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Research in action: using positive deviance to improve quality of health care.

Bradley EH, Curry LA, Ramanadhan S, Rowe L, Nembhard IM, Krumholz HM - Implement Sci (2009)

Bottom Line: Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete.The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices.The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT, USA. elizabeth.bradley@yale.edu

ABSTRACT

Background: Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality.

Methods: We synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction.

Results: The positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care); study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices.

Conclusion: The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.

No MeSH data available.


Related in: MedlinePlus

Key drivers of the diffusion process.
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Figure 2: Key drivers of the diffusion process.

Mentions: Promoting wide dissemination of best practices, particularly among health care organizations, has been the subject of expansive theoretical inquiry [45]. A distinguishing strength of the positive deviance approach is the focus on active dissemination of best practices. Existing theories [44,46,51-55] identify several factors that influence the shape of the trajectory of diffusion, or spread, of innovations throughout an industry (Figure 2): features of the innovation, the dissemination strategy, the alignment of the external environment with adoption of the innovation, and features of the adopting organizations, or users.


Research in action: using positive deviance to improve quality of health care.

Bradley EH, Curry LA, Ramanadhan S, Rowe L, Nembhard IM, Krumholz HM - Implement Sci (2009)

Key drivers of the diffusion process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2690576&req=5

Figure 2: Key drivers of the diffusion process.
Mentions: Promoting wide dissemination of best practices, particularly among health care organizations, has been the subject of expansive theoretical inquiry [45]. A distinguishing strength of the positive deviance approach is the focus on active dissemination of best practices. Existing theories [44,46,51-55] identify several factors that influence the shape of the trajectory of diffusion, or spread, of innovations throughout an industry (Figure 2): features of the innovation, the dissemination strategy, the alignment of the external environment with adoption of the innovation, and features of the adopting organizations, or users.

Bottom Line: Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete.The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices.The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, CT, USA. elizabeth.bradley@yale.edu

ABSTRACT

Background: Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality.

Methods: We synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction.

Results: The positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care); study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices.

Conclusion: The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.

No MeSH data available.


Related in: MedlinePlus