Developing your system

Earlier today I pointed out a story in the New York Times about solving problems using local knowledge and resources.

https://dressagesnob.wordpress.com/2013/02/28/when-deviants-do-good-nyt/

The gist of it is solutions from the outside are often poorly implemented or accepted by the recipients–even if those people really do want improvement.  Anything that is not part of one’s routine can be a stretch to accept.

Horses are no different.  Something that is accepted as obvious in one part of the world, can be taken as complete heresy in another.  And many areas, with many different “systems” produce fine horses and fine riders.  But sometimes, regrettably,  some areas repeatedly produce really terrible ones!  Trainers and riders use the resources available, often repeating patterns by rote, “because it is done like this.”

Indeed.

These patterns may or may not work–but they are often repeated nonetheless.

If, as pointed out before, one of the characteristics of successful people everywhere is ruthless self-evaluation, then that process should be first on the list.

Here are several–totally imaginary–barn models and how they seem to work–or not!

Professional A has a very successful training program, a happy family and a group of satisfied clients, some of which show quite successfully on a local level.  Professional A never gets on a horse. Broken arm in trailer accident in her twenties does not allow her to ride.  Her clients must do it all.  The ones that show all have very good horses.  Most of which have been purchased at considerable cost from active barns in the south.  The median cost is four times what people locally “like” to spend–these are “made” amateur horses from Europe that did not work out in the more competitive regions.  Professional A’s program is working–no cure necessary as long as enough clients have the ante-in necessary.

Amateur B has a full-time job and a long commute.  He keeps his horses at home in a herd group at low-cost per horse, but a lot of ultimate cost.  Amateur B has a history of producing frightening and spoiled horses that are no fun to be around–and lots of them!  Amateur B has many, many horses in the field and none of them get much professional work–it is too expensive.  And when one does go in for work is it likely to be  a wreck because so very many unattended to problems surface when an alternative program is enacted.  What’s the cure?

Professional C has a long career and a great “out-of-town” image.  Many high quality horses peer out of Professional C’s stalls.  Clients from out-of-town appear at regular intervals to train, increasing her status.  But none of these expensive horses seem to progress up the levels, and none of the clients actually do very well at the shows.  However, Professional C is actually getting some nice scores on the one, expensive, horse she likes to ride.  How is that working for the clients?

Amateur D also has a full-time job, and someday he dreams of being a top-level judge.  He puts lots of effort into networking, attending seminars, judging local shows.  But there is never enough time to really ride or train with the regularity to get “to the next level”  (Upper level judges now have to have a string of very, very good scores–four at 65% at the lower FEI is nothing to sneeze at.  You really have to have a good horse, and be able to pilot it, to rake those numbers  in.)  So even though he is successful, he wants the next level and it is nowhere in sight.  What is the answer?

Professional E likes to show.  She will enter four horses in two classes each on every day available.  She gets really good scores on horses she has trained herself, well into the FEI.  But her clients never progress and they are frustrated at the expense of showing not so successfully.  How could this be different?

Professional F likes to train.  A lot of young horses have come and gone through the barn over the years.  Some are nice, some not so nice.  Professional F will work with anything, citing sympathy with her clients “not being able to afford it.”  The selection process sometimes looks like dumpster diving, but the training is good–a lot of her off-breed horses have beaten the local warmbloods.  What should she be doing differently?

Professional G finally convinced her clients to purchase some nice young warmblood stock.  Now it is time to put them to work.  None of the clients have any experience with young horses, but they are used to it being cheap.  (A young horse is much less expensive to keep than an adult in work)  The clients are not in the habit of budgeting for full-time training.  They are going to do the work themselves.  Is this likely to work?

Amateur H makes a lot of trips to the vet.  She has a nice trailer and a large, expensive, pickup.  All of Amateur H’s  horses are lame, some very sick.  (If a horse in a town without possums is going to contract EPM, it is hers.)  She spends thousands at the state vet hospital every month and the horses then sit in the field recuperating.  When she buys a horse she does not ask for help and its front legs are so crooked that arthritis is already setting in.  She says she can deal with it.  She likes the horse and if it does not work out she has space.  Is there a smarter method to success?

All of the examples above have strengths in their training programs.  But most of them have a fatal flaw. Even the cheapest of them are still spending a lot of money–or their client’s money.  The only one that is really working for the clients appears to be the first example.  Professional A sets clear entry parameter--you are going to need to spend a good bit on a horse if you want to show.  Then time put in on the student, NOT the student’s horse.  (Sad fact, most trainers are not very good riders–and it doesn’t do you THAT much good to put any, but a very, very good rider on your horse for upper level work.  In fact, it may cause harm)  And sometimes the “not so good” trainer is not even working the horse (time spent holding a longe line and a cell phone does not count).  But you KNOW if you have had a riding lesson!

So, if you want to show with high scores, you are going to need a very good horse that is trained, and then take the time to get the training yourself.  Dressage horses do not ride themselves.

If you want to make and break your own, do not choose a warmblood as your trial project.  Pick something small and mellow.

If you want your horse to be good at trail riding, take him or her to someone who knows how to get a horse to cross streams and logs.

If you want your horse to know Prix St Georges, take him or her to a known Grand Prix trainer–better yet, buy one that already knows it!

If you want your horse worked, go to someone who likes to work horses–the person who can make any mutt into a decent citizen.  (Hint–then don’t bring the mutt, get something good!)

The client is ultimately in charge of the program–because they choose it.  Doing horses is a lot like arranging a good diet: the skillful lesson that was easy and makes you feel satisfied right after, might in fact be the TV dinner of the horse world.

Real progress, like real food, takes time and effort and money and thought.

The take home message is have a look at the parameters of how you, and each person you might use, works their program.  Look hard, then be honest with yourself about what you actually know how to do. And more importantly what success you have had in the past.  If you are not happy with it–change something!

Any other approach is a lot like going into a big box store and just buying a big box.  It might be helpful to have had a glance inside before you take it home. . . .

When Deviants Do Good NYT

A very interesting article.  Take away message: find someone locally who appears to be doing it right and ask them how they are managing that success.

http://opinionator.blogs.nytimes.com/2013/02/27/when-deviants-do-good/

When Deviants Do Good

By TINA ROSENBERG
Fixes

Fixes looks at solutions to social problems and why they work.

Jerry and Monique Sternin and their son were among the very first Americans to move to Hanoi when they arrived in Vietnam in 1990. They had come from the Philippines, where Jerry had been director of Save the Children’s program there.

At the time, Vietnam was losing its imports of subsidized rice from ideological backers and shifting from collectivized to private agriculture. The dislocation was deadly — “a near-famine situation,” Monique Sternin said in an interview from Addis Ababa this weekend. About two-thirds of children were malnourished. International feeding programs had helped, but when the programs ended, villages fell back into hunger. The government had asked Save the Children to try to find a lasting solution. Some officials didn’t like having Westerners brought in. You have six months to show results, the government warned. If you don’t, you’re out.

The Sternins had seen in their previous work how big programs run by outsiders created dependency. “The essence of development is to help people build capacity to do things themselves,” said Monique (Jerry died in 2008). “We were struggling to find something.”

They had just read a book, however, by Marian Zeitlin, a professor of nutrition at Tufts University, called “Positive Deviance in Nutrition.” The word deviant usually has negative connotations, but Zeitlin wrote about children who thrived even as those around them were poorly nourished. Zeitlin suggested that nutrition could be improved if a village looked at what these children’s families were doing right.

The Sternins were not experts in fighting malnutrition. But they thought they knew where to find some.They went into villages and asked for volunteers to weigh all children under 3, and to characterize each family’s level of income. The volunteers concluded the obvious: the poorer the family, the more likely the children would be malnourished. Then the Sternins asked if any of the families characterized as “very, very poor” had well-nourished children.

The volunteers checked the list and excitedly reported that there were some.

“So it’s possible for a very, very poor child in the village to be well nourished?” asked the Sternins.

“Let’s go see what their families are doing differently,” the volunteers said.

The volunteers fanned out to interview these “positive deviant” families — in each village there were a few, perhaps 5 or 6. They found several practices in common. Children in the village were fed twice a day, mostly rice. Local custom held that an adult diet was harmful for young children. But the positive deviant parents were collecting tiny crabs or shrimps from rice paddies and giving them to the children along with the greens from sweet potatoes. While village wisdom held that you don’t feed a child who has diarrhea, the positive deviant families did. They also fed their children often throughout the day, and washed their children’s hands before they ate.

The Sternins knew that helping villagers to learn about these deviant behaviors would not be enough. “Knowledge doesn’t change behavior,” said Monique. “Practice changes behavior.” They convened meetings of villagers to discuss how best to spread the behaviors. The villagers decided that parents of malnourished children would gather with their children daily at a neighbor’s house for two weeks. Each family had to collect a handful of shrimps, crabs or greens and bring it to the gathering. With a trained health volunteer, the families cooked meals using the nutritious foods and tried out the new practices. If they didn’t become habit and the children were still malnourished, the families could do another two-week cycle the next month. “Trying something new always makes you a little scared. People got confidence through their peers,” said Monique.

Five and a half months after the Sternins had arrived in Vietnam, authorities weighed the children in the district who had participated in the program. More than 40 percent were now well nourished, and another 20 percent had moved from severe to moderate malnutrition. The Sternins got their visa extended. Vietnam eventually replicated the program in 250 communities.

Poor-country development usually works like this: Outsiders come into a community where there is a problem. They bring in “best practice” ideas that have worked elsewhere, and design ways to teach the community to change its culture and adopt these new ideas.

And then they leave.

If they come back later, however, they might find that not much has changed: a few people adopted the new idea, but not many. And since that was not the way the community did things, even those adventurous few might abandon their new practices.

Here’s how the positive deviance approach is different:

* Outsiders don’t bring in ideas to change a community’s culture. Instead, they ask the community to look for its own members who are having success. Those local ideas, by definition, are affordable and locally acceptable — at least to some people in the community. Since they spring from a community’s DNA, the community is less likely to feel threatened by these ideas and more likely to adopt them.

* The focus is not a community’s problems, but its strengths.

* Outsiders don’t design a communication or training strategy to teach the idea. Outsiders can bring people in the community into one room, but local people design a way to spread the new behaviors.

* Local leaders are not the ones who come up with solutions. That is the job of everyone on the front line dealing with the problem. The leaders’ job is to facilitate the process of finding and spreading these solutions.

* Outsiders don’t monitor success. They show people in the community how to do that. “If they see that things are getting better, that’s further incentive to continue the new behavior,” said Monique.

Positive deviance has now been used in dozens of countries to attack a wide variety of problems. The nutrition program has been replicated all over the world — in each place using different, local solutions. Positive deviance has helped to reduce rates of female genital mutilation in Egypt, improved prisons in Denmark, helped the mentally ill in Pittsburgh strengthen social connections and cut infections at Veterans Affairs hospitals across the United States. Tufts University is host to the Positive Deviance Initiative, which has a staff of four and several consultants who teach the process around the world (Monique is a senior consultant), and the Sternins wrote a book, “The Power of Positive Deviance.”

In 1997, the Pittsburgh Regional Healthcare Initiative was formed to try to improve hospital care. One of its goals was to reduce the infection rate of MRSA, a deadly resistant form of staph, in local hospitals. The city’s V.A. Pittsburgh Healthcare System agreed to run a pilot program beginning in 2001, adopting the Toyota Production System. (Paul O’Neill, the former treasury secretary, was one founder of the Initiative; he had used Toyota’s manufacturing and logistics strategies when he ran Alcoa.) “This went a long way in solving some of the technical problems — providing soap, gowns and gloves where they were needed in quantities they were needed,“ said Jon Lloyd, a prominent Pittsburgh surgeon. “But the so-called behavioral problems were untouched. Once resources were withdrawn from the Toyota model it fell apart. The frontline staff didn’t own it. Physicians, especially, were not washing their hands — nurses were at 70 percent for hand hygiene, but physicians were at 15 percent.”

Lloyd read an article in Fast Company about positive deviance, and invited Jerry Sternin to come speak. He agreed, with the condition that Lloyd produce everyone in the hospital who touched patients in any way. In July 2005, Jerry asked those 150 people who they felt was responsible for preventing infection; they pointed to nurses and the hospital’s infection control officers.

“Six months later Jerry asked the same question, and every hand went up,” said Lloyd, who became the hospital’s positive deviance adviser and coach, and now does the same with other Pittsburgh organizations. “The housekeepers at the VA turned out to be world authorities on infection prevention — people who are never asked for their opinions.”

Related
More From Fixes

Read previous contributions to this series.

Ideas came from all over. Edward Yates, on the housekeeping staff, was a wellspring of anti-infection ideas; his unit chose him to brief the staff (including high-ranking doctors) on the unit’s progress. One hospital pastor told his colleagues that he kept his Bible from spreading germs by gowning it with paper hats. He changed the hat with each new patient.

Lloyd said that the other pastors began to do the same. “No one had to tell the others to do this,” he said. “There was just a quiet understanding of a solution that came from somebody who shared their professional DNA.”

Six months later, the infection rate had fallen by more than half, and the gains did not go away. (Since this was not a randomized control trial, there’s no way to know how much of the gains came from the use of positive deviance.) The V.A. then adopted these changes in virtually all its hospitals, recommending that hospitals use the positive deviance approach and offering training in it. From October 2007 to June 2010, MRSA infections in intensive care units at the 153 V.A. hospitals in the program dropped by 65 percent; in nonintensive care units they dropped by 45 percent. (Again, we don’t know if the intervention can take credit, although it is significant that there had been no change in MRSA infection rates during the two years before the intervention.)

Pittsburgh’s experience, ultimately successful, also shows why positive deviance can fail. “It’s particularly difficult for donors who want to have a clear sense of what outcomes will be,” said Roger Swartz, the executive director of the Positive Deviance Initiative. Donors have solutions they like, and they will finance programs that use those solutions. But with positive deviance, you don’t know what the solution will be; it has to emerge as part of the process.

The approach can also be threatening to people at the top. They are used to being the experts, but with positive deviance, it’s the people in the field who are the experts. In hierarchical institutions like hospitals, housekeeping staff members do not usually brief physicians. But where managers can accept revolutionary new ways of doing business, positive deviance can succeed. “I don’t know how this is going to work,” the Pittsburgh V.A. chief Rajiv Jain told his workers when they began the program. “But I have total confidence that you as the front line staff will know.”