The solution to America’s healthcare crisis might just lie in deviant thinking. This is the message of Dr. Atul Gawande, this year’s commencement speaker at the University of Chicago’s Pritzker School of Medicine. Gawande is a general and endocrine surgeon at Brigham and Women’s Hospital in Boston, an associate director of their Center for Surgery and Public Health, an associate professor at the Harvard School of Public Health and at Harvard Medical School.
His concept of positive deviants identifies those communities and physicians who discover innovative ways to reduce costs and improve care to deliver better outcomes.
Gawande cites a nutritionist who spent his career attempting to reduce hunger in Vietnamese villages. This man asked villagers to identify which families had the best-nourished children to determine a “positive deviance” from the norm. The answer was that those children’s mothers did not act in accordance with accepted village wisdom had the best outcomes. Rather, they fed their children even when they had diarrhea; fed them several small meals daily rather than one or two large ones; and fed their children foods that others considered low class but were nutritious such as sweet potato greens.
In the American healthcare system, the positive deviants resist the tendency to view patients primarily as revenue streams – but as human beings. Rather, these physicians deliver high-value healthcare without focusing too strongly on their practices’ bottom lines; they neither over-treat nor under-treat their patients with extraneous but profitable tests and procedures.
To quote Gawande, “Look for those in your community who are making healthcare better, safer and less costly. Pay attention to them. Learn how they do it. And join with them.”
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