 Thank you, Ruth, and also thank you, Melanie, and thank you, Alex, and all the organizers. And I'll be thanking a few people along the way as we move forward today. And what an audience. This is almost like 360 degrees. It's my voice coming through to everybody. With now cast, yes, looking good on the screen. So let me also welcome all the viewers who have joined in by webcast. And Clayton promised me when I talked to him that he would make this man look even better. So I'll be the judge when I see the webcast later. I want to begin with a blank screen. And this is part of my presentation because it could be that as the presentation moves on, we would be bringing a lot of who we are and how we are trained and how we think into the conversation with what's going to happen here. And the Zen Buddhists have a beautiful line which says that a beginner's mind is an open mind. It's full of possibilities whereas an expert's mind is a closed mind and usually doesn't have very many possibilities. So the invitation to you with this blank screen and the challenge to you, and I challenge myself too, is if it's possible for us to suspend, even if it's temporarily, some of our cherished notions of how we look at the world, perhaps your engagement would be a little different. So I'm saying don't fight it, embrace it if you can, and if you fight it and cannot embrace it, that's perfectly fine too. But the invitation is beginner's mind, open mind, let's see if we can embrace it. And in many ways for those of us who work in an academic institution, cultivating habits of the head mostly, this notion of beginner's mind is key because we can reset our mind and we can say, well, I'm open, let me listen. Alex, do you recognize anybody on the screen? And we really have to applaud Alex for looking at a screen which is flipped upside down and still able to, so please give him a big hand. Now there's a reason why I begin with a flipped picture, and it's a flipped picture of somebody whom many of us, most of us, some of us, can recognize. And I'd like to tell you a story about President Abraham Lincoln. But before that, let's ask the question, how tall was President Lincoln? I'm going to take a guess. Six feet four, absolutely right. And what if you put on a stove pipette as he is doing on top, yes, about seven, two. And you know his stove pipette was his working office, so as he wrote a carriage he would use it as a desk and he always had his speeches and so on and so forth. Anyway, that's another story. So during the Civil War, as Commander-in-Chief, as President, trying to save the Union, there's a story of Lincoln visiting a hospital, which he often did, to meet with Union soldiers. And you know that about 8% of the adult population men, male adult population in the U.S. was a casualty of the Civil War. So this weighed very heavily, of course, on Lincoln's shoulders. And the story is that he's gone around in this hospital ward and as he walks in he says, sons, I'm going to be coming around and I'd be shaking your hand and as I shake your hand say your name out loud for me. So he's gone around and shaking hands and he comes to a bed, there's a Union soldier lying who gets up and clicks his heels and salutes the Commander-in-Chief and extends his hand and says, I am Sergeant Robert Wood. And the handshake for the soldier is sort of like this. And for Lincoln, it's like this. And so the Sergeant in shaking the hand says, oh, you're tall. Mr. President, how tall are you? And without batting an eyelid, Lincoln says, my son, like you, tall enough that my feet reach the ground. My son, like you, tall enough that my feet reach the ground. How tall are you? And Alex, how tall are you? Beautiful. Now ordinarily, if you would ask people how tall they are, you'd get a certain answer. And it's ordinarily not the answer that we have just gotten. So how do experts measure height? We measure height in a certain way, no? And we are very precise, no, I'm like, my mother always says I'm five foot four and a quarter inch. And that quarter inch is important. In Lincoln's world, and there's nothing wrong with five feet four and a quarter inch. There's nothing wrong with 180 centimeters. They're all certain ways of viewing the world. But in Lincoln's world, with a petty soldier, even though he's Commander-in-Chief, as President of the U.S., he still says, my son, like you, tall enough that my feet reach the ground. And Lincoln had this certain way of thinking, which was flip thinking. In fact, he was very interested. He was an autodidact. He never went to university or school. He had only a year and a half or two of formal education, thank God. And if you go back and analyze how he came to the Emancipation Proclamation, there was a lot of Euclidean geometry that guided his thinking. He was fascinated by Euclid and geometry because of the notion of proof. And he was a country lawyer. And what constitutes proof? And so this notion of tall enough that my feet reach the ground wasn't just a cute statement. It was a statement which exemplified the kind of mindset that Lincoln had, that what's the common ground? And are we all standing on the common ground? And if we are, and if we are, then you can understand the Thirteenth Amendment and you can understand the Emancipation Proclamation. So the reason why I'm beginning again with a blank page and with the notion of flipped mind is because positive deviance is about a flipped mindset. Mindset, the way we think. And of course, what follows if we begin to think in a certain way? That sounded like me. And it sounded very good. So what is this conversation about? And if some of you are feeling uncomfortable with the way information is presented here, who knows, maybe all my slides are flipped, that's okay. And that is precisely the point. Can we truly embrace a different way of thinking, a different way of expressing, a different way of looking, because it is different. And it's that difference which will lead us to a different place. But we haven't done a very good job of solving all the complex social problems that exist in this world. I don't think our scorecard is one that we can really pat our backs and we keep struggling often with the same things over and over again and we just try harder, put a little more force, make your voice louder and more strident. And there may be other ways, there may be other flipped ways. And that's the invitation of this conversation. So far so good. You're with me? So let's get things straight. Now, a few minutes before the presentation, I was approached by Shirley Watkins. And Shirley said that the endowed professorship that you hold at the University of Texas El Paso, which is in the name of her grandparents, Samuel Shirley Annette Marston, your grandparents, was instituted by your mother, Silene Stembridge. And she walked up to me and said, you know, well, she didn't say it, but I said it to her, your mother was the reason which brought me to UT El Paso. And so I'm very proud, I abbreviated it because it's such a long title, but I hope Samuel Marston endowed professor honors the memory of your grandparents and also the memory of your mother. I want to acknowledge, and I believe it's the first time we've met, and I also want to acknowledge Phil. I also want a few words of gratitude to people. There's a beautiful speech made by Nelson Mandela in which he says, he begins by saying, we owe it to our ancestors who brought us here. We owe it to our ancestors who brought us here. And we owe it to our children who will take us there. And in some ways, Shirley, your grandparents, your mother, you, and where this is going to go. So my teachers in the realm of positive deviance are Jerry and Monique Sternen. The late Jerry Monique is still with us. And I was very fortunate in 2004 that my paths crossed with them. This picture was taken at our home in Athens, Ohio in 2005 when I had more hair, as you can probably see. And I just want to thank Jerry and Monique for bringing me here. They've brought me here. But there's some other special people. And I would Monique Sternen, who was supposed to be here, couldn't be here when I was saying that, oh yeah, I'm preparing to go to San Antonio. She said, you may see Gretchen Bergeron in the room. I may even ask you to stand so that we can, if you want, mind and applaud you, Gretchen. And Gretchen is sitting next to Ruth because these are Ruth's parents. And Monique told me that when you are there, and if you see Gretchen and if you see Ruth, which you might, then let them know that they were our teachers when we went to Vietnam to do the positive deviance work. And Monique talked very fondly about how Gretchen arrived with a Xeroxed or a Mimeographed or a Gallied copy of Marion Zaitland's book. And how you helped train them in some ways. In beginning to look at things in a somewhat different way. So this goes to all of those who has, all the teachers in some ways, who've had teachers, who've brought us to this point. And I think it also goes to all the students and the young people who are going to take us there. And since we are talking of young people, I want to bring in my son, who at this time, when this picture was taken in 98, was two and a half years old. But he had undergone several surgeries. He was a preemie baby, weighed 658 grams. He had BPD, GERD, you know, was at very high risk for ROP. I mean, these are terms that some of you understand. And he had a struggle, a slug fit. This was for two years at the Children's Hospital in Columbus. And he's now 19, and at UT Austin. And it was during the time that we were caring for him for those two years. And he actually had surgery three weeks ago. And we were again caring for him three weeks ago. That I became very mindful of what was happening in this field, which many of you embrace health care. So I began to take extreme notice of that one positively deviant medical doctor, neonatologist, who when he did his rounds, he had his interns and fellows and other pediatric students bring a little stool with them, which was unusual practice. And they would sit down. They would sit down around a little baby's bed. And they would invite the parents, Mr. and Mrs. Singul or Mr. and Mrs. Johnson, would you please join the conversation? And the question always would be, you are the ones who are taking care of your child for the last 24 hours. You know what's happening with them. Could we begin by asking you how you believe your child is doing? Now these were not normative practices. You know what the normative practice is. You have a bunch of white coats. That's what parents see who come. And they spend a minute or two and the chart is red. And very quickly some decisions are made and they move on. And nothing wrong with that. That's perfectly fine because all of the neonatologists, the 12 or 15 who attended on our son, they were phenomenal neonatologists. They were trained very well. But this person, as I said, believed in sitting down. What happens when those who are doing rounds sit down? What happens? Things slow down. It's almost like I'm not in a hurry. What happens when they invite you to be part of the circle? You feel, oh my God, I'm a parent. I am included in my child's care, as opposed to being on the outside, trying to make sense of what's going on. And what happens when they ask you the first question? How do you think your child is doing? I would bet, and you would ask me for evidence, and that's okay. I would bet that our son had phenomenally better clinical outcomes because we were included in some of the conversations that were critical. I'm reminded of the anesthesiologist who believes in first administering to a child such as ours, verbal anesthesia. Because what's normative practice of administering anesthesia? Oh, just go to a pre-op where you prepare a patient to go into surgery. And little kids being held down by force while somebody finds the right place where a needle or two can go in. It's not easy to find the right spot if your child is 658 grams. And you may take seven or eight jabs while the child, and they fight it with all their might. And the various surgeries that our son underwent, they were all phenomenal pediatric anesthesiologists, except this one. The first one, well, she was extra phenomenal. She would say, Mr. and Mrs. Singal, do I have permission to hold your son? And while she's administering verbal anesthesia, which we often know as peek-a-boo, one of her assistants has found just the spot. And very gently, the needle goes in at the first try. Better clinical outcomes. And by the time the child realizes something's happened, you know, there's Dr. Mami. And imagine what happens to a parent when she asks for permission to carry your baby to the surgical theater, not wheel them. Which is normative practice? There's nothing wrong with that normative practice. There's nothing wrong with measuring height the way we do. But what happens to the child, to the parent, when a pediatric anesthesiologist makes the decision and asks for permission and says, Mr. and Mrs. Singal, do I have your permission to carry your child to the surgical theater? It does something. And what happens to you when she turns around? And this is a small PD behavior. And says, don't you worry, he'd be fine. And what does it do to you to hear that from somebody whom you know is going to put your child to sleep and hopefully bring him back? Which the other pediatric anesthesiologist did as well. But the reason why I'm telling you about this is that the secret sauce, whether it's sitting down, whether it's inviting you into the conversation, whether it's holding your baby, whether it's peek-a-boo, whether it's carrying your baby, whether it's turning back and saying, he'd be okay. This is the little difference that often makes the big difference. Both clinically, clinically, which I know we are important evidence. I can tell you as a parent, you don't need to be a rocket scientist to know that that makes a difference. So when our son graduated, several of his invitation cards went to these medical professionals who 18 years ago took care of him. So far, so good, you're doing okay. I haven't even talked about positive deviants yet. All right, that's what he looks like now. Okay, so our conversation frame, and this is not a disclaimer. I'm doing this with pride, okay? Positive deviance is one approach among many. It's not the only one. You may have a cherished approach, embrace it. Keep working at it. Maybe there's room for PD, maybe not. What PD does, what positive deviance does, it expands the solution space. We begin to see things that we ordinarily would never see. And that's that flip. And you can only begin to see things if you can create the conditions for you to begin to see things differently. I would venture to say, and I first met Monique and Jerry Stone in 2004, that positive deviance is least understood and less practiced in the general schemata of social change or change approaches. And there's some people who are doing it. But the fact that there are only three or four monographs which even have the title positive deviance. The fact that when I did my last literature review, there are only about a hundred pieces in journals that have the title positive deviance shows that this field is in its infancy. And so I really commend UT San Antonio Health Sciences. And this is the first time ever that a university has decided that it's gonna spend one full day and make it a conference theme. Which means that we have a lot of distance to go in this and that's the invitation to all of you. Now I cannot help but also acknowledge three other people in this room at least and they are representative. May I ask Alejandra, Claudia, and Lucia to stand up? And you may just give them a little, they're all products. I'm very proud to say of the University of Texas, El Paso. Like you are all proud products of other university systems, especially students who are here from UT San Antonio. But Lucia, Alejandra, and Claudia are representative of this new generation of PD scholars because all three of them had positive deviance in their dissertation or in their thesis titles. So they are the ones who are gonna take us there. We go back to Mr. Mandela. And I'm very happy they're here. All right. And PDE, I guess the last thing I'll say is it can solve, not just address. You know, is positive deviance can solve complex social problems in new ways, in surprising ways. In ways that you will never, ever imagine. In fact, I have begun to seriously question even the way we make inferences. Because we make inferences in two ways. That's how I learned it when I did my doctoral work. Trained as a hardcore social scientist. We make inferences through deductive reasoning and through inductive reasoning. And in the world that we live in today, we do a lot of deduction. Hypothesis testing, hypothetical deductive work. There's nothing wrong with that work. PDE operates, in my opinion, and we can talk about this, in a completely different world. It works in what is known as, and I'll ask you for a show of hands, in what is known as the abductive way of reasoning. How many of us have learned the abductive way of reasoning? Okay, good, please raise your hand high up. You're the positive deviance in this, so okay. And what's the abductive way of reasoning? It's often something that we call the Sherlock Holmes way. It's exemplified in that little remark, it's elementary, Mr. Watson. After you've solved the case, it's like, it's elementary. You've solved it. So hopefully as this conversation proceeds and you see the simplicity of the answers to solve complex social problems, you'll say, of course, it's elementary. And you will never get to that reasoning if you are holding on to the only way of making inferences that you know, which is deductive reasoning. PD flips that completely. I'm just building the base for us to have this conversation. All right, so this is our flow. What, heck, I'm 30 minutes into this presentation and I haven't even talked about how this will go. But this is sort of the flow. And we're in no hurry. We can flip things if needed, but is it okay, is the space okay? Yeah, okay, I think nods mean it's okay. And if it's not, you know, I'll just apologize, but it'll still continue, okay. So understanding the narrative foundations of positive deviance. This is the way I, and you know, I'll take all the blame and responsibility for sharing what I believe is the way to understand positive deviance. And I've run it by Monique and she hasn't said your way off the charts. And I'll tell you three stories. Very quick, three stories. And these to me are the foundational stories of positive deviance. So I know that Gretchen, you and Warren received an award from Mother Teresa. And I started a correspondence relationship having grown up in India with Mother Teresa when I was 16. And that relationship lasted for a long time. So I'm a collector of Mother Teresa's stories. And this story is particularly relevant because I think it's a foundational positive deviance story. So the story goes that she arrives in Washington DC, Dallas airport. There are thousands of people who are there to welcome her. And this was a surprise because private visit. And a representative walks up and says, Mother, we're so happy you're here. Tomorrow we have a march in Washington. We want you to join us. And Mother Teresa says, my child, what is the march about? And the representative says the march is against the Vietnam War. And there's silence. And the representative says, so Mother, you'll march with us, right? And she says, my child, I am so sorry. And the representative says, well, Mother, why not? I mean, why wouldn't you march with us? And Mother Teresa says, my child of the march that you're having is against the Vietnam War. I am so sorry. But my child, should you choose to have a march in Washington for peace will be the first to leave. So the question, you don't need to answer it. The question to pose is the following. Is being against the war and being for peace one and the same thing? Well, not in Mother Teresa's mindset. They're so different, because in one year saying, the thousand of us, we are here, we want you to march against the war. And she says, I'm sorry. And then she says, but should you so choose to have a march in Washington for peace, for peace, for peace? I will be the first to leave. Now, we are trained, me included, as problem solvers. If you're trying to solve a problem, the first question you don't even think we ask is what's the problem? What are we up against? What are the gaps? What are the needs? That's what gets us going. Nothing wrong with it. It's one way. What Mother Teresa is maybe telling us is there may be other ways to ask that same question. What's working? What are you for? Get the idea? I think it's a foundational PD story. At least for me, it has served as being a, so I tell myself, can you do a Mother Teresa flip, Arvind? Because I will bet you, if you're a problem solver, 95 to 98% of the conversation that you'd engage in will be about what's the problem. Who's at the highest risk? What are the factors that, and that's okay. There's value to it. PD comes at it. It begins at a very different place. You're still interested in solving the problem, but you always begin by asking what's working. How many of us recognize the Gandhi? Now this is another foundational PD story, in my opinion. So in my class, and I teach a 16-week class, I think it's the only class in the world at the present time, I think. And if somebody is teaching this, please tell me, because I'd love to hear from people who, and I'm doing this at the University of Texas, El Paso. It's the only class that's taught in the world, 16 weeks on positive deviance. And in this class, we are always saying, do a Mother Teresa, do a Gandhi. So how do we do a Gandhi? So the story is, Mr. Gandhi never held any political office, no commander of armies, no president, no nothing, no artistic gift, no scientific, he lived the life of a poor man. He said, my goal in life is to reduce myself to zero. And in so doing, he became the Mahatma, Mahatma, Mah, great, Atma, soul. And he always traveled third class, you can see, no? I think this has a little, oh, I feel so empowered when I can point, traveled by train and traveled third class. And this would drive many people, you're the father of the Indian nation, you're Rashtrapita, you're, you know, and you travel third class, you know, it's like Bapu, we call them Bapu, father, loving father, father. We can do better as a country. You don't need to travel third class. And so he was repeatedly asked, why do you travel third class? And his response was always the same. I travel third class because as you know, there is no fourth class. And if you think about it, what Gandhi is telling us, very easy to think, very hard to do, because when I'm, you know, bumped up to business class, when I'm flying on a long flight, I mean, you know, you sort of look back and say it goes, and you find a way to, you know, call your wife and say, well, the olives are, you know, mm-mm. Easy to make that flip, even though we don't do it. Very hard to practice. And PD fundamentally, not only takes from Mother Teresa in terms of what's working and what's working. And you take from Gandhi, which is what's working for those for whom it shouldn't be working. Those who have no extra resources, well, we're even gonna go beyond that. What's working for those who are the poorest of the poor? The ruralist of the most remote. Because if something is working and working for those, for whom it shouldn't work, those who belong to the fourth class, then boy, there's hope. So this is a foundational. So Gandhi tells us, don't just ask the question, what's working, go a step deeper and ask the question, what's working for those for whom it shouldn't be working? Those who are at the highest risk. That's the PD way. And of course, I'd be remiss if I didn't share with you a story with Jerry Stern and absolutely love to tell. And this is the story of Nasiruddin. And some of you may have heard about Nasiruddin. He comes up in various folk literature. If you're born in Central Asia or Central Europe, you may hear a lot of Nasiruddin stories. And I've become a collector of Nasiruddin stories. And this story is particularly relevant. The story begins with Nasiruddin going to the mountain top and saying, I am a smuggler. I am a smuggler. Microphone. And the invitation is to all customs officials who are very well trained in catching smugglers. And he says, catch me if you can. And you can imagine all the customs, like they're gonna nail you Nasiruddin. So every morning Nasiruddin, ride on a donkey with hodes of other donkeys behind, loaded with stuff, comes to the border checkpoint. Customs are like, what do you have Nasiruddin? And he says, look, the customs official with their training, look. And they look here and they look there and empty this bag and empty that bag. And they find absolutely nothing of interest. So what do you do? What can you do, Donna? You've got to let Nasiruddin go. Of course Nasiruddin. And the next day he's back, riding his donkey with lots of other donkeys loaded with stuff and the customs, I'm gonna nail you today. What do you have Nasiruddin? And he says, look. And now the customs official really looks. Really looks and looks, empties this and empties that and looks here and there and puts on his X-ray glasses and his sniffer. And he finds absolutely nothing of interest. So what does he do? What can he do? He's got to let him go. And off he goes. And the next day, you know what happens and the next day. And so this happens day after day and week after week and month after month and year after year and decade after decade and a few decades go by. And the customs officials, in the meantime they've gotten a PhD degree from UT San Antonio and customs checking, you know. Gained their expertise, went to Harvard to do this extra course and they're unable to catch Nasiruddin in an act of wrongdoing. So they meet in San Antonio on this campus close to a star, let's say in a Starbucks. There's Starbucks here. What street? That's the one, exactly. And the customs official says, Nasiruddin, now that I'm an old man and now that I'm in no official capacity to do anything to you, please. For heaven's sake, please, could you tell me what is it that you were smuggling? Donkeys says Nasiruddin. Now the question is the following. And stories can take us to places where we've never been. There's tremendous power in stories. The question is the following. Why was the customs official unable to see that the solution to the problem that he was trying to catch was smack right there in front of him? He couldn't see it. If there was a child who had not undergone all these trainings and was asked what the heck is this guy smuggling, let's say donkeys at the first go. Now, some people study this. The customs official, as many of us are, as trained customs officials, we are victims of our own training. We call it trained incapacity. You are incapacitated by your own training. You only look at things in a certain way, like in my world of deductive reasoning, and that's okay, as was okay for the customs official. Positive deviance takes you to a place which is not so readily visible. So what's the conference title? Would somebody who has the program read it for me, please? The answer in plain sight. The answer in plain sight. We don't see it because we are trained not to see it. And we are trained not to see it because of all the wonderful training and the baggage that we carry. When we say, well, it's not the way that is supposed to be. So the positive deviance premises the following. Solutions to problems exist. They stare us in the face. We do not see them. We are actually incapable of seeing them. We don't even know where to look because we don't have a roadmap. And the old problem-solving maps that we are trained in are quite useless, which means we've got a long way to go. That's the reason why I'm so excited about this approach that in the last 11 years, ever since I first heard about it, I went up to Jerry and I said, I want to be your apprentice. And I think I'm devoting 70 to 80% of my time as some of my colleagues know, whether it's teaching or research, trying to pursue this line of work because this is a very exciting way of solving intractable complex problems. All right. Am I correct, Melanie, that I can go on until about 10, 15? Yeah, and then we'll have some time for Q&A. So I've got 16 minutes. We are on part two of our flow, okay? And this is a story that you can hear it from Gretchen. So I'll go through this quickly. And this is described in many of the writings and maybe some of you who. So the year is 1990, December 9th as Jerry used to tell us that he and Monique with their son, Sam, who's a toddler, well, who was whom they were carrying arrived in Hanoi. And they were sent there in some ways by Ruth's family. They worked for Save the Children. And they arrived there to address a problem. The problem was the problem of malnutrition. And the numbers, what I've heard, are that at that time about 60 to 65% of the kids under the age of five in Vietnam were malnourished. Big challenge, no? And thanks to Gretchen, who brought along a book by Marion Zaitlin and was doing this in your own practice as a clinician, you were doing this even before, of course. In Haiti, you were doing this in Haiti, exactly. So there's new thinking that comes in because Jerry and Monique have been doing this kind of work. They were in the Peace Corps and with Save the Children and doing this kind of, so they arrived there. And Jerry tells this story of the government official who called them, who summoned him to his office and said, Mr. Sternin, you've got six months. Six months to show results. Six months? He said, oh yeah, you've got six months to show results. There's very high suspicion of US-based NGOs. And this is Save the Children, USA. And you better show results or... And so, things that we've done in the past to solve malnutrition may not work. And Gretchen and input and, well, maybe there's another way to ask the question a little differently. And so, a flipped PD question in the context of Vietnam would look somewhat like this. And you can see the Mother Teresa in this question and you can see a Gandhi in this question, you know? The question would be are the children under the age of five from poor rural households that are well-nourished? This is precisely what Ruth was talking about. What's working and what's working for those for whom it shouldn't be working? And the work began in four communities and there were about roughly 3,000 children under the age of five. And each of that, each of those were weighed and a growth chart was plotted. And oh, okay, notice that it is an improbable question. PD always begins with an improbable question, which is not the way we begin our hypothetical deductive work. We begin with a probable question and even have limits in terms of less than equal to 0.05. So the communities engaged in weighing the children, those who are under the age of five and plotting who is well-nourished and who's not. And then you basically, you're looking at the plots and you're saying, oh, okay, well, 65% of the kids are malnourished, red dots, let's say, and 35% are okay, well-nourished, green dots. I'm simplifying this greatly so we can understand. And then with positive deviants, where do you begin? You're trying to solve the problem of the red dots, but where do you begin? You begin with the green dots. But you are not interested in all the green dots because most of the green dots, your regression equation will tell you, should be green. Right? It's predictable that they're green. You are interested in the green dots that should be red. That should be red. So basically, it's like, whose house is this? Oh, this is the house of, oh, okay, well, the green dot is understandable, until you come to a green dot and it's like, this shouldn't be, this is a poor woman. She lost her husband. She's got a small patch of land. She has no milk animals. Heck, but she still has well-nourished children. Maybe the donkey lurks here, right? You still don't know what the donkey is. But oh, oh. And so basically, they took a few households in these initial four communities, which were unexplainables, improbables. And then the community, since the community identified them as being improbable, is like, you go figure out what the heck they're doing. You figure out what the heck they're doing. And they come back and they say, you wouldn't believe what this mother does. What does she do? This mother adds the greens, the shoots of sweet potato plants to the broth, to the whole, to the right. What, the greens of sweet potato plants? Uh-huh, what do most people do with the greens of sweet potato plants? How many of us eat the greens of sweet potato plants? Get the idea. And then you can add, oh, what do they have? Well, they've got greens, they've got minerals, they've got micronutrients, they've got beta-carotene, vitamin A. You know, whoa. This is what the TVians are doing. They're taking the shoots and they're adding it. The solution, the wisdom is all there. The donkeys are there. How long have you been doing that for years? Ah, okay, the donkeys have been coming and going for years. You just didn't have the eyes to see them. And then there's another, you know, some other house. You wouldn't believe what these people are doing. What are they doing? These mothers, when they finish work in the rice fields, in Vietnam, a lot of rice, rice fields, a lot of water. And you know what happens when there's a lot of water in rice fields, organic matter, you know? Teeny, tiny shrimps and crabs and shellfish. So these mothers, what they do, it's like the doctor sitting down and they bend down, no? For 30 seconds when they're finishing work and they pick up these tiny shrimps and crabs. Teeny, tiny. Come back home and, you know, remove the crust and now they've got a little pulp and they wash it and heck, they add it. Whoa, this is not normative practice. What's normative practice? Well, this is not considered as human food. In fact, I've been in Vietnam where you have, you know, rice farmers bring their chickens and ducks and, you know, they go, you know, they're munchin' at these little crustaceans. The wisdom to solve the problem. The resources are right there. You don't need to import protein biscuits from Denmark and create a warehouse and then have a distribution system and you know what happens once that goes. And then there were other things. There were mothers who were actively feeding their child, active feeding. Those normative practices, you know, the child begins to sit and the mother's busy, you know. They eat some and they're feeding themselves. They're eating some and leaving some and dropping some but active feeding. And the mother's not there. You know, the sibling is actively feeding. All right, that's makin' the difference. And there were some mothers who were feeding their child four times a day instead of the customary two or two and a half times a day. Well, they must be feeding them more food. No, no, that's not the point. They're not feeding them any more food. They're just taking the same amount of food and breaking it into smaller portions. All right, what does that do? And now you can answer it scientifically, you know. Gee, I mean, more better metabolism and assimilation. So by doing a positive deviance inquiry, they were able to unearth the donkeys that were always there. Among the mother Teresa's, yeah, what's working and among the gandhis, what's working for the fourth class. So now these solutions that were discovered within the community could be replicated. And the secret sauce of PD, as Ruth has said, is how do you then take what you found and disseminate it? Because PD follows a very different dissemination logic than tell them, this is the logic that I was often trained in. If you have a best practice, tell them. Share it with them. Whereas in Vietnam, Jerry actually coined a beautiful phrase based on a wisdom from a Vietnamese elder who told him that what I learned from my ancestors is that a thousand hearings is not worth one seeing. And a thousand seeing is not worth one doing. Whereas the way we learn our cognitive processing of information and stages of change and whether it's psychology 101 or 501 or 1001, you are always thinking of linearly going from knowledge to action. Whereas in Vietnam, based on this Vietnamese elder's notion of doing being important, Jerry almost made this a dictum that in positive deviance, the way you take the accumulated knowledge, the wisdom that you've unearthed, the donkeys, is you have people act their way into a new way of thinking. You have them do. Focus is not on telling and showing. Focus is not on appealing to their ears and their eyes. You flip that too, and you begin by having them do, do, do. And it's in that doing that there is ownership. In that doing is that the behavior gets reinforced because once you do and your child is healthy, you don't need to be convinced of any additional knowledge or your attitude needs to move. Anyway, so self-discovery involving the community, having them do, act your way. These are important things. We act our way into a new way of thinking. We come together, we cook. We add the little shrimps and crabs. We add the little, we cook. We feed our children actively. And so what happened in Vietnam is the following. And this is very well documented. You should just read the special issue of Food and Nutrition Bulletin 2002. And I know Warren has a piece in it. And maybe you too, who? Warren, yeah. The 16 articles which capture this Vietnam story from various ends. So who are positive deviants? It's a good visual image. Ordinary people who have found better or even extraordinary solutions to existing problems with no extra resources. In fact, against all odds. Now, if you wanna look at it statistically, we all love the normal curve. I think I know enough about the normal curve that I can say that I don't really like it as much. It has value. But if you're trying to solve complex social problems, the normal curve valorizes the central tendency, the mean. The more standard deviations away you are, it's like, don't wanna be there. In PD, you're saying I am interested in the outliers. It's a data-driven process. You're interested in the positive outliers, those who've made it work. There are other ways to finding positive deviants than doing a data-driven inquiry. And some of that work was done when we did our work with US hospitals, where we devise certain methods like discovery and action dialogues, and so on to identify a wisdom that may exist in a unit or in a hospital about reducing the spread of MRSA and so on. Let me flip through my slides so that you have an idea of the applications of PD. I still have three, four minutes. I think I can say there's a mounting, mounting, even if it's a slow-mount evidence of effectiveness. And there's literature, no? And all these four books are available, Melanie, for you too. I think these are the only four books that I know of that really have the title positive deviants in it. They're all written in the last five years. So PD to reduce hospital-acquired infections. Dr. Pranavi is right there. Yeah, she works in this space and Lucia has worked with Dr. Pranavi on this. You're going to be having a conversation later. So the question that was asked in some U.S. hospitals in 2005 when PD was first implemented in the U.S., in a U.S. healthcare institution, Waterbury Hospital in Connecticut, where we were looking at positive deviants to address the issue of medical, medication reconciliation, big issue, no, for patient safety. And then, of course, it went to six hospitals looking at the prevention and control of MRSA or hospital-acquired infections. And this was a study that was funded by Robert Wood Johnson Foundation. And one of the books here addresses that. So the question that was asked was very simply this. In the hospital context, are there some doctors, nurses, patients, chaplains, blah, blah, blah, blah? Who better prevent and control the spread of hospital-acquired infections than most of their peers? And the answer was yes. And these are like donkeys, no? You'd never guess them. So let me give you some examples. Here's Daryl. Patients in hospitals are looked upon as problems, especially if you're dealing with infectious disease. They are the ones who carry infectious. At the VA in Pittsburgh, we had this patient who had figured out a way to save himself from any healthcare provider if they had not washed their hands. How did Daryl do it? Well, if you walked into Daryl's room and you were a surgeon or a doctor or a nurse, Daryl would look at you, acknowledge you, welcome you non-verbally. But if you didn't go to the wash basin or to the alcohol dispenser to get, shh. He would look at you and then look away. And then he'd look back at you and then he would give you a wink and a nod until you. And he'll give you a wink and a nod until you. Daryl had figured out a way to protect himself from all those folks who were not observing hand hygiene protocols. The wisdom was there with Daryl. So what did we do? You take Daryl's wisdom, you make a 60 cent poster which says this, you ask the patients, where should we put it? And they say, well, you know, just put that smack in front of the wall where our beds are. And now the patients know, all you have to do is just keep looking, staring at that poster now. If they're not doing their job or you may look at them and look at the poster. The wisdom to solve this problem came from Daryl. I can give you a thousand examples, hundreds from our work in these six hospitals where the wisdom lay in places where you'd never find it. Mr. Daryl, how long have you been doing this for years? Because I'm a veteran, I've been back and forth. How did you know about this? Well, I know about MRSA. Mr. Palmer, he was a transporter, escort department. Albert Einstein Hospital, I mean, this. Like, he has some wisdom? Yes, he's the late Mr. Palmer, he passed away last year. Mr. Palmer had a way of de-gowning and de-gloving. You can see that in slow motion. Isolation gown comes up, folds it back, and then with one, you know, smooth motion wraps it up, one glove, one ball, the other glove, all the gown and glove inverted, condensed, all wrapped in one glove. And now you can toss 200 of them in a can, whereas the traditional way, we, I don't know, you must all do the de- Mr. Palmer method, right? No, you've got a little to learn from Mr. Palmer about how to dispose. And they did a little study. What happens when you, you know, remove the gown the regular way, and throw it. Mr. Palmer's method contains the risk of infection transfer, the gown and the glove being the vector, by 70 to 80%. It's the Palmer method, it's named after him. How long have you been doing it, Mr. Palmer? I've been doing this for 20 years. The donkeys have been coming and going. We never look at the Daryls or the Panas. They're there, they exist. You don't have the eyes to see them. Walt Fairfax, what's wrong with this medical doctor in the middle? No white coat, no suit, no tie. That's wrong with him, that's what's wrong with him. He's infectious disease. He knows what that does. And there's one thing which Mr. Walt Fairfax, Dr. Walt Fairfax at Billings Clinic in Montana does that most infectious disease doctors I'll bet don't do. Maybe they do. He has a certain way in which he visits his patients when he does his rounds. He sees all the infected patients who are in isolation last, no matter where they may be. He doesn't bounce around. This is not normative practice, based on what I've been told. You just bounce around, you're a busy doctor and you're a doctor, you're God, right? I think, they've my son's life. So, who does his rounds? So our work with the hospitals is a pilot project funded by Robert Wood Johnson Foundation. Six hospitals and this is what happened. We know what the rates of MRSA spread and hospital acquired infections are. They're going through the roof. We know of President Obama's but anti-mic, something, yeah, yeah. Yeah, well, I don't think they've heard about PD, although I'm at the White House, April 15th and 16th. I don't know whether I'll have a chance to utter the term PD, I will, if I get an opportunity. Okay, so, you know, I'll just flip this. Maternal and Child Health, HIV AIDS. In Danish prisons, you know, for burnout, human resource management issues. In summary, PD is about the secret sauce that some people have and we don't even have the eyes to see it. And it's making a difference, a real difference. Today, now, small things that people do that most others do not that make a big difference. There's the doctor who sits down. There's the anesthesiologist who, this is the mother who actively feeds. This is Daryl who refuses to make eye contact. This is, yeah, you get the idea. Ordinary people doing extra ordinary things. And of course, during the course of this day, you will hear about other examples and other projects that you've been a part of. So Jerry Sternen, and I'll close here, have this beautiful, oftentimes you'd be sitting as Gretchen is doing this now. Jerry's sitting there and he's doing this. And what is this? It's the flip. It's the 180 degree flip. And basically it's an invitation. Can you flip your head, goddammit? It's not gonna cost you anything. It's not your body. It's not a somersault. And what's wrong with that? Can you for a moment flip and ask what's working? Can you ask what's working with those with whom it shouldn't be working? Can you, once you discover what's working, do a flip and say can people act their way into a new way of thinking as opposed to let's tell them, let's tell them, let's tell them and we are clever and smart. And we aren't. So PD is a statement of extreme humility. We begin with a blank page because there is strength in ignorance. Is tremendous strength in ignorance. And there is tremendous folly in expertise of a certain kind that we tend to nurture. So PD expands the solution space focusing on what's working. Solution exists with ordinary people. It's about acting one's way once you discover what the solution is. With PD you don't have to wait. Usually we make these mega plans I'm gonna do this and do. But with PD by definition somebody today is doing it. And making it work. So you don't have, they're doing it, they're making it work. There's the social proof that you can begin now. And somebody's doing it with no extra resources. So you can begin now and you can begin now with no extra resources, fundamentally. That's the PD promise. Always end with Robert Frost. And this was something that Jerry liked. We dance around, we dance around in a ring and suppose and the truth sits in the middle and knows. So I'll end here. Thank you very much. So we have, I believe microphones for you. And did I just know? I can take that. It's airing now. Okay, so we will do this in a somewhat flipped manner. Typically what happens is normative practices are there any questions? And one or two hands may go up maybe. And maybe they'll get all the air time. And that's okay. That's one way of doing things. Here's what I suggest. We have seven minutes, Melanie. We'll keep to time. In seven minutes we are going to have 400 conversations. How are we gonna do this? Well, we'll do crosstalk, yes, of a certain kind. This is what we'll do. Crosstalk, which will be intelligible, okay? I would like you to take 15 seconds. You, each one of you is invited, take 30 of solitude, silence. Think about what you have heard. You know, what does it say to you? About who you are and the work that you do, okay? You may have a question that's, you know, frame your question. You may have a comment, frame that comment. After 30 seconds I'm gonna clap. I would like you to turn to the person next to you and share with them, take a minute, and share with them what that insight was. I don't need to necessarily hear it. I'd much rather have each one of you engage in a conversation with somebody else. And then if there's some very burning questions that rise up in those, we'll take them. And you can come to the microphone and rattle off these questions all at once. Because first we wanna hear all the questions. If there's time, maybe I'll take the closing minute for providing an answer. And of course I'll answer all the questions. All right, starting now. 15 seconds, I'll give you a little thump, and then you'll share with one more person. And then we'll very quickly harvest. One way of getting attention. Please begin to talk. Oh, the microphones are available. If you have questions or a comment, you get two sentences, okay? You only get two sentences. And we'll take the next three minutes for you to take two sentences and share with the rest, whatever you wish to share. It could be even something that you may have heard. The microphones are here. All right, since the microphones are not going to be used, I suggest you do the following. Take the groups, the pair of two that you have right now, in which you've shared, and if you wish to rise, you can rise or you can turn your tables. Make this a quad, make this a group of four, okay? And in that group of four, share what you heard. Not interested in you sharing what you said. Share what you heard. Starting now. And you have two minutes to do that. How are you? What do you think? Was there anything about positive deviance that appealed to you, especially? I feel like they've heard about having the same resources. True positive. Right. Right, right, right. Yeah, because the privileged ones are explainable. And PD would even go so far as to say, with no resources or with against all odds. One more. See how many conversations you can have versus having one person or two askin' a question, yeah? So we will take with Melanie's permission, 30 seconds. If you heard something which you think needs to be shared with this group, if you heard something which you believe needs to be shared with this group, I invite you. And I should invite three or four people to do so. And then it'll be a good way to wrap it up. Raise your hand if, oh, pull it straight up. There's the, yes, Elliot. Yes, sir. Someone in my group was talking about applying these concepts to pediatric mental health in San Antonio and try to address the problem before it's a crisis in more of an outpatient community-based and just inpatient-like recovery-based. Thank you, Elliot. PD has been applied, beginning to be applied to mental health issues in a big way. We've done work in Netherlands recently and in a week or two I'll be in the state of Oklahoma where Oklahoma's Department of Rehabilitation Services after a two-year conversation about PD wants to go whole hog. Yes. What did you hear, heard? What did you hear, Nicole? That positive deviance can be applied in many different aspects of life. It's a very versatile strategy. And what did you hear? And you're hiding your name. Oh, okay. Duyen. Oh, Duyen. Vietnam. Yes. That we can use, we think outside of the box and apply it. There's value in thinking outside the box. And, sir. Unfortunately, I didn't quite understand. Ah, okay. I think that's what I got from it. It sounds good, but I don't quite understand it. That probably is one of the most revealing statements of the day. It is. And, you know, we have to respect what Dr. Thomas Henry Guerrero has said that I don't quite understand. Because that is a statement of deep humility. Yeah. Which means we've got some ways to go to do some work. Jaime, what did you hear? What did you hear? I listened, he talked. He was asking about leadership in PD process and how you can bring it to a higher level that so that it gets sustained over populations. And I think I have to ask a question. To say some closing words to close this session. Yeah, wouldn't it be appropriate? Please. Well, Ruth just shared with me how the answer came from the patient in the example that you gave. And very often we leave, and your illustrations also brought out the patient themselves can bring a great part of the solution to the problem. And I was sharing that a mother in Haiti kept pulling at my sleeve and telling me that I go for clean water five times a day while I was trying to lead some students to get a 24 hour simplified diet recall. And she kept saying, but I go for water, clean water five times a day. And finally, I was able to think outside the box. Her children were not getting diarrhea and they were well nourished. Thank you, gradually. So we will end on that note. Thank you again for participating for all your questions and all the comments and also all the sighs because if you are sighing, that's great. Work done.