ENHANCING AGENCY AND REDUCING RISK A CASE

ENHANCING AGENCY AND REDUCING RISK: A CASE FOR POSITIVE DEVIANCE Adam J. Parrish University of Central Florida An Equal Opportunity University

STRUCTURATION THEORY • Structures- “Rules and resources drawn upon in the production and reproduction of social action. ” • Rules- Reasons for acting • Resources- Material and nonmaterial tools • Systems- Patterns of interactions (Giddens, 1984)

PURPOSE • Organizations face external and internal threats. • Internal threats can be generated by the structures developed and reinforced within a system. • Positive deviance research challenges systems effectively, yet remains atheoretical and somewhat unpopular.

THE DUALITY OF STRUCTURE • The rules that we create to govern the use of resources (i. e. , structures) can enhance, constrain, destroy, or transform a system. • Agency- The ability and freedom of a person to “act otherwise. ” (Giddens, 1984)

A TRADITIONAL STRUCTURE • Rules are made by people at the top of the organization. • Resources are controlled by the same people. • People at the top of the organization have the most agency.

THE CASE • In 2005, VAPHS implements CDC program to reduce MRSA transmission in six hospitals. • The program failed. • A skeptical administrator attempted a novel method (i. e. , positive deviance).

POSITIVE DEVIANCE METHOD • Within every system, there agents who have found ways to behave to their benefit, despite having to better access to material or nonmaterial resources. • The PD method takes an “all in” rather than a “top-down” approach to systems, structures, and agency.

PROFOUND RESULTS • Jerry and Monique Sternin were asked to find a way to reduce childhood malnutrition in Vietnam. • Researchers looked for children were healthy, even though their parents had no better access to food or money. • Childhood malnutrition rates dropped by 85% within two years.

PD SYSTEMS • Who can devise solutions to complex problems? • The usual suspects- Administrators, physicians, infection control experts… • The unusual suspects- Valets, chaplains, custodians, cafeteria workers…

PD STRUCTURES • Nontraditional material resources- “The Pudding Play. ” • Nontraditional nonmaterial resources. Creativity, dialogue, involvement

PD AGENCY • Two groups were excluded initially from the PD intervention. Resistant Bacteria: Methicillin Resistant Staphylococcus aureus and Vancomycin Resistant Enterococcous” • Patients • The dementia ward VS “Keeping America’s Veteran’s Healthy—A Guide to MRSA—A Simple Way to Shorten Your Stay. ”

TRANSFORMATION • MRSA infection rates dropped by 50 percent in the first six months. • MRSA screening and hygiene behaviors increased by 90 percent. • Communication networks expanded creating a more proactive, inventive, and democratic system.

LIMITATIONS • Findings are not gerneralizable. • Other theoretical explanations are possible. • PDI sounds like it’s magic, but it requires significant time, resources, and buy-in from stakeholders.

FUTURE DIRECTIONS • PD can be effective in the development and diffusion of innovations. • PD may be effective in risk and crisis preparedness. “If you’re going to be deviant, be positive. ” –Chippy Mc. Nish