“We must be the change we wish to see in the world.” -Mahatma Gandhi

It seems I’ve heard or seen this quote a thousand times – in graduation speeches, on high school yearbook pages, so on and so forth. After awhile, it just seemed overused, and it lost its motivational impact.

It seems I’ve heard or seen this quote a thousand times – in graduation speeches, on high school yearbook pages, so on and so forth. After awhile, it just seemed overused, and it lost its motivational impact.

However, the saying took on a renewed meaning for me this week, as I attended the first day of the 3M Infection Prevention Leadership Summit in St. Paul this week, and sat in on a talk given by Jon C. Lloyd, MD, FACS.

He talked about an idea known as Positive Deviance (PD), which, according to the website, 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 people, it says, face the same challenges and have the same resources as everyone else. The PD approach, then, looks to teach a community or group the solutions found by the positive deviants not by just telling them, but by actively engaging them in the solution.

For example, Dr. Lloyd discussed the work of Jerry and Monique Sternin, a couple who traveled to Vietnam to experiment with using the PD approach to promote behavior change in families facing childhood malnutrition.

According to Dr. Lloyd, the families with the malnourished children would feed rice-only. Meanwhile, families with children with better nutrition would collect shrimp, crabs, peanuts and other protein to add to the rice, and would feed small meals throughout the day to the children.

As part of the PD approach, the Sternins helped the families struggling with malnutrition by bringing them to the homes of the more successful, “resource families.” The learning families would be responsible for bringing the protein sources to the resource families home, and there, the resource families would teach the learning families their solutions. The families would learn through the “primacy of action,” Dr. Lloyd explained. “Knowledge alone doesn’t change behavior,” he said.

By learning this new behavior, the families struggling with malnutrition adopted new solutions to feeding their children. As a result, they saw positive effects – weight gain in the children in a matter of weeks. And, once they’d learned this new behavior, they continued to live by it — because they had learned it, and as Dr. Lloyd said, “People don’t turn their back on things they learn themselves.”

Dr. Lloyd went on to explain how this PD approach can be applied in hospitals and surgical facilities to change infection control practices to lower rates (and hopefully eliminate) hospital-acquired infections (HAIs).

He said the PD approach in health care began at his hospital, the Pittsburgh VA Health Care System, with a group of volunteers – everyone from infection preventionists to surgeons to nurses to housekeeping – who wanted to change infection control practices to decrease HAIs. Many of these volunteers are classified as “touchers” – front line clinicians who are directly touching patients on a daily basis and thus main culprits for transmission of infection.

“Who could know better than touchers how to prevent transmission in their own line of work?” Dr. Lloyd explained.

By dissecting their work patterns, the team was able to find changes in their daily work patterns at the hospital to better prevent infection from spreading. Because they had come up with the solutions and implemented the changes themselves, they changed their behaviors and practices more effectively than if they had simply been told to implement new practices by a higher-up hospital official. Since implementing the PD approach, the health care system has seen a steady decrease in HAIs and continuously works to improve practices to prevent infection.

According to Dr. Lloyd, the true value in the PD approach is that these hospital staff members did not rely on anything “new” to achieve their goals. They did not utilize new infection-preventing technology, or any new resources. They were the change. The clinicians and staff members used the resources they had – what they’ve always had – and figured out a way to improve infection prevention practices at their hospital for their patients and themselves.

As I sat in the audience listening to Dr. Lloyd, Gandhi’s quote popped into my head again, and it took on a renewed motivational meaning. Sometimes, we don’t need to rely on some novel technological innovation, or bright, out-of-this-world, genius idea to achieve change in surgical practices. Often, the solutions are right in front of us in the hospital or OR. We just have to be willing to “be the change” in order to truly make a difference.

Have you implemented changes in your facility? How have you accomplished it? E-mail me at