Pittsburgh, 2005. A superbug called MRSA was spreading through the VA hospital, moving from patient to patient, and the experts had run out of new rules. The trouble was that the rules weren’t the problem. Everyone already knew them. Wash your hands. Gown up. Clean the room. Doing them, every time, on every shift, was the problem. So the VA Pittsburgh team tried something unusual. They stopped telling and started asking. Nurses, doctors, janitors, and cooks, hundreds of staff in small conversations, all answered one question: who here is already doing this well, and how? The answers came from people nobody had thought to ask. Hand cleaner where patients shared bingo cards and newspapers. Checklists for cleaning rooms. Disposable covers for Bibles. Within about a year, the infection rate had dropped by about half.
The leaders didn’t bring the answer. They went looking for it inside their own walls. That’s the part most of us skip. When something isn’t working, our instinct is to write a better memo, add a training, or roll out one more rule. The intention is good. But a new rule handed down from the top feels very different from being asked what we already know. The people closest to the work often have the answer the whole time. They’re waiting for someone to ask.
This week we shared the BLG Leadership Framework. It rests on one belief: high expectations require high levels of trust. Two of its six domains show up plainly in the Pittsburgh story, Know and Grow Your Team, and Clarify Decisions and Share Ownership. Asking the people closest to the problem is how trust becomes visible, and it’s how a high standard turns into something the whole team owns instead of something handed to them. If we want a quick read on where our own team stands across all six, BLG Leadership Lite is free and takes 5 to 7 minutes.
Our Insights page carried three talks pointing the same direction. Will Guidara on the secret ingredients of great hospitality, which starts with noticing what people care about and then acting on it. Tom Wujec on the marshmallow challenge, where kindergartners often beat business students because they try, learn, and adjust together instead of fighting for status. Carol Dweck on the power of believing we can improve, and how the word yet turns a setback into learning. Each one asks us to look closely at people before we decide what they need.
Here’s one thing to try this week. Pick one problem that keeps coming back on our team. Before we write a new rule for it, find the person who is already getting it right, the one whose shift, classroom, or desk doesn’t have the problem, and ask two questions: “What do you do that works?” and “What would it take for the rest of us to do it too?” Then, wherever we can, let them show the team instead of us explaining it. A practice spreads faster from a peer than from a memo.
What problem on our team keeps coming back, and who is already solving it without being asked?
Sources
- The New York Times Magazine, “Positive Deviance” (Dec 14, 2008): https://www.nytimes.com/2008/12/14/magazine/14ideas-section3-t-005.html
- Plexus Institute, VA Pittsburgh Healthcare System project summary: https://plexusinstitute.org/apd/va-pittsburgh-healthcare-system/
- Positive Deviance Collaborative case study: https://positivedeviance.org/case-studies-all/2019/12/13/pd-mrsa-prevention-for-va-pittsburgh-healthcare-system