The wonderful Atul Gawande delivered this past Friday a commencement address, titled “Money,” to the graduates of the University of Chicago Pritzker School of Medicine. He touched on and expanded on the theme of his groundbreaking article “The Cost Conundrum” that was reviewed on this site.
The transcript of the commencement address is definitely worth reading because it is another powerful call for structural changes. But it has one particular advantage for me. I learned of the Positive Deviants, a concept that has been in existence since the 80’s. This concept can explain what I have witnessed with ACOR for 14 years.
Because Positive Deviants derive their extraordinary capabilities from the identical environmental conditions as those around them, but are not constrained by conventional wisdoms, Positive Deviants standards for attitudes, thinking and behavior are readily accepted as the foundation for profound organizational and cultural change.
That is definitely how you would describe every one of the most active patient advocates you find on Twitter. Most of them have created large followings because they demonstrate an exceptional ability to think outside the box and create solutions to their particular problems.
I believe that we have not been attentive enough to the many positive deviants out there, who probably stand by the thousands, if not more, and that have found on their own, a personal solution to their main healthcare problems.
The strong reaction to Kevin Kelly’s Quantified Self blog post about the Journal of Participatory Medicine is a clear indication that, as the system is breaking down a little bit more every day, people have found many adaptative solutions that have never been catalogued, let alone studied. Note that studies about Positive Deviants consistently show that the single most important element in their patterned behavior is their passionate commitment expressed through their mental model. However, they don’t usually know they have a mental model and it is difficult for the new person to grasp the model because it is both unconscious and defined using highly abstract thinking. That sounds remarkably like all the e-Patients I have met!
As we build the Society for Participatory Medicine, it is my hope that we will embrace all the deviants, as long as they are of the positive type!