If you are reading this today, there is every possibility you are alive because of the research of Dr Ignaz Philipp Semmelweis.  Dr Semmelweis was an early pioneer of antiseptic procedures and a tragic example of what it may cost to play the role of the change agent. In the mid-1800s mothers giving birth had a 10 – 35% chance of dying of puerperal fever. Through careful research Dr Semmelweis showed that mortality in childbirth could be reduced to below 1%.  And what was the amazing, life-preserving process? He got his doctors to wash their hands in chlorinated lime solution between each patient.

He was celebrated throughout Europe

Well actually, no, this didn’t happen.

At all!

Dr Semmelweis’s observations on hand washing offended the established scientific and medical community. He was ridiculed for not having a scientific explanation (which had to wait for the work of Louis Pasteur and Joseph Lister). Outraged at the thought of having to wash their hands, and the implied judgement of being responsible for so much death, the medical fraternity ostracised Dr Semmelweiss. The response has been called the Semmelweis reflex, the reflex-like rejection of new knowledge because it contradicts entrenched norms.

Semmelweiss was broken. 20 years after his discovery he was committed to an ‘asylum’. Within two weeks, he was beaten by the guards and in a tragic irony, he died of the resulting infection.

Being a change agent is tough. Almost by definition, the change agent is the one lying in a pool of blood when the change has happened.  Richard T. Pascale and Jerry Sternin wrote an exhaustively illustrated article in the May 2005 edition of Harvard Business Review about how to use ‘positive deviants’ to trigger change. This process is closely aligned to Solutions Focussed thinking. The original paper is well worth reading if you are interested in large-scope change.

The positive deviant approach to being a change agent

Find those who are getting the change right. Then do more of what they are doing. It is that simple. But it is not always easy. It may take hard work to identify the positive deviants. And once you have, it is possible to reach the right conclusions and still make the wrong decisions.

The authors describe how companies transcribe positive deviation into ‘Best Practice’ (a wrong turning off the right road). Enforcing best practice through ‘external experts’ creates resistance.

As a more effective alternative, the authors offer a six step process:

Step 1: Engage the community.

The change agent often takes on too much responsibility, absolving the community from owning the change. In the positive deviance model, problem identification, ownership, and action begin in, and remain with, the community.  This posting is really about denial.  However here is another story to support the concept of the power of denial.

Step 2: Refocus on positive exceptions

Identify the positive exceptions. Describe what they do differently. Encourage the community to see the problem in a new light that allows them to see new possibilities. This will get you out of the ‘box’.

Step 3: Build learning into your way of doing – make it safe to learn

The route to solution often runs through risks and potential loss. Acknowledge this danger. Make it OK, even as an authority figure, to be learning rather than having all the answers. Create safety around discussing difficult topics without fear of being implicated in (witch-hunts around) the problem.

Step 4: Make the problem concrete.

Find a way to illustrate the hard facts of the problem. Make it tangible. Do not allow anyone to hide evidence in convoluted PowerPoint shows. This goes beyond specific facts. Create an illustrating example or test that portrays the facts in a way that highlights the pivotal issue in a meaningful, unavoidable way. Reducing the death-rate from 35% to 1% sounds pretty convincing to me.

Step 5: Leverage social proof.

Let the community see the change in action. Engage the community in the conversation around the impact of the change and how it was brought into being.

Step 6: Deal with the Semmelweis reflex

The authors use the metaphor of fire: “Don’t rely on firebrands from corporate. Rather fan the embers within the community.” Involve the community in discovering positive deviations. Engage informal leaders in the creation and execution of a roll-out plan.  Make the community the change agent. Create a scoreboard for the community to measure progress towards goals.

The Leader’s New Role as change agent

The leader’s new role in the process is facilitative. Set aside your ego (now there is a change project) and habitual identities. Instead of being the ‘go-to decision maker,’ guide the community towards positive deviance as it unfolds. Manage attention, allocate scarce resources, encourage the change agents, reinforce the momentum of inquiry. Once the community has chosen a course of action, apply score-keeping mechanisms to sustain attention on progress toward goals.

We have our own targeted change agent here in South Africa where Dr Tim Noakes, a medical doctor, sports scientist and local promoter of Low Carb – High Fat eating (LCHF) has been hauled before the Health Professions Council of South Africa by the president of the Association for Dietetics in South Africa because he tweeted advice about nutrition.


He is up against some big players. LCHF cuts right across a whole industry built around the ‘Food Pyramid’ and the ‘7 Nations Study’.

Like Dr Semmelweis, the threatened establishment is intent on vilifying Prof. Noakes.  But unlike Semmelweiss, Noakes has sound science to draw on. The Dietitians don’t seem to be that interested in scientific facts. Their expert witness had been involved in drafting national guidelines for our country that were devoid of any guidelines for addressing obesity. And there is no way of describing the extent of that problem without falling into unintended puns. She had not read about LCHF. She had not read the evidence compiled by the Noakes team. She had not even read his book in which the diet, and the science behind the diet are explained quite clearly.

Here I kick my soap-box back under my table.

Could the six step processes have assisted Dr Semmelweis? Could it have helped Dr Noakes? Who knows? Perhaps some changes are too far reaching and the implications too damaging for the establishment for the agent of change to avoid the pool of blood.

If you want to read more about change you can click on the free gift box on the Home Page to download my ebook on the psychodynamics of change.