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Posts Tagged ‘positive deviance’

What Healthcare Providers Can Learn From This Taco Bell

Posted by Plish on May 17, 2014

The Best Taco Bell For Medical Procedures


There’s a Taco Bell that I’ve been stopping by for a quick taco or two.  I would stop there to get medical tests if I could.

??? What???

You see, every time I’ve visited and someone at the register needed to go and help on the food assembly line, that person has done something amazing.

Well, at least it’s (unfortunately) amazing by healthcare standards.

The person washes her hands.

I’m not talking the typical ‘bathroom’ wash that you see most people do.  You’ve seen it, it goes like this:

  1. Turn on the water
  2. Use a little soap if around
  3. Wash for about 5 seconds, maybe 10
  4. Shut the water off (if it’s not automatic)
  5. Shake the hands and grab a paper towel to dry(maybe)
  6. Leave

In fact, researchers have found that only about 5 percent of people wash their hands properly.

But, these folks at this Taco Bell are amazing.  They wash the way hands are supposed to be washed, which I must say, I usually don’t see consistently happening in healthcare facilities. (I’ve even seen healthcare workers skip the easier anti-microbial hand sanitizer squirt!)

The Taco Bell folks do the following:

I actually counted to see how long these people wash and rinse and they’re following best practices.    It also doesn’t matter if they’re busy or slow.  I’ve seen workers take the time to wash (and follow with an antimicrobial squirt) no matter how crazy the atmosphere or how long the lines.

This is a TACO BELL people!

Customers are there for their food and they want it quick.   Employees could easily pull a line that’s often heard in healthcare hand-washing studies: “I don’t have time to wash.” But, these conscientious workers have made it a part of their culture to make sure they wash their hands.

What’s even more important is that if employees are taking the time to wash, they certainly are doing other things right as well.

Congrats Taco Bell on Grand!  Keep up the good work!

For all the healthcare facilities out there, it might be worth doing some self-examination and asking, “Why can Taco Bell do it and we can’t?”

If you can’t find the answer, pay Taco Bell a visit and watch.





Posted in Case Studies, Customer Focus, Design, Health Concerns, Healthcare, problem solving | Tagged: , , , , , , , , , , , , , , , , | Leave a Comment »

When US Healthcare Delivery Meets The Cheesecake Factory: The Stuff Innovation is Made of

Posted by Plish on August 24, 2012


What do the U.S. healthcare delivery system and The Cheesecake Factory have in common?

According to Dr. Atul Gawande, potentially a great deal.  The Dr. recently penned an article over at The New Yorker called, “Big Med.”  Inspired by his experience at The Cheesecake Factory (TCF), he wondered if perhaps there weren’t some way that the system at The Cheesecake Factory could be used as a pattern for US healthcare delivery.  After all, TCF delivers millions of meals in a cost-effective and profitable manner – why couldn’t the healthcare system treat millions of people in a cost-effective and profitable manner?

The Dr. shares that, indeed, there are already some clinicians implementing TCF-esque solutions.  While the Dr. doesn’t bring it up,    this article over at The Economist, highlights how healthcare delivery is undergoing innovation in India – reflecting in many ways, Dr. Gawande’s TCF inspired vision.

In response, Steve Denning at Forbes, wrote an article entitled: “How Not to Fix US Healthcare: Copy The Cheesecake Factory.”  Mr. Denning thought that Dr. Gawande was way off base using The Cheesecake Factory as a pattern.  He cited Innovation Scholar, Clayton Christensen, and then claimed that Dr. Gawande’s argument is flawed in these ways:

1.Wrong question
2.Wrong knowledge model
3.Wrong management model
4.Wrong conclusions about scaling

In actuality the above discussion is  both/and vs. either/or.  When trying to come up with truly innovative solutions, the goal is to take two or more ideas/metaphors, slam them together, and see what comes out of the mix.

Personally, I think Dr. Gawande’s perspective is highly provocative and has something going for it. His thinking isn’t ‘pie in the sky.’ There is, as the Dr. demonstrates, plenty of room for standardization and better management of spending/costs without sacrificing care.  Precisely because the TCF model is, on first blush, so different from the healthcare world and yet similar with regards to servicing millions in a cost-effective, profitable manner, that we will benefit greatly from creating a synthesis between healthcare delivery and what goes on in The Cheesecake Factory.

We should smash the TCF metaphor up against current healthcare practices and see what comes out of it.  That’s where great innovation will come from!    After all, the Cheesecake Factory IS successful and is doing something right. Many healthcare institutions in India ARE doing something right. The doctors in Dr. Gawande’s article ARE doing something right, saving money and improving outcomes.   There’s got to be something we can learn, be inspired by, and perhaps  implement and test, when metaphors dance into a tertium quid.

It doesn’t further discussions, and in fact limits solutions, to caricature Dr. Gawande’s insights.  Instead of claiming, as Mr. Denning did, that everything is “wrong” with Dr. Gawande’s vision, the discussion would be furthered by full-hearted listening, combining of metaphor, and dreaming of what can be.

I think the discussion would be even better if done over a meal at The Cheesecake Factory.

Posted in Best Practices, Design, Disruptive Innovation, Healthcare, innovation, problem solving, Service Design, Wellness | Tagged: , , , , , , , , , | 2 Comments »

Looking to Outliers For Innovative Brilliance

Posted by Plish on August 17, 2012

(Before reading please watch the above short video)

I can’t help but smile every time I watch this video.  The innocence of Butters (the character that sits ‘backwards’ on toilets,) is key.  He does something that seems totally normal and makes perfect sense.  With a little creativity he goes above and beyond what is commonly practiced.

If you’re going to read while on the toilet, you need a shelf to hold your reading material, right?

If you want to have a drink, you need a shelf, so why not the same one used for your books?

And best of all?

Flushing is easy; The handle is conveniently located on the left. No getting up, twisting, or turning!

Everybody looks at Butters as if he’s nuts.  Everybody looks at him as if their awkward, minimally functional method of using the toilet is the right way!  But, nevertheless, there’s a wisdom in Butters’ approach – a simple, elegant, wisdom.

Looking to Butters for ideas for improving the toilet experience would be an example of positive deviance.  What is positive deviance?

“Positive Deviance is based on the observation that in every community there are certain individuals or groups (the positive deviants), whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers. These individuals or groups have access to exactly the same resources and face the same challenges and obstacles as their peers. ” (From Positive Deviance website)

In other words, often times solutions to problems come from the fringes.  Solutions come from the people who see what everybody else sees and yet they behave differently.  These people find ways of making the most out of what others see as mundane.

Think about the product opportunities that would exist if we redesigned the toilet experience with Butters’ insights!

How would the toilet look? Where would the toilet paper go?  What would be the best way to deal with the pants around the ankles?

It’s questions like these that can get the ideation ball rolling even if the majority of people won’t use the toilet ‘in reverse.’

Questions based upon the behaviors of positive deviants can be great provocations in designing unique solutions.

But, there is one slight hitch to gaining the insights of these folks:

The Butters of the world usually aren’t in a room boldly offering up their visions of the way things could be…

They’re on the fringes…

Posted in Creative Thinking Techniques, creativity, Customer Focus, Design, innovation, Innovation Tools, problem solving | Tagged: , , , , , , , , , | 1 Comment »

Four Rules for Building a Positive Deviance Repository – A Model Based on Woman’s World Magazine

Posted by Plish on April 28, 2011

Positive Deviance is based on the observation that in every community there are certain individuals or groups (the positive deviants), whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers. These individuals or groups have access to exactly the same resources and face the same challenges and obstacles as their peers. ” (From Positive Deviance website)

“Woman’s World is written for the traditional, family-oriented working woman. Woman’s World delivers a feel-good mix of heart-warming human interest stories and practical everyday solutions for work and home in every issue – America’s premiere weekly service book.” (italics mine) – Woman’s World Mission Statement

While recently thumbing through an issue of Woman’s World magazine, it dawned on me that Woman’s World  is a repository of positive deviance (And consequently is a database of possible business opportunities!).  In fact, Woman’s World’s Mission Statement emphasizes that their goal is to provide practical everyday solutions for work and home.  This also includes solutions for health and beauty. They make it a point to amass and share tidbits of information – helpful information that others may not have thought of or had access to.

These insights come from women who have the same resources and face the same challenges and obstacles as the readers of  Woman’s World.  In fact, many times it is  readers that contribute!

For a buck seventy-nine you get, as the magazine claims on every cover, “A Great Week Made Easy!”.  You also get solutions to problems (that you often didn’t realize you had until you saw them printed),  and you feel better about yourself because you’re making an effort to change (i.e. design) your life, and the lives of those around you, for the better.

How does Woman’s World do this and what can you do to  build a system for sharing positive deviances?

Follow each of these four rules and you’ll be on your way. 

  1. You need a repository or framework where ideas can be exchanged.  It doesn’t have to be high-tech.  Woman’s World is a magazine – it’s old school, not web 2.0! In fact, its paperness is a major strength (See number 2 below)
  2. People need to have easy access to the repository. Woman’s World is usually placed in the check out aisles.  People get it while they’re waiting to do something else!  It also means that it should be easy (and even fun!) to read, easy to navigate.  Information shouldn’t be presented as long drawn out treatises, but as short and sweet pericopes.
  3. People need to see themselves as belonging to a community in which they can share their problems and solutions without judgement.  The members of this community share a common goal:  the growth and/or improvement of individuals, families and communities. 
  4. The repository needs to address what is important to community members. This goes beyond obvious systemic needs (how to do x,y,z more effectively) and includes things like spirituality, health/wellness, etc . 

In addition to these four rules,  there are two guidelines that must be followed:

  • Once you start getting a Positive Deviance Repository in place, don’t forget to experiment and improve on your system.

Violating either of these guidelines will result in stagnation of your system, or worse, alienation of  the system’s users.  Positive Deviances are proposed and adopted from the ground up.  If they’re imposed from the top down, they will often lose their efficacy.  You want people to be active and engaged in reading and contributing to the Positive Deviance Repository.

After all, who wouldn’t want  their customers/members to contribute to the growth of the company and/or society, and for them to feel better at the same time?

Posted in Best Practices, Design, innovation, Innovation Tools, problem solving, Social Innovation | Tagged: , , , , , | 1 Comment »

A New Approach to Education for Minimizing Healthcare Associated Infections

Posted by Plish on May 20, 2010

At any one time around the world, 1.4 million people are suffering from infections acquired in hospitals.  It adds almost 7 billion in cost per year to healthcare facilities and impacts families and people in tragic ways

Big Problem.

What really makes these infections even more tragic is that most of them are preventable through changes in behaviour.

To increase awareness and educate healthcare providers, Kimberly-Clark has started the “Not on My Watch” campaign.  Instead of waiting for institutions to train their employees, Kimberly-Clark is cruising around the country with the “HAI (Healthcare Associated Infection) Education Bus,” a mobile classroom bringing CE accredited courses right to the doorstep of hospitals.

Additional info videos are available on this website along with additional references.

Overall, this is a pretty slick idea to bring CE accredited courses to clinicians as opposed to them having to schedule time away from their work.  Kimberly-Clark should be applauded for their efforts in keeping HAI’s in the forefront of people’s minds.

There are two issues here though that could be improved upon.

First, there doesn’t seem to be any succinct, articulated goal.  Yes, the purpose here is to keep healthcare workers updated on the most current trends in infection management and to bring down the incidence of HAI’s.  But, nowhere is there an explicit goal as there was in the 5 Million Lives Campaign.  The use of the phrase, “Not on my watch,” while powerfully motivating to individuals to prevent HAI’s while they’re on the floor, has a built-in blame as in: “That happened on your watch,” when something happens.  Yes, blame can be a powerful motivator as well, but no one wants towork under fear.

Second, research has shown that educational campaigns are only as good as the systems into which they’re planted.  In other words, people learn and people forget.  Even when people know what the right thing to do is, pressures from hospital admins, superiors, patients and families, often result in the right thing not being done.  I’ve personally witnessed well-educated nurses doing the wrong thing more times than I, or anyone, would like to see.    A perusal of the Tools page , while full of treatment guidelines and recommendations, reveals little that most healthcare workers haven’t already been exposed to.  That said, it is helpful to have these all in one place.

So, is this a good thing that K-C is doing?  Of course! It’s admirable and good to educate. 

But, what would be really cool, and would probably have more impact, is to have a bus full of designers that goes from hospital to hospital teaching them how to apply tools like positive deviance in improving healthcare outcomes.

Hmmmm, I wonder where I can get a bus….

Posted in Best Practices, Customer Focus, Design, design thinking, Health Concerns, Healthcare, innovation, problem solving | Tagged: , , , , , , , | 2 Comments »

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