon the diffusion of innovations tradition, are
premised on the following tenets (Rogers, 2003; Singhal & Staphylococcus aureus (MRSA), a deadly pathogen resistant
Dearing, 2006; Singhal, 2010): that new health information to commonly used antibiotics. MRSA infections have quin-
tupled in the United States in the past decade, and MRSA is
or ideas come from the outside and are promoted by a change
agency through expert change agents, who use persuasive a formidable enemy, for it can survive for up to 6 weeks on
surfaces and transmits easily through contact.
communication strategies to educate their client audience.
Amidst this alarming reality, a handful of U.S.
In this short essay, an alternative conceptualization of dif-
fusing health innovations is broached whose premise is that hospitals—Billings Clinic in Montana, VA hospitals in
Pittsburgh, Albert Einstein in Philadelphia, Franklin Square
innovative ideas are often lurking within the system, where
Hospital Center in Baltimore, and the University of
the change agents’ primary role is to facilitate a process
whereby which the community can self-discover these ideas, Louisville Hospital Center—have shown sharp, almost
unbelievable, declines in MRSA infections in the past
and where dialogue and “social proof” result in an organic
spread of the innovation, in contrast to passive adopters three years, ranging from 84 to 30% (Buscell, 2008;
buying into a change agency’s prescription. Lloyd, Buscell, & Lindberg, 2008; Singhal, Buscell, &
McCandless, 2009; Singhal & Greiner, 2008).
This alternative approach to diffusing health information
or ideas is known as the positive deviance (PD) approach. What are these hospitals doing differently? As opposed
PD is an approach that enables communities to discover the to the traditional approach of focusing on what does not
work, and communicating with, motivating, and rewarding
wisdom they already have, and finds a way to amplify it
(Pascale & Sternin, 2005; Singhal & Dura, 2009). We illus- employees to fix those problems, these hospitals are focus-
trate the key tenets of the PD approach through an example ing on what works, believing that among its employees
are individuals who practice certain simple yet uncommon
of its application in dramatically reducing hospital-acquired
infections in U.S. health care settings. behaviors that prevent MRSA transmission. For instance,
in these hospitals, the following uncommon behaviors were
Despite being 100% preventable, hospital-acquired infec-
observed:
tions (HAIs) kill 100,000 people each year in the United
States, mainly because hygiene protocols are compromised. – A patient who refuses to make eye contact with a doctor
That is more deaths than breast cancer, HIV/AIDS, and road or nurse if he does not hear the tap run or the sanitizer’s
accidents combined. Adherence to hand hygiene protocols dispensing swish. He then alternatively looks at the wash
basin and the health care provider until the nonverbal
Correspondence should be addressed to Arvind Singhal, Department of
equivalent of “please wash your hands” is understood.
Communication, University of Texas, El Paso, 202 Cotton Memorial, El – A pediatric anesthesiologist who carries her little patients
Paso, TX 79968. E-mail: asinghal@utep.edu in her arms to the operation theater. She notes that the
606 SINGHAL

act of carrying a child, in contrast to wheeling the child girls, increasing school retention rates, and promoting higher
in, has a calming effect on the baby, is highly reassuring levels of condom use among commercial sex workers.
to the parents, and creates a compassionate ambience in Health communication scholars and practitioners can
the surgical theater. Further, a calm baby means that it is gain much from further incorporating this asset-based
easier to administer anesthesia, hook IVs, and such. approach in their quest to improve the quality of life of
– An intensive care unit (ICU) nurse who is not afraid to individuals and communities.
hand a sanitized gown and a pair of gloves to a surgeon
who drops in to check on his patient. While most nurses REFERENCES
dare not verbally confront a surgeon, she knows that a
cordial attitude and warm smile helps her overcome the Buscell, P. (2008, Autumn). Mapping the positive deviance/MRSA preven-
power differentials. tion networks at Pennsylvania and Montana health care facilities shows
promise. Prevention Strategist, pp. 41–45.
These individuals are “positive deviants” because their Dura, L., & Singhal, A. (2009). Will Ramon finish sixth grade? Positive
“deviant” behaviors, many of them communicative, are not deviance for student retention in rural Argentina. Positive deviance
wisdom series, Number 2, pp. 1–8. Boston: Tufts University, Positive
the norm, and “positive” as they model the desirable MRSA- Deviance Initiative.
Downloaded by [University of Oklahoma Libraries] at 03:11 30 March 2015

prevention behaviors. These positive deviants—patients, Gawande, A. (2007). Better: A sugeon’s notes on performance. New York:
doctors, and nurses—make distinctive and valuable contri- Metropolitan.
butions to enhancing quality of care and patient safety. In the Lloyd, J., Buscell, P., & Lindberg C. (2008, Spring). Staff driving cultural
transformation diminishes MRSA. Prevention Strategist, pp. 10–15.
PD approach, through a set of dialogue and discovery pro- Pascale, R. T., & Sternin, J. (2005, May). Your company’s secret change
cesses, essentially communicative processes, the multiple agents. Harvard Business Review, pp. 1–11.
identities and contributions of the positive deviants are col- Pascale, R. T., Sternin, J., & Sternin, M. (2010). The power of positive
lectively mobilized and amplified for the larger public good. deviance: How unlikely innovators solve the world’s toughest problems.
Boston: Harvard University Press.
As more people discover these positive deviants among them Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free
(social proof) and learn how they practice safety, the norm Press.
across the institution begins to shift (Singhal, 2010). Singhal, A. (2010). Turning the diffusion of innovations paradigm on its
Evaluations of PD initiatives in the United States and head. In A. Vishwanath & G. Barnett (Eds.), Advances in the study of the
diffusion of innovations: Theory, methods, and application. New York:
in more than three dozen countries show that one of the Peter Lang.
main reasons why PD works is because the community Singhal, A., Buscell, P., & McCandless, K. (2009). Saving lives by chang-
owns the solution, self-discovers it through dialogic inquiry, ing relationships: Positive deviance for MRSA prevention and control in
and there is “social proof” that those ideas can be imple- a U.S. hospital. Positive deviance wisdom series, Number 3, pp. 1–8.
Boston: Tufts University, Positive Deviance Initiative.
mented locally with no extra resources (Dura & Singhal,
Singhal, A., & Dearing, J. W. (Eds.). (2006). Communication of innova-
2009; Pascale, Sternin, & Sternin, 2010; Singhal & Dura, tions: A journey with Ev Rogers. Thousand Oaks, CA: Sage
2009). Positive deviance is now being applied widely in Singhal, A., & Dura, L. (2009). Protecting children from exploitation
U.S. hospitals to address such diverse issues as medication and trafficking: Using the positive deviance approach in Uganda and
reconciliation, diabetes control, end-of-life diagnosis, and Indonesia. Washington, DC: Save the Children.
Singhal, A., & Greiner, K. (2008). Do what you can, with what you have,
HIV/AIDS prevention. In overseas contexts, PD has been
where you are: A quest to eliminate MRSA at the Veterans Health
used to address malnutrition, childhood anemia, the eradica- Administration’s hospitals in Pittsburgh. Deep Learning, 1(4), pp. 1–14.
tion of female genital mutilation, curbing the trafficking of Complexity-in-Action Series. Allentown, NJ: Plexus Institute.