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​​“By working together you can actually find solutions to the problem,” says Liz Rykert, President of Meta Strategies and a Positive Deviance (PD) coach who is working with a team on the Canadian Research Project on Positive Deviance and as lead coach with the Safer Healthcare Now! New Approach to Controlling Superbugs (NACS) intervention. This work is focused on helping to reduce the spread of superbugs in hospitals. As a PD coach Liz acts as a resource, helping others have a conversation where they are comfortable and can listen, respond to each other, and act on the things that they come up with.

“One of the things that I appreciate about Positive Deviance work is that it gets people talking to each other,” says Liz. “They may pass each other in the hall everyday – they know each other, but don’t stop to have a conversation about how well they are doing in preventing infections. With PD, what we are doing is connecting the dots.”

One of the tools Liz is using in her PD coaching is the Discovery Action Dialogue (DAD), which is based on the flow of six questions:

  1. How do you know when someone has an infection?
  2. What do you do to protect yourself and others?
  3. What keeps you from doing this or taking these actions every time?
  4. Is there anyone you know who seems to do a better job of this?
  5. Does anyone have ideas on how we can overcome barriers to the problem?
  6. What needs to be done to make this happen? Any volunteers? Who else needs to be involved?

Liz says that the watershed question is what keeps you from doing this or taking these actions every time? “It is a great way of showing respect and understanding that the problem is beyond your control and a lovely way of saying, we know you know what to do, but sometimes things keep you from doing it. How can we help break down those barriers? Suddenly, people start talking openly.”

“With positive deviance people identify and act on ideas from the frontline,” adds Liz. “It is a process that uses data and this helps define what you are going to work on and how you will know if it is making a difference. Every institution has a very unique culture and that local context is at least 50 per cent of the mix in terms of getting this process going. Knowing how they communicate; who connects with whom; and how things happen formally and informally within the institution are all very important to the process.”

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