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Discussion: Applying the Concept of Positive Deviance

Focus on the successful exceptions (i.e., positive deviants), not the failing norm.

—Pascale, Sternin, & Sternin, 2010

Positive deviants—those who are able to innovate and create affirmative results—do so within the same constraints that others face. These outliers reveal how the desired outcomes can be achieved by expanding beyond the boundaries of the status quo, while maintaining a focus on what is professionally, legally, and morally appropriate.

Consider the following example:

In 1990, Save the Children (SC), a nongovernmental organization in the United States, was asked by the government of Vietnam to create a program to enable poor villages to solve the overwhelming problem of childhood malnutrition. Given just six months to create a sustainable solution, those involved realized that they needed to look at the positive results that some had been able to achieve relative to the lack of success others had encountered under similar circumstances. They posed the question: “If some individuals in a community were better able to solve problems than others with access to exactly the same resources, could we use that provocative discrepancy?” Taking this tack, they were able to identify approaches that differed from the norm and apply this knowledge to produce positive results that led to a dramatic improvement in child health (Dura, Singhal, and Sternin, 2009).

In this Discussion, you examine a health care problem or issue and consider how you could apply the concept of positive deviance to produce systems-level change that leads to improved quality.


To prepare:

Review the information in this week’s Learning Resources, including the first chapter in Pascale, Sternin, and Sternin book and the Bradley, Curry, Ramanadhan, Rowe, Nembhard, and Krumholz article.

Reflect on health care quality problems or issues that warrant systems-level change. Consider the significance of each problem/issue. Identify one, in particular, that you would like to focus on for this Discussion. Note: You may use the quality improvement issue that you selected for your Course Project, if appropriate.

With this problem or issue in mind:

How would you apply the principles of positive deviance to address this problem/issue? What specific steps would you take to move from identification of the problem/issue through evaluation of outliers to implementation of a larger scale change to improve quality?

What examples of positive deviance, if any, are you aware of related to this problem/issue? Conduct research as necessary to see if you can locate one or more instances of positive deviance.


Post a brief description of the health care quality problem or issue you selected and explain how it could be addressed using the principles of positive deviance.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional resources.


Required Readings

Bradley, E. H., Curry, L. A., Ramanadhan, S., Rowe, L., Nembhard, I. M., & Krumholz, H. M. (2009). Research in action: Using positive deviance to improve quality of health care. Implementation Science, 4(25), 1–11.

Retrieved from the Walden Library databases.

The authors of this article review literature on positive deviance as well as break down a step-by-step approach in applying positive deviance in a research model to improve quality.

Dingfelder, H. E., & Mandell, D. S. (2011). Bridging the research-to-practice gap in autism intervention: An application of diffusion of innovation theory. Journal of Autism & Developmental Disorders, 41(5), 597–609.

Retrieved from the Walden Library databases.

The authors discuss the need to apply Roger’s diffusion of innovation theory in an effort to improve autism intervention for patients.

Seidman, W., & McCauley, M. (2009). A scientific model for grassroots O.D. Organization Development Journal, 27(2), 27–37.

Retrieved from the Walden Library databases.

Seidman and McCauley explore the grassroots nature of an organization’s culture and the effect of positive deviance, fair process, and neuroscience on creating change in the culture.

Required Media

Laureate Education (Producer). (2013h). Risks and benefits of positive deviance. Retrieved from https://class.waldenu.edu

Note:  The approximate length of this media piece is 4 minutes.

Dr. Kenneth Rempher discusses how to encourage positive deviance while maintaining ethical and moral standards.

Accessible player

Optional Resources

Pascale, R. T., Sternin, J., & Sternin, M. (2010). The power of positive deviance: How unlikely innovators solve the world’s toughest problems. Boston, MA: Harvard Business Press.

Chapter 1, “Introduction: Against All Odds” (pp. 1–18)

NURS 6231: HEALTHCARE SYSTEMS AND QUALITY OUTCOMES – Discussion 5 (Grading Rubic and Media Attached)
MSN Discussion Rubric Criteria Levels of Achievement Outstanding Performance Excellent Performance Competent Performance Room for Improvement Poor Performance Content-Main Posting 30 to 30 points -Main posting addresses all criteria with 75% of post exceptional depth and breadth supported by credible references. 27 to 29 points -Main posting addresses all criteria with 75% of post exceptional depth and breadth supported by credible references. 24 to 26 points Main posting meets expectations. All criteria are addressed with 50% containing good breadth and depth. 21 to 23 points Main posting addresses most of the criteria. One to two criterion are not addressed or superficially addressed. 0 to 20 points Main posting does not address all of criteria, superficially addresses criteria. Two or more criteria are not addressed. Course Requirements and Attendance 20 to 20 points -Responds to two colleagues’ with posts that are reflective, are justified with credible sources, and ask questions that extend the Discussion. 18 to 19 points -Responds to two colleagues’ with posts that are reflective, are justified with credible sources, and ask questions that extend the Discussion. 16 to 17 points Responds to a minimum of two colleagues’ posts, are reflective, and ask questions that extend the Discussion. One post is justified by a credible source. 14 to 15 points Responds to less than two colleagues’ posts. Posts are on topic, may have some depth, or questions. May extend the Discussion. No credible sources are cited. 0 to 13 points Responds to less than two colleagues’ posts. Posts may not be on topic, lack depth, do not pose questions that extend the Discussion. Scholarly Writing Quality 30 to 30 points -The main posting clearly addresses the Discussion criteria and is written concisely. The main posting is cited with more than two credible references that adhere to the correct format per the APA Manual 6th Edition. No spelling or grammatical errors. ***The use of scholarly sources or real life experiences needs to be included to deepen the Discussion and earn points in reply to fellow students. 27 to 29 points -The main posting clearly addresses the Discussion criteria and is written concisely. The main posting is cited with more than two credible references that adhere to the correct format per the APA Manual 6th Edition. No spelling or grammatical errors. 24 to 26 points -The main posting clearly addresses the Discussion criteria and is written concisely. The main posting is cited with a minimum of two current credible references that adhere to the correct format per the APA Manual 6th Edition. Contains one to two spelling or grammatical errors. 21 to 23 points -The main posting is not clearly addressing the Discussion criteria and is not written concisely. The main posting is cited with less than two credible references that may lack credibility and/or do not adhere to the correct format per the APA Manual 6th Edition. Contains more than two spelling or grammatical errors. 0 to 20 points -The main posting is disorganized and has one reference that may lack credibility and does not adhere to the correct format per the APA Manual 6th Edition or has zero credible references. Contains more than two spelling or grammatical errors. Professional CommunicationEffectiveness 20 to 20 points -Communication is professional and respectful to colleagues and response to faculty questions are answered if posed. -Provides clear, concise opinions and ideas effectively written in Standard Edited English. -Responses posted in the Discussion demonstrate effective professional communication through deep reflective discussion which leads to an exchange of ideas and focus on the weekly Discussion topic. 18 to 19 points -Communication is professional and respectful to colleagues. -Provides clear, concise opinions and ideas effectively written in Standard Edited English. -Responses posted in the Discussion demonstrate effective professional communication through deep reflective discussion which leads to an exchange of ideas and focus on the weekly Discussion topic. -Responses are cited with at least one credible reference per post and a probing question that extends the Discussion. Adheres to the correct format per the APA Manual 6th Edition. No spelling or grammatical errors. 16 to 17 points -Communication is professional and respectful to colleagues. -Provides clear, concise opinions and ideas effectively written in Standard Edited English. -Responses posted in the Discussion demonstrate effective professional communication through deep reflective discussion which leads to an exchange of ideas and focus on the weekly Discussion topic. -Responses are cited with at least one credible and/or contain probing questions that extends the Discussion. Adheres to the correct format per the APA Manual 6th Edition. May have one to two spelling or grammatical errors. 14 to 15 points -Communication is professional and respectful to colleagues. -Provides opinions that may not be concise or ideas not effectively written in Standard Edited English. -Responses posted in the Discussion may lack effective professional communication that does not extend the Discussion, leads to an exchange of ideas and/or not focused on the weekly Discussion topic. -Responses are not cited and/or do not contain a probing question. May not adhere to the correct format per the APA Manual 6th Edition. May have more than two spelling or grammatical errors. 0 to 13 points -Communication may lack professional tone or be disrespectful to colleagues. -Provides opinions that may not be concise or ideas not effectively written in Standard Edited English -Responses posted in the Discussion lack effective professional communication through discussion that does not extend the Discussion, do not lead to an exchange of ideas and/or not focused on the weekly Discussion topic. -Responses are not cited and do not contain a probing question. May not adhere to the correct format per the APA Manual 6th Edition. May have multiple spelling or grammatical errors. Timely Submission 0 to 0 points All criteria met: Initial post submitted on time. Response to two peer initial posts. Response on 3 separate days. -5 to 0 points 5 points deducted for responding to less than two peers or 5 points deducted for responding less than three days. -10 to -5 points 5 points deducted for responding to less than two peers and 5 points deducted for responding less than three days. -10 to -10 points 10 points deducted for Initial post submitted late. -20 to -15 points Initial post submitted late and 5 points deducted for responding to less than two peers and/ or 5 points deducted for responding less than three days. © 2016 Laureate Education, Inc. Page 5 of 5