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CPSI Share                                                  
4/18/2011 6:00 PM
​​As a facilitator and seasoned coach leading change projects, Erika Bailey is deeply steeped in ideas of how to help people get to where they want to go without actually doing their work for them. While attending a Conference in 2007, she was intrigued by a session named Positive Deviance (PD) and wanted to learn more. Leaving the session inspired, Erika quickly began researching PD, became connected with the PD community and has since become a PD coach with the Canadian Positive Deviance Research Project and is a coach/ faculty member of Safer Healthcare Now! New Approach to Controlling Superbugs to help control the spread of infection in hospitals.

“As a guardian of the process, my coaching role is to support teams in applying the PD philosophy and tools, while at the same time being really curious about how PD is evolving,” says Erika. “PD is not always one thing and it does not look the same everywhere you go.  It can be helpful for site teams to have someone ‘helicoptering’ above the process, asking questions, and nudging them to try something new.” PD can be a very elusive and vague concept until you start doing the work.  Having a coach can help you answer questions along the way, gain support, and coach you through organizational challenges.

Positive Deviance is about findng ways to deviate positively from the norm, and more importantly, finding ways where people are already deviating from the norm.  “Anytime you have a big ugly problem that is difficult to look at -- such as nosocomial infections, you likely have people who are deviating from the norm (the poor rates) despite having the same access to resources,” says Erika. “If the rates of infection are not 100 per cent, then you know there are positive deviants out there. By discovering who these people and practices are, you discover and create practices to help people stay healthy and not get infected.”

With PD, the front-line people own the problem and own the solutions. Where are the positive deviants, what are they doing and how are they doing it? Look for positively deviant behaviours, positively deviant people and then look at the system to see if you can replicate it. “Unit to unit, you can look at what is positively deviant, can it be applied here, and say okay let’s try it,” says Erika.”If it useless move on and try something else that is positively deviant.”  By throwing out the discovered data that is “true but useless” you allow for each unit to discover what is going to work for them in their context. 

Look at the barriers to being positively deviant. Being in dialogue with others can get things moving in a new direction. “There are a zillion things that get in the way of doing the right thing when it comes to washing hands, or donning personal protective equipment,” adds Erika. “Many tiny pieces get unearthed through this process and the dialogue with one another. PD methods make a space to say it is not always easy to use best practices because of these barriers.”  By asking what keeps you from doing the things you know you should be doing 100 per cent of the time? PD invites people to comment on what slows them down or prevents their consistent use of best practices. 

Innovation – At times you will find a gap and find something that is just not there and needs to be there, so you need to innovate and make the change.  Many sites have discovered little points of innovation opportunity that solve procedural, safety, and relational problems.  A simple innovative solution (as small as a sticker, or as big as a culture shift in peer-to-peer accountability) can make all the difference in making it easier for healthcare workers to enact positively deviant behaviours. 

“Most often, the command and control works in hospitals, but we’re noticing that in infection control the ground-up approach through PD is showing some really great results,” adds Erika. “The work that I do as a PD coach impacts people’s lives and I find that very rewarding.”

If you are interested in learning more about controlling the spread of superbugs through Positive Deviance, visit or