DADs make it easy for a group or community to discover practices and behaviors that enable some individuals (without access to special resources and facing the same constraints) to find better solutions than their peers to common problems. These are called positive deviant (PD) behaviors and practices. DADs make it possible for people in the group, unit, or community to discover by themselves these PD practices.
DADs also create favorable conditions for stimulating participants’ creativity in spaces where they can feel safe to invent new and more effective practices. Resistance to change evaporates as participants are unleashed to choose freely which practices they will adopt or try and which problems they will tackle. DADs make it possible to achieve frontline ownership of solutions.
Discover, Invent, and Unleash Local Solutions to Chronic Problems
Five Structural Elements – Min Specs
1. Structuring Invitation
- Invite people to uncover tacit or latent solutions to a shared challenge that are hidden among people in their working group, unit, or community. Ask anybody interested in solving the problem to join a small group and participate in a DAD. In the group, ask seven progressive questions:
- How do you know when problem X is present?
- How do you contribute effectively to solving problem X?
- What prevents you from doing this or taking these actions all the time?
- Do you know anybody who is able to frequently solve problem X and overcome barriers? What behaviors or practices made their success possible?
- Do you have any ideas?
- What needs to be done to make it happen? Any volunteers?
- Who else needs to be involved?
2. How Space Is Arranged and Materials Needed
- DADs take place in a local setting or unit
- Groups may be standing or sitting around a table
- Paper, flip chart, or software/projection equipment needed to record insights and actions
3. How Participation Is Distributed
- Facilitator introduces the questions
- Everyone who is around is invited to join and be included
- Everyone in the group has an equal opportunity to contribute
4. How Groups Are Configured
- Facilitator works with a partner to serve as a recorder
- Group size can be 5–15 people
- Diversity in roles and experience is an important asset
5. Sequence of Steps and Time Allocation
- State the purpose of the initiative being discussed and the DAD and invite brief round-robin introductions. 5 min.
- Ask the 7 questions one by one in the order given in the Invitation. Address them to the whole group and give everyone the opportunity to speak to each question. Make sure your recorder captures insights and action ideas as they emerge—big ones may emerge when you least expect it. 15–60 min.
- Ask your recorder to recap insights, action ideas, and who else needs to be included. 5 min.
- Engage frontline people in finding solutions to thorny challenges
- Discover tacit and latent behaviors and practices that are positively deviant from the norm
- Spark the emergence of new solutions
- Inspire rather than compel behaviors that solve complex problems
- Generate changes that are sustained because they are discovered and invented by the people doing the work, rather than imported and imposed
- Solve local problems locally and spread momentum across units
- Build relationships between people in diverse functions and levels that otherwise don’t work together to solve problems
Tips and Traps
- Question #2 often consists of two parts: how the problem affects the individual personally and how it affects others. For instance, “What do you do to protect yourself from infections and what do you do to prevent infection transmissions?” or “What do you do to keep your students engaged and what do you to keep yourself energized and enthusiastic?”
- Hold the DADs where the participants work to minimize obstacles for participation
- Make impromptu invitations for people to join in as you enter the area
- Create an informal “climate,” starting with introductions and an anecdote if appropriate
- Maintain eye contact and sit with the group (not higher or away from the group)
- Be sure you talk much less than participants, encouraging everyone to share stories and “sift” for action opportunities
- "Dramatizing Behavior Change to Stop Infections” in Part Three: Stories from the Field
- Notice when you form judgments in your head about what is right or wrong, then count to ten and “let it go” before you say anything (you may need to ask for the help of your recorder or a facilitator colleague)
- Avoid statements like “that’s a good idea” and leave space for participants to make their own assessments
- Demonstrate genuine curiosity in everyone’s contributions without answering the questions yourself: study at the feet of the people who do the work
- Do not give or take assignments!
- Don’t judge yourself too harshly: it takes practice to develop a high level of skill with this approach to facilitation. Be sure to ask your recorder for direct feedback.
Riffs and Variations
- Use TRIZ-like questions instead of the first three, namely: (1) What can you do to make sure that problem X becomes much worse? (2) Is there anything you are doing that in any way, shape, or form looks like any of the practices you just listed? (3) What is preventing you from stopping these practices?
- Use insights and barriers that surface to develop scripts for Improv Prototyping scenes and organize Improv sessions
- Use the same sequence and type of questions to guide one-on-one conversations
- With virtual groups, use the chat function to share answers to each question, then select powerful stories/behaviors/actions to be vocalized with the whole group
- For reducing harm to patients experiencing safety lapses (e.g., wrong-side surgery, patient falls, medication errors, iatrogenic infections) with cross-functional groups. Video of a DAD in progress to reduce the transmission of infections from UHN in Toronto.
- For use as an ethnographic data-collection tool within a multi-site research project
- For eliminating practices that keep professionals from helping clients change unproductive behaviors
- For a series of local dialogues to help community members discover solutions to a chronic problem (e.g., disruptive children in a classroom, a cycle of violence that is not solved only by punishing offenders)
- For researching and unleashing action to build professional competencies (e.g., in medical schools and social-service agencies). See “Developing Competencies for Physician Education” in Part Three: Stories from the Field.
- For use in a one-on-one conversation to find approaches to a tough challenge
Tips for running this activity online
- Pick an online whiteboard tool that allows you to use a large, zoomable canvas.
- Set up each topic at a different area of the board, spread them out just like you would do it on the walls of a room.
- Invite participants to zoom in and visit each section during the review section of this exercise.
- If you’re not using an online whiteboard, we’d recommend using a collaboration tool such as Google Docs to collect the information for each step under a separate heading. Invite everyone into the document to share their ideas but be very clear in regards to editing rights.
- When facilitating group discussion, we’d recommend that participants use non-verbal means to indicate they’d like to speak. You can use tools like Zoom’s nonverbal feedback tools, a reaction emoji, or just have people put their hands up.The facilitator can then invite that person to talk.
- During group work, use a video conferencing tool where you can assign the participants into breakout rooms (eg. Zoom).
- When briefing the exercise and assigning the pairs or groups to work together, keep all participants in the main video conference room and explain best practices.
- After this step is completed, turn on breakout rooms so each group can work on their tasks.
- After the group breakout groups are completed and participants return to the main room, debrief the exercise.
- If you do not have breakout sessions, keep everyone in the main room, though invite groups to communicate in private messages or small groups in Slack.
Attribution: Liberating Structure developed by Henri Lipmanowicz and Keith McCandless together with a group of coaches working to eliminate MRSA transmissions in hospitals: Sharon Benjamin, Kevin Buck, Lisa Kimball, Curt Lindberg, Jon Lloyd, Mark Munger, Jerry Sternin, Monique Sternin, and Margaret Toth. Inspired by Jerry and Monique Sternin’s work in Positive Deviance.
Source: Liberating Structures