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2016 ; 25
(3
): 190-201
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What methods are used to apply positive deviance within healthcare organisations?
A systematic review
#MMPMID26590198
Baxter R
; Taylor N
; Kellar I
; Lawton R
BMJ Qual Saf
2016[Mar]; 25
(3
): 190-201
PMID26590198
show ga
BACKGROUND: The positive deviance approach focuses on those who demonstrate
exceptional performance, despite facing the same constraints as others. 'Positive
deviants' are identified and hypotheses about how they succeed are generated.
These hypotheses are tested and then disseminated within the wider community. The
positive deviance approach is being increasingly applied within healthcare
organisations, although limited guidance exists and different methods, of varying
quality, are used. This paper systematically reviews healthcare applications of
the positive deviance approach to explore how positive deviance is defined, the
quality of existing applications and the methods used within them, including the
extent to which staff and patients are involved. METHODS: Peer-reviewed articles,
published prior to September 2014, reporting empirical research on the use of the
positive deviance approach within healthcare, were identified from seven
electronic databases. A previously defined four-stage process for positive
deviance in healthcare was used as the basis for data extraction. Quality
assessments were conducted using a validated tool, and a narrative synthesis
approach was followed. RESULTS: 37 of 818 articles met the inclusion criteria.
The positive deviance approach was most frequently applied within North America,
in secondary care, and to address healthcare-associated infections. Research
predominantly identified positive deviants and generated hypotheses about how
they succeeded. The approach and processes followed were poorly defined. Research
quality was low, articles lacked detail and comparison groups were rarely
included. Applications of positive deviance typically lacked staff and/or patient
involvement, and the methods used often required extensive resources. CONCLUSION:
Further research is required to develop high quality yet practical methods which
involve staff and patients in all stages of the positive deviance approach. The
efficacy and efficiency of positive deviance must be assessed and compared with
other quality improvement approaches. PROSPERO REGISTRATION NUMBER:
CRD42014009365.
|*Health Services Research
[MESH]
|*Quality of Health Care
[MESH]
|Delivery of Health Care/*organization & administration
[MESH]