Canadian HR Reporter

SEPTEMBER 8, 2014 Canadian HR RepoRteR & StRategiC Capability netwoRk Contagious culture change A positive deviance approach can infect organizations with positive culture By Liz Bernier During a major C. difficile out- break in a Toronto hospital ward, a husband and wife both contracted the infection. e wife became so ill, she ended up in a long-term care facility. e husband died. "ose stories happen every five minutes in health care — they are constant," said Michael Gardam, director of Ignite Consulting and an infectious disease specialist in toronto. "If it's not C. difficile, it's someone falling, breaking a hip. It's someone lying in bed getting a pres- sure ulcer. It's someone getting the wrong medication… these things are a dime-a-dozen." Just about everyone has some sort of story about a negative health-care experience. And it's stories like this that demonstrate just how high the stakes are, just how critical it is for health-care workers to get it right. "is is what motivates me in the work that I do — trying to prevent these terrible stories from happen- ing," said Gardam. When he was asked several years ago to lead a group looking at how to prevent the spread of a super- bug, Gardam found the experience frustrating. "It really didn't work — and the rates of the superbug (infections) kept going up," he said. But through that experience, Gardam met a group of American researchers who took an unusual tact: Instead of developing a tradi- tional change management model, they focused on a positive deviance approach. Most organizations follow a fairly standard script when approaching a problem or implementing change: e leadership team meets behind closed doors, hammers out a strat- egy and then hands it down to the organization at large. But when that new "cure-all" change strategy reaches front-line employees, it's rarely accepted with open arms, said Gardam. his experience working in the health-care field — and specifically in the area of infection control — has given him a unique insight into why that traditional change management approach usually doesn't work. "e sort of traditional approach that we use… is education," he said during a Strategic Capability net- work event in toronto. "When that doesn't work, we'll do it again. And when that doesn't work, we'll make the education mandatory. And, at some point, maybe it'll sink in and people will start doing what they're supposed to do." Best practices, detailed data and an evidence-based approach are the lynchpins of this traditional ap- proach — but they aren't always the right solutions, he said. "We love our evidence-based practice… but, of course, for many of the things we're trying to do, the evidence may not be ideal," he said. "We love our information and data, and we always want more in- formation and data. But one of my favourite phrases is 'You can't fatten a cow by weighing it.' We're very good at collecting stuff but we don't nec- essarily do anything with that stuff… We're not necessarily taking that and saying, 'So what? What are we going to do about this?'" Positive deviance presents an entirely different approach. Instead of crunching all the data and devel- oping a sweeping, one-size-fits-all set of best practices, a positive de- viance approach focuses only on the outliers — the best outcomes — and examines what is different about them. "Positive deviance is a social phe- nomenon where there are some people in a particular population that outperform others," he said. "ey don't know they're special, they don't know they're good, they just do their thing and they're out- performing. It's been around forever but, in the last 40 years, it's started to be used as an approach to changing problems." When designing a solution, it's im- portant to consider there are differ- ent types of problems, said Gardam: simple, complicated and complex. "A simple problem is like baking a cake — you follow the recipe, you put it in the oven, there's going to be a cake in there. It's not going to be a puppy, it's not going to be a car; it's going to be a cake. And if the cake isn't perfect, you can tweak the rec- ipe and then you can figure it out," he said. "A complicated problem, as you might expect, is a little but more in- volved. (One example) is sending a rocket to the moon — many more steps involved, many more people involved but, ultimately, it's linear. You can predict what's going to hap- pen. If nothing goes wrong, you're going to get there." A complex problem, however, is like raising children: each child is highly individual and there is no one script or solution to follow. "Much of what we deal with in health care is complex like that — you can't come up with a script on how to do it," he said. "So for simple problems, like bak- ing a cake, one size fits all. You want to standardize. is is the world of problem-solving, of checklists, of best practices — this is the world where education really is going to get you a long way. "In a complex world, all the rules change. And once we acknowledge that the rules are different, we use different tools to try to bring about change in complex environments." A key factor in complex problems is the "social immune response," said Gardam — people may be quite of- fended when you try to impose a solution. "no one's going to say, 'Whoa, back off buddy, I don't want your cake recipe.' But if I come and tell you how to do something (more com- plex), you may very well be offended. What if I show up and tell you how to raise your children? It's probably going to be offensive. Why? Because it's very complex. I don't know you, I don't know your children, I don't know what's important to you… in a complex world, one size never fits all," he said. Implementing culture change when the problems are complex isn't about standardized solutions — and it's also not about a strict, top-down hierarchy, said Gardam. stRICt > pg. 10 Credit: Lightspring/Shutterstock

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