The Power of Positive Deviance

In this column, I often focus on the value of standardization in healthcare and the supply chain.  So why would I be writing about deviance, even if positive? I first discovered the concept of positive deviance while doing research for the U.S. FDA, as to why some medical device manufacturers went beyond what was required by the agency’s unique device identification rule in order to help their customers effectively use the standard identifiers. More recently, I have witnessed positive deviance in action while exploring the extraordinary results achieved by midsize distributor Concordance. After hearing about how the company supports health equity, inclusive hiring, and system-level supply chain visibility, I asked CEO Lisa Hohman why the firm chooses to take on these larger challenges. Her answer (described at the end of the column) is relatively simple and universal. 

Let’s start with the definition of positive deviance. I am particularly drawn to those that speak to intentional behaviors¹ and the solutions coming from within a community,² vs. being mandated as so often happens in healthcare. 

Health equity

Concordance first piqued my interest after I heard how the company responded to a question in an RFP from Rush University Medical Center about supporting economic development in a disadvantaged Chicago suburb; Concordance won the contract, and has since built a 175,000-square-foot distribution center on the west side of Chicago and hired and trained local residents to work there. Concordance is now working with local authorities, community organizations, and non-profits on ways to provide reliable and affordable daycare for its employees and west side residents. Read more about how Concordance is supporting other west side initiatives—from job shadowing and training certifications to lowering supply chain greenhouse gas emissions—in the December 2022 and May 2023 issues of Value.Delivered. 

Food insecurity

Going above and beyond is not new to Concordance. Years ago, the company began helping a health system address food insecurity among patients living in food deserts (where there is an overabundance of fast food and convenience stores but limited access to nutritious food).  Concordance helped the health system package boxes of healthy food to distribute to patients upon discharge. 

Human trafficking

In 2012, Concordance learned about the human trafficking of young women from the work of Theresa Flores, author of A Girl Next Door. Collaborating with local leaders, Concordance (then Seneca Medical) helped establish a not-for-profit organization, Sisters In Shelter, which provides education, support, housing, and counseling for those negatively affected. Today, Concordance remains the largest single contributor to the organization. 

Inclusive hiring

Concordance’s inclusive hiring program has delivered benefits for both those hired and the company. With proactive intent, Concordance reaches out to community organizations that serve differently abled persons and, with the help of work coaches, develops jobs customized to their capabilities. Company employees say the positive attitude of the workers is contagious, boosting both morale and productivity. 

Supply chain resiliency and visibility

When the pandemic hit, Concordance was one of six distributors working with federal agencies, including the Strategic National Stockpile (SNS), to help supply personal protective equipment and other products where they were needed most. Recognizing that the private healthcare sector had limited knowledge as to how the SNS operates, Hohman spearheaded a partnership with the trade association SMI to educate and engage members around emergency preparedness. 

Concordance participated in a SMI-sponsored research effort with providers, suppliers, the SNS, and the state of North Carolina to create lessons from how they individually and collectively responded to supply shortages during the pandemic. Concordance was also among the first to call for public-private initiatives to rotate stockpiled products into use to avoid them expiring or becoming unusable while sitting on the shelf. 

More recently, Concordance was the driving force behind a new industry platform to support supply continuity. Concordance has signed a 10-year contract with data analytics company Palantir to create a healthcare supply chain platform that provides visibility at the system level.   The platform, known as Surgence, is open to all providers, distributors, and manufacturers, enabling trading partners to share actionable information with authorized users on inventory and consumption levels, and help ensure products are where they are needed most. Surgence also supports temporary shifts to clinically equivalent products as needed during shortages. 

Finally, I promised I would share what Lisa believes to be the secret behind her company’s positively deviant behavior and results. She admits being a privately held company supports flexibility and an entrepreneurial spirit, but she gives the biggest kudos to her team, which she says is constantly looking for ways to support the communities they serve. 

On a personal note, Lisa credits her mother for her own positivity: “Even on the worst of days, my mother could find some good in everything.” She describes losing her brother when he was just 20 years old in a car accident. “On the day he passed, my mother had the fortitude to recognize that at least no one else was injured. Her ability to always find something to be thankful for shaped my view of the world. Live every moment; always find the good in the world; and when there is a need, figure out how to positively impact lives.” 

As scholars continue to search for the root causes of positive deviance, we may need to look no farther than our own world view. Maybe it is just believing in one another and encouraging work for the collective good. And this, I believe, is something we can all do. As Lisa says, “It costs nothing, but the rewards are tremendous.”

References

[1] Spreitzer G, Sonenshein S. Toward the construct definition of positive deviance. The American Behavioral Scientist. 2004;47(6):828-847.

[2] Sternin, J., & Choo, R. (2000). The power of positive deviancy. Harvard Business Review