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Positive deviance: a different approach to achieving patient safety.

Lawton R, Taylor N, Clay-Williams R, Braithwaite J - BMJ Qual Saf (2014)

View Article: PubMed Central - PubMed

Affiliation: Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK Institute of Psychological Sciences, University of Leeds, Leeds, UK.

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Mortality reviews, incident reporting systems and audits all focus attention on what goes wrong and how often, why errors occur, and who or what is at the root of the problem... The focus on error detection and its management has not produced the expected gains in patient safety, primarily because these methods are not well suited to a complex adaptive system such as healthcare... Behaviours that produce errors are variations on the same processes that produce success, so focusing on successful practices may be a more effective tactic... It became a source of pride to be labelled as such, elevating the importance of hand hygiene, and the prestige of those working to improve it... Although a limited study, this work illuminated the potential of such an approach to bring about improved safety outcomes... Despite these encouraging findings, mobilising or learning from positively deviant teams and organisations has not gained widespread acceptance by those planning quality improvement interventions or managing poor performance... Patient safety initiatives still tend to focus mainly on the negative cases, and finding the problems, root causes, or the culprits responsible for adverse events (negative deviance), rather than attempting to identify unusually effective practice... In the modern patient safety paradigm, unlike the instantaneous, negative and often publicised response to an adverse event, the consistent delivery of well-executed safe care under typically difficult circumstances tends to go unrecognised; if, by chance, positively deviant individuals or teams are identified, they tend be labelled so retrospectively, after a successful enterprise has been proclaimed... Detecting positively deviant safe patient care is particularly challenging because of the lack of reliable measures of safe care, and comparable patient safety performance measures between individual healthcare professionals, wards and organisations... It is also unclear how to define sustained safe patient care (eg, is it the extent to which effective processes for ensuring patient care are embedded within an organisational system, or the length of time since a patient safety incident has occurred on a particular ward?)... Harnessing strategies from the negative deviance approach applied to positive deviance might involve: allocating resources usually focussed on reporting and reducing error to spreading positive behaviours, recognising positively deviant teams, and creating a sense of urgency about spreading positive exemplars of practice... The myopic focus on errors, harm and near misses has been sending negative messages for a long time... Politicians, bureaucrats, managers, the media and those leading enquiries as far back as Bristol Royal Infirmary and earlier, and more recently Mid-Staffordshire in the UK, have essentially indicated to clinicians: you are prone to making mistakes, and we must insist that you reduce the harm or potential harm you cause; and if you do not, we will regulate your activities, tightening the rules over time.

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Steps in the positive deviance approach. Modified from Bradley et al.7
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BMJQS2014003115F1: Steps in the positive deviance approach. Modified from Bradley et al.7

Mentions: One approach to focusing on success is positive deviance. While positive deviance can be used to describe the behaviour of an exemplary individual, the term can also be extended to describe the behaviours of successful teams and organisations. Originating in international public health projects,5 positive deviance has recently been embraced to improve quality and safety of healthcare delivered in organisations.67 The premise is that solutions to common problems mostly exist within clinical communities rather than externally with policy makers or managers, and that identifiable members of a community have tacit knowledge and wisdom that can be generalised. Moreover, because the solutions have been generated within a community, they tend to be more readily accepted and feasible within existing resources, thus increasing the likelihood of success and, potentially, of adoption elsewhere.8 The specific steps in the positive deviance approach, modified for our purposes to represent the organisation, team and individual, are outlined in figure 1.7


Positive deviance: a different approach to achieving patient safety.

Lawton R, Taylor N, Clay-Williams R, Braithwaite J - BMJ Qual Saf (2014)

Steps in the positive deviance approach. Modified from Bradley et al.7
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215344&req=5

BMJQS2014003115F1: Steps in the positive deviance approach. Modified from Bradley et al.7
Mentions: One approach to focusing on success is positive deviance. While positive deviance can be used to describe the behaviour of an exemplary individual, the term can also be extended to describe the behaviours of successful teams and organisations. Originating in international public health projects,5 positive deviance has recently been embraced to improve quality and safety of healthcare delivered in organisations.67 The premise is that solutions to common problems mostly exist within clinical communities rather than externally with policy makers or managers, and that identifiable members of a community have tacit knowledge and wisdom that can be generalised. Moreover, because the solutions have been generated within a community, they tend to be more readily accepted and feasible within existing resources, thus increasing the likelihood of success and, potentially, of adoption elsewhere.8 The specific steps in the positive deviance approach, modified for our purposes to represent the organisation, team and individual, are outlined in figure 1.7

View Article: PubMed Central - PubMed

Affiliation: Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK Institute of Psychological Sciences, University of Leeds, Leeds, UK.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Mortality reviews, incident reporting systems and audits all focus attention on what goes wrong and how often, why errors occur, and who or what is at the root of the problem... The focus on error detection and its management has not produced the expected gains in patient safety, primarily because these methods are not well suited to a complex adaptive system such as healthcare... Behaviours that produce errors are variations on the same processes that produce success, so focusing on successful practices may be a more effective tactic... It became a source of pride to be labelled as such, elevating the importance of hand hygiene, and the prestige of those working to improve it... Although a limited study, this work illuminated the potential of such an approach to bring about improved safety outcomes... Despite these encouraging findings, mobilising or learning from positively deviant teams and organisations has not gained widespread acceptance by those planning quality improvement interventions or managing poor performance... Patient safety initiatives still tend to focus mainly on the negative cases, and finding the problems, root causes, or the culprits responsible for adverse events (negative deviance), rather than attempting to identify unusually effective practice... In the modern patient safety paradigm, unlike the instantaneous, negative and often publicised response to an adverse event, the consistent delivery of well-executed safe care under typically difficult circumstances tends to go unrecognised; if, by chance, positively deviant individuals or teams are identified, they tend be labelled so retrospectively, after a successful enterprise has been proclaimed... Detecting positively deviant safe patient care is particularly challenging because of the lack of reliable measures of safe care, and comparable patient safety performance measures between individual healthcare professionals, wards and organisations... It is also unclear how to define sustained safe patient care (eg, is it the extent to which effective processes for ensuring patient care are embedded within an organisational system, or the length of time since a patient safety incident has occurred on a particular ward?)... Harnessing strategies from the negative deviance approach applied to positive deviance might involve: allocating resources usually focussed on reporting and reducing error to spreading positive behaviours, recognising positively deviant teams, and creating a sense of urgency about spreading positive exemplars of practice... The myopic focus on errors, harm and near misses has been sending negative messages for a long time... Politicians, bureaucrats, managers, the media and those leading enquiries as far back as Bristol Royal Infirmary and earlier, and more recently Mid-Staffordshire in the UK, have essentially indicated to clinicians: you are prone to making mistakes, and we must insist that you reduce the harm or potential harm you cause; and if you do not, we will regulate your activities, tightening the rules over time.

No MeSH data available.