Solution-Focused approaches & the Positive Deviance Process

[Paolo Terni]

In a recent posting I talked about an intervention for reducing hospital infections.
I noted how that intervention had all the ingredients of a Solution-Focused approach, and that the authors called that approach "Positive Deviance".
Some of my friends, in the comments, mentioned that "Positive Deviance" is a school of thought of its own.
That is undoubtedly correct.
However, I still think that Positive Deviance and Solution-Focused approaches share the same foundations, allowing for different focus and goals.

For example, in a presentation that describes the Positive Deviance Process and that can be found online here, Positive Deviance is contrasted to traditional Problem Solving approaches in the following way:
- internally fueled (by "people like us", same culture and resources) vs. externally fueled (by "experts" or internal authority)
- down-up (sic), inside out vs. top-down, outside in
- asset based "what's right here?" vs. deficit based "what's wrong here?"
- begins with analyses of demonstrably successful SOLUTIONS vs. begins with analyses of underlying causes of PROBLEM
- bypasses Immune System (solution shares same "DNA" as host) vs. triggers Immune System "defense response"
(slide number 17).
I think most, if not all, Solution-Focused practitioners could use this very same list to explain how their approach is different from a more traditional problem solving approach.

There are, though, differences between the Positive Deviance Process and Solution-Focused approaches, given the different focus:
- the Positive Deviance Process is used for finding outliers (single individuals who do things differently) in a population or in a community. From the Positive Deviance Initiative website, "Positive Deviance (PD) is a development approach that is based on the premise that solutions to community problems already exist within the community."
- the Solution-Focused approach is mainly used for finding outliers (single behaviors which lead to different outcomes) in a single individual or team. From the Solution Focused Brief Therapy Association website, "because these solutions appear occasionally and already within the person, repeating these successful behaviors is easier than learning a whole new set of solutions that may have worked for someone else".
In other words, the focus of the Positive Deviance Process is a set of individuals; the focus of Solution-Focused approaches is a set of behaviors within a specific individual or team.

Given the different focus, the skills required are different:
- skills for conducting fact-finding interviews: members of the community are interviewed to establish what the norm is and to identify who the "positive deviants" are (i.e. the outliers, individuals who manage to have different outcomes if compared to the norm) for the Positive Deviance Process; once they are identified by other members of the community, they are interviewed to find out what they are doing differently that leads them to different, positive outcomes.
- "skills for not knowing" (De Jong, Berg; 2002) and conversational skills specifically aimed at eliciting exceptions from single individuals regarding the situation viewed as problematic (i.e., times when the person expected the problem but the problem did not occur) for the Solution-Focused practitioners; once exceptions are identified, the person is interviewed to find out what they did differently, or what was different in that specific situation at that specific time, which led to a more desirable outcome.

Notice that the framework of a Solution-Focused conversation and of a Positive Deviance Process are different.
In the Positive Deviance Process the goal is set beforehand and the Process is a tool to meet that goal.
In a Solution-Focused Intervention the goal is to be negotiated with the individual or the team, within the conversation itself.

The key tenet is the same: focusing on solutions rather than problems.
However, while Solution-Focused protocols are born by inductively finding out what works in a conversation with a therapeutic goal, the Positive Deviance Process is born to identify what the outliers do differently within a community of similar individuals tackling problems like the spread of infectious disease, malnutrition, sanitation.

Positive Deviance Process, in focusing on populations, deals with outliers differently from the Solution-Focused approach.
In Positive Deviance Process, a procedure is designed to help other people of the community model the successful behaviors of the outliers (see the "Palmer Method" video here); in Solution-Focused approaches, exceptions are unique to each individuals: there is no "modeling", no "designing", just an invitation to do more of what works, more of what leads to even slightly better outcomes - incremental change is the name of the game.
Positive Deviance Process's aim is to spread best practices found locally to a whole community of similar individuals.
Solution-Focused approaches' aim is to increase the frequency of useful behaviors exhibited by an individual to a whole set of similar situations.

Note: for a health-care perspective on these very topics, go to HOP (Health-care Organizing People)

Cross-posted on my website.

[Hans-Peter Korn]

Thank you, Paolo, for this compliment:

| as usual, you provide me with food for thought!

And HERE is a (IMHO) even more "nourishing" article describing much more details and applications of the "Cynefin" framework - which is a "sense-making framework" and not a "categorization framework"!

Cheers,
Hans-Peter

[Paolo Terni]

Hi Hans-Peter,
thanks for your comment!

You write: "So - let's make use of this obvious useful process!". I could not agree more!

Funny that you mention Positive Deviance and Cynefin. I was actually integrating some idea for my presentation in Texel (which is going to be about SOlution-Focus and NOT Positive Deviance) with the Cynefin framework for decision-making!

Thanks for the reference, I will look it up: as usual, you provide me with food for thought!

Best,
cheers,
Paolo

[Hans-Peter Korn]

Thank you, Paolo, for reflecting on the differences about "Positive Deviance" and "Solution Focus".
For me this differences are an offer to use BOTH approaches in an appropriate way:
The idea, to help other people of the community model the successful behaviours of the outliers may serve as a very useful starting point to search for exceptions which are unique to each individuals as an invitation to do more of what works for the individual already.

In Switzerland the very established "3 - step - models" of apprenticeship is:
"observing the master how to do it / co-working with the master / working alone observed by the master"

So, "modelling the working of the master" seems to be a quite powerful way of learning. And this, for me, is the background of the Positive Deviance Process.
So - let's make use of this obvious useful process!

Concerning "Positive Deviance" I have the impression that it is a very attractive concept maybe because of it's simplicity: "Look - there are few individuals in this community having found a way to master the situation xxx in a better way - based on the same circumstances of all others. So, let's learn how they did that!"
And, by the way, "Positive Deviance" (and not SF) is cited e.g. by by David J. Snowden and Mary E. Boone in the paper about the "Cynefin framework" published in Harvard Business Review with the title "A Leader’s Framework for Decision Making" on page 6 in the left box "Tools for Managing in a Complex Context" as part of "Open up the discussion".