Positive Deviant

Step one: Don't presume that you have the answer.

"We were like orphans at the airport when we arrived in Vietnam," Sternin says. "We had no idea what we were going to do. We had no delusions of grandeur. Our attitude was, Oh my God, what's going to happen?"

When Sternin and his wife arrived in Hanoi, they started with a clean slate, a beginner's mind. They were ready to listen, not to talk. They knew little about Vietnam, but they were certain that the only way to come up with a plan to fight malnutrition was to discover it within the Vietnamese village culture itself.

The Sternins, along with the Vietnamese Save the Children staff and a Vietnamese volunteer named Nguyen Thanh Hien, helped mothers identify the positive deviants within their villages -- the mothers whose children were not malnourished, the mothers who had discovered ways to feed and care for their children effectively. They then enabled everyone else in the village to practice those survival behaviors on their own.

Step two: Don't think of it as a dinner party.

Lots of change programs emphasize the importance of cross-departmental teams. Sternin's approach takes the opposite tack: When defining the community that you want to change, you shouldn't mix people from different social groups or departments. Your aim shouldn't be to produce a lively conversation among diverse individuals, and you shouldn't mix and match people to jump-start the flow of creative ideas. Everyone in the group that you want to help change must identify with the others in the group. Everyone must face the same challenges and rely on the same set of resources to come up with answers. If group members don't see themselves as working on identical challenges with identical sets of resources, then positive deviance won't work.

"You can't find someone whose uncle in the next village gives the family free medicine," Sternin says. "That solution won't work for everyone, because not everyone has such a resource. A solution has to be repeatable. It's the same thing in business. If you try to change behavior in order to enhance sales, productivity, or communication, positive deviance can work. However, when you define the community, you have to be careful to use a definition that's acceptable to the group. If the group feels that you're going outside to where things are so culturally different, then it's just another way to impose best practices, and you're not using positive deviance."

Step three: Let them do it themselves.

Set up a situation in which people -- including those who need to change the way that they operate -- can discover, on their own, a better way to do things. Raise questions, but let the group come up with the answers on its own. Establish research guidelines that isolate and analyze the behavior of positive deviants inside the group itself -- and that highlight the superior results that the study achieves.

"We said, 'Let's test this theory out,' " says Sternin. "We went into four villages. We trained women to chart growth by age and weight. They compiled a list, and then we asked them if they knew of any children under age three who came from poor families but were well nourished. The answer came back: 'Có (pronounced 'Gah'), có, có,' " says Sternin, using the Vietnamese word for yes. "Then we asked, 'You mean it's possible today in this village for a very poor family to have a well-nourished child?' Again, we got the same answer: 'Có, có, có.' "

The Vietnamese women were amazed by the discovery. Their reaction: Let's go see what they are doing -- today, before anything changes. "That's how it starts," says Sternin.

Step four: Identify conventional wisdom.

Before you can recognize how the positive deviants stray from conventional wisdom, you first have to understand clearly what the accepted behavior is. Establish what it is that most group members do. Clarify the conventional wisdom of the average and of the majority.

In the case of the Vietnamese children, Sternin asked his village volunteers to observe how all mothers fed their children. The conventional Vietnamese wisdom was that certain foods were low-class, common food, even though these foods were nutritious. In general, mothers didn't actively encourage eating. Some believed that it was not good practice to feed children with diarrhea -- another tenet of conventional wisdom that led to worsening conditions.

"Conventional wisdom said no to eating certain kinds of nutritious foods," says Sternin. "Most people were too busy working to take an active role in feeding their children. They just left food around, and if it fell on the floor, the children might eat it. Or they fed their children once or twice a day. In contrast, the positive deviants fed their children small portions many times a day, because there's only so much rice that a starving child's stomach can hold."