FF Daily #393: The positive deviance approach for habit change

June 9, 2021: Atul Gawande on why simple changes are hard to follow and what really works; Has the pandemic changed economics; Burnout; [Video] Reflections on peace: Michael Caine

Founding Fuel

[Photo by Devyn Holman on Unsplash]

Good morning,

In Better: A Surgeon's Notes on Performance, Atul Gawande writes about the difficulty of getting hospitals to follow something that could have a huge impact on reducing infections and saving lives—washing hands. Simple things are hard to follow in general, as we have found with the simple habits that would have helped us manage the pandemic better. Wearing masks, maintaining physical distance and, yes, washing hands. The insight from Gawande’s book is that such things are difficult even for healthcare workers in hospitals. He narrates several solutions that intelligent men have put in place, all of which had only limited success. Then, he talks about how a surgeon, Jon Lloyd, tried to solve the problem.

Gawande writes: “Lloyd was bitten by the positive deviance idea—the idea of building on capabilities people already had rather than telling them how they had to change. By March 2005, he and Perreiah persuaded the veterans hospital leadership in Pittsburgh to try the positive deviance approach with hospital infections. Lloyd even convinced the Sternins (who had worked on a successful project earlier) to join in. Together they held a series of thirty-minute, small group discussions with health care workers at every level: food service workers, janitors, nurses, doctors, patients themselves. The team began each meeting saying, in essence, ‘We’re here because of the hospital infection problem and we want to know what you know about how to solve it.’ There were no directives, no charts with what the experts thought should be done. ‘If we had any dogma going in,’ Jerry Sternin says, ‘it was: Thou shalt not try to fix anything.’  

“Ideas came pouring out. People told of places where hand-gel dispensers were missing, ways to keep gowns and gloves from running out of supply, nurses who always seemed able to wash their hands and even taught patients to wash their hands, too. Many people said it was the first time anyone had ever asked them what to do. The norms began to shift. When forty new hand-gel dispensers arrived, staff members took charge of putting them up in the right places. Nurses who would never speak up when a doctor failed to wash his or her hands began to do so after learning of other nurses who did. Eight therapists who thought wearing gloves with patients was silly were persuaded by two of their colleagues that it was no big deal. The ideas were not terribly new. ‘After the eighth group, we began to hear the same things over and over,’ Sternin says. ‘But we kept going even if it was group number thirty-three for us, because it was the first time those people had been heard, the first time they had a chance to innovate for themselves.’”

The initiative had a huge impact. Infection rates dropped. When the book went to print, the approach was getting implemented in more hospitals. Gawande concludes: “But nothing else has worked, and this is the most fascinating idea anyone has had to solve the problem in a century.”

In this issue

  • Has the pandemic changed economics?
  • Feeling burnt out?
  • [Video] Reflections on peace: Michael Caine 

Has the pandemic changed economics?

In Bloomberg, Matthew Boesler gives a fascinating overview of how the economic policy response to the pandemic by the US and other advanced economies might have fundamentally changed economics. “In the new economics, fiscal policy took over from monetary policy. Governments channeled cash directly to households and businesses and ran up record budget deficits. Central banks played a secondary and supportive role,” Boesler writes.  

The new economics varies from the 2008 approach in details too. For example, consider the question on who should get the aid. Boesler writes: “In 2008, US policymakers were overly selective about who should and shouldn’t receive aid and erred on the side of doing too little, according to [Neel] Kashkari [president and chief executive officer of the Federal Reserve Bank of Minneapolis]. In a Washington Post op-ed article published on March 27, 2020—the same day lawmakers passed the $2.2 trillion Cares Act, the main pandemic stimulus package—Kashkari reflected on those earlier efforts to help homeowners struggling to pay mortgages.

“‘By applying numerous criteria to make sure only ‘deserving’ families received help, we narrowed and slowed the programs dramatically, resulting in a deeper housing correction, with more foreclosures than had we flooded borrowers with assistance,’ Kashkari wrote. ‘The American people ultimately paid more because of our attempts to save them money.’

“By contrast, the logic of pandemic policy went more like this: Clearly no Americans thrown out of work by the pandemic—mostly low-paid workers in restaurants and other service industries—lost their jobs through any fault of their own. This made politicians comfortable supporting a big fiscal response. Unlike the Fed actions that dominated crisis firefighting in the past, government spending landed directly in people’s bank accounts.”

Dig deeper

Feeling burnt out?

Earlier this week, Somesh Jha took to Twitter to post a thread that explained his decision to move out of journalism. He spoke about how he felt burnt out. “I had hit a wall. Burnout is beyond exhaustion. Not only do you feel that you have no energy left to work, even if it's the kind of work that you enjoy, you also feel detached. Cynicism takes over, efficiency takes a hit and nothing seems to pull you up.

“In (sic) past 8 years, journalism has not only been a career, it has been my calling. I TOTALLY LOVE digging stories & holding the system accountable. I worked at (an often unhealthy) neck-breaking pace but that's something I enjoyed doing until...burnout hit me, & it hit pretty hard.

“Suddenly, I lost all motivation to chase a story. The COVID-19 pandemic exacerbated the feeling of emotional, physical and mental exhaustion. As a policy reporter, meeting people is a core part of the job and the pandemic only made things worse.”

There is much else he had to say and resources for other professionals in the domain that they may look up for help. It appears his thread struck a chord because it was amplified across the Indian social media landscape. 

[By Carine06, CC BY-SA 2.0, via Flickr]

“Saying ‘no’ is not a mark of belligerence, but a requirement for surviving modern life.”

Even as Jha’s thread was being applauded, commentators in other parts of the world started to acknowledge the reserves of courage tennis player Naomi Osaka may have had to draw on to walk out of the French Open. “Far and wide, in public and in private, workers are choosing personal boundaries over professional ambitions. Rather than comply with mandates to return to the office, employees are quitting altogether. Job vacancies in the United States are at a 20-year high,” The New York Times pointed out. “Saying ‘no’ is not a mark of belligerence, but a requirement for surviving modern life.”

Dig deeper

Reflections on Peace: Michael Caine

This video begins with the British actor Michael Caine opening a book and reading Rudyard Kipling’s poem If. Having done that, he goes on to speak about the time his father read it to him when he was a boy, the impression it left on him, how it got him to abhor violence, and why peace matters to him.

What’s helping you get through these tough times? Send us the song, poem, quote that is your balm now. And we will share it through this newsletter.

And if you missed previous editions of this newsletter, they’re all archived here.

Bookmark Founding Fuel’s special section on Thriving in Volatile Times. All our stories on how individuals and businesses are responding to the pandemic until now are posted there.

Warm regards,

Team Founding Fuel

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