In the last month I have attended two important industry events, the IDN Summit and Expo in Orlando and the annual MediClick User Conference in Raleigh. Both invigorated my long-held belief in the value of stepping beyond the walls of our comfort zones on a regular basis to spend time learning from our customers and colleagues.
Stepping out, so to speak, is without a doubt the best way to find out about new ways to solve common problems; and even better, to find out how to solve problems you didn't even know you had.
There is a concept called Positive Deviance, which Dr. Jon Lloyd, surgeon and senior clinical advisor with the Plexus Institute, discussed during a Summit session in Orlando. Positive Deviance teaches us how to identify individuals within our community, discover their uncommon practices that lead to success, and then use these practices to facilitate our own particular solutions and improvements.
Positive Deviance is all about "bottom up" problem solving. (I do like the term – it can be construed as an oxymoron in certain contexts or an apt description of the personality of a good friend!) Before I apply Positive Deviance to the healthcare supply chain, let me share one of Dr. Lloyd's examples of how well it can work.
Lloyd, a member of the Positive Deviance Initiative Advisory Board, used the epidemic of childhood malnutrition in 1990s Vietnam to describe the concept in action.
The Vietnamese government asked Jerry Sternin, Asian Director of Save the Children Federation, and his wife Monique, to find a solution to a major national crisis. An astounding 85% of children under the age of five were moderately to severely undernourished.
As experts sometimes do, the Sternins could have studied a subset of "representative" villages, formulated causes of childhood malnutrition and comprised a list of best practices to be implemented by the government nationwide. This, of course, would be the classic top-down approach.
Instead, the Sternins formed a team of individuals from four villages and worked closely with them "on the ground" to understand and solve the crisis from the bottom up.
The team identified families whose children appeared better nourished than the general village populations. Through a series of interviews with these Positive Deviant families, the workers discovered a list of common practices: adding available sources of protein like shrimp or peanuts to the regular diet of rice, feeding the children more than the usual two meals per day, and feeding kids more – not less, as was the custom – during bouts of illness.
Then, instead of printing up a list of best practices, the Sternins helped organize several community dinners where the rice was provided. The price of admission: a protein source. This motivated villagers to get in the habit of gathering protein, an act that enabled them to quickly solve their own nutrition problems.
The Positive Deviance approach worked. Understatement! Malnutrition rates dropped from 85% to 15% in just three months!
Dr. Lloyd's story came to mind two weeks ago when our customers met in Raleigh for the MediClick User Conference. I must tell you I stand in awe of our customers and what was accomplished together in the three days they were with us. The one-on-one coffee break exchanges, the customer-taught classroom sessions, and the peer-to-peer interactions enriched everyone, and they revealed ways we could improve our products and our company. The power of Positive Deviance was bountiful.
Let me share one example, which I was witness to by virtue of buying the beers. A supply chain director at a large teaching hospital that had recently gone live on MediClick for the Supply Chain could not get his requisitioners – usually nurses with pressing clinical duties – to look at existing backorders before placing a requisition for out-of-stock items. The nurse on the 1st shift sees an item is out of stock and orders it. The nurse on the 2nd shift, seeing that the item is … yep … still out of stock, walks over to the computer, enters the same requisition again, and hurries back to his clinical duties WITHOUT glancing a couple of columns over on the order guide to see that the item is ALREADY backordered. Net result: they need 5 but end up with 10, creating yet another pocket of expensive inventory bloat.
Over our vintage IPAs the MediClick newbie shared his problem with another MediClick customer. This more seasoned veteran explained how she solved the very same dilemma by using a clever teaching approach to get the folks on the floors in the habit of checking for existing backorders before pushing the "finish" button. She also talked about her high-impact meetings with the departmental managers as she showed them the havoc that inventory bloat was wreaking on their monthly expense reports. Best of all, she exuded an empathy that made the new guy realize he wasn't the first one up this creek, and she gave him the paddle.
I spent three wonderful days with our customers, on the front line if you will, and it only strengthened my conviction that they are the ultimate source of uncommon solutions. I'm not sure that they would cotton to being considered Positive Deviants, but our customers are indeed consummate change agents.
Your Positive Deviants are out there, too, brimming with knowledge. They are patients, and they are also the nurses, techs, engineers, cleaning staff, even physicians from our own organizations or others. Seek them out, sit down for a chat, and be inspired by what you learn that can help you create a better supply chain.
Just as the villagers who were motivated by the improved health of their children, once you start, you won't stop – the successes and flow of ideas are addicting. And upon your next promotion, make sure to shout out a big thanks to your allies and enablers: those lovable Positive Deviants.



