Key characteristics of positive deviance applications within healthcare organisations
| Stages addressed: * | |||||||
|---|---|---|---|---|---|---|---|
| Author and year | Location | Healthcare setting | Problem or issue addressed | 1 | 2 | 3 | 4 |
| Primary care | |||||||
| Bradley et al 201254 | Ethiopia, four regions | Primary Healthcare Units | Quality, access and usage of primary healthcare in rural, low-income settings | Y | Y | N | N |
| Gabbay et al 201321 | USA, Pennsylvania | Primary Care Medical Homes | Variation in diabetes care across medical home practices | Y | Y | N | N |
| Taliani et al 201320 | USA, Pennsylvania | Primary Care Medical Homes | Variation in the definition and implementation of care manager roles | Y | Y | N | N |
| Kim et al 200811 | Indonesia, East Java | Public clinics | Nurse–patient communication within a family planning context | Y | Y | N | N |
| Kraschnewski et al 201322 | USA, national | Primary care providers | The provision of advice to obese and overweight adults on weight loss/setting weight-loss goals | Y | Y | N | N |
| Ma and Magnus 201223 | USA, Los Angeles | Community public health | Black mothers and women with low education or socioeconomic status have lower initiation of breastfeeding | Y | Y | N | N |
| Marsh et al 200224 | Pakistan, Haripur | Primary care | Infant mortality ratio | Y | Y | N | Y |
| Rose et al 201225 | USA, national | VMSCs—primary care | Substantial variation in anticoagulation control | Y | Y | N | N |
| Secondary care | |||||||
| Abrahamson et al 201126 | USA, Indiana | Cancer care organisations | Clinical practice to manage psychosocial distress in patients with cancer | N | Y | N | N |
| Abrahamson et al 201127 | USA, Indiana | Cancer care organisations | Clinical practice to manage psychosocial distress in patients with cancer | N | Y | N | N |
| Anzarut et al 201128 | Inferred as Canada | Inferred as acute hospital | Unsatisfactory plastic surgery journal clubs | N | Y | Y | N |
| Curry et al 201129 | USA, national | Acute hospitals | Variation in 30 days risk standardised mortality ratio (RSMR) for patients with acute myocardial infarction (AMI) | Y | Y | N | N |
| Cherlin et al 201230 | USA, national | Acute hospitals | Variation in 30 days RSMR for patients with AMI. One-third of deaths contributing to RSMR occur after discharge | Y | Y | N | N |
| Bradley et al 201231 | USA, national | Acute hospitals | Variation in 30 days RSMR for patients with AMI | N | N | Y | N |
| Landman et al 201332 | USA, national | Acute hospitals and emergency services | Collaboration between hospital and emergency services to reduce variability in RSMR for patients with AMI | N | Y | N | N |
| Griffith et al 201310 | USA, national | Healthcare organisations | Use of knowledge management within healthcare practises | Y | Y | N | N |
| Kennedy et al 199933 | USA, Mid-West | Children developmental clinics | Infants with very low birthweight are at higher risk of clinical problems. Premature infants who grow well have better developmental outcomes | Y | Y | N | N |
| Lindberg and Schneider 201334 | USA, Maine | Medical centre (including community hospital/tertiary care) | MRSA infections | N | Y | N | Y |
| Lindberg et al 201335 | USA, New Jersey | Outpatient haemodialysis centre | Blood stream infections | Y | Y | N | N |
| Downham et al 201236 | USA, New Jersey | Outpatient haemodialysis centre | Blood stream infections | N | Y | N | Y |
| Marra et al 201037 | Brazil | Hospital Step Down Units | Hand hygiene compliance | Y | Y | N | N |
| Marra et al 201138 | Brazil | Hospital Step Down Units | Hand hygiene compliance | Y | Y | N | N |
| De MacEdo et al 201239 | Brazil, Sao Paulo | Hospital Step Down Units | Hand hygiene compliance | N | Y | N | N |
| Marra et al 201340 | Brazil and Thailand | Hospitals (1 ward, 8 intensive care units) | Hand hygiene compliance | N | N | Y | N |
| Zaldi et al 201241 | Pakistan | Medical school | Student achievement in preclinical written work often does not reflect achievement in clinical work | Y | Y | Y | N |
| Awad et al 200942 | USA, Houston | 1 VAMC | Incidence of MRSA surgical site infections | ? | N | Y | Y |
| Bonuel et al 200943 | USA, Houston | 1 VAMC | Increased incidence MRSA infection and inconsistent application of prevention methods | ? | N | Y | N |
| Ellingson et al 201144 | USA, North-East | 1 VAMC | Antimicrobial (MRSA) resistance in US healthcare facilities | Y | Y | N | N |
| Evans et al 201345 | USA, national | VAMCs (Spinal Cord Injury Units) | Patients with spinal cord injury are at higher risk of developing healthcare-associated infections such as MRSA | ? | N | N | Y |
| Forsha and Richmond 200746 | USA—VA Pittsburgh Healthcare System | Acute, long-term and behavioural services | Reduction of healthcare-associated Staphylococcus aureus infections such as MRSA | Y | Y | N | ? |
| Jain et al 201147 | USA, national | VAMCs (intensive care/non-intensive care units) | Reduction of MRSA infections in acute care facilities | ? | N | N | Y |
| Regional/national level/other | |||||||
| Awofeso et al 200848 | Australia, New South Wales | Justice health services | Smoking cessation in prisoners | Y | N | Y | Y |
| Green et al 200649 | Canada, British Colombia | Vancouver Island Health Authority | Provision of recommended/evidence-based care for patients with chronic conditions | Y | Y | N | N |
| Klaiman et al 201350 | USA, nine states | Local Health Departments | Extensive local differences in public clinic vaccination processes | Y | Y | N | N |
| Klaiman et al 201451 | USA, nine states | Local Health Departments | Extensive local differences in school-based vaccination distribution | Y | Y | N | N |
| Naimoli et al 200852 | Sub-Saharan Africa, six countries | National health departments | Substantial variation in immunisation coverage to reduce childhood mortality | Y | Y | N | N |
| Primary and secondary care | |||||||
| Assefa et al 201453 | Ethiopia, national | Tertiary/general hospitals and health centres | Patient retention in antiretroviral treatment programmes | Y | N | N | N |
*Stages from the Bradley et al process for positive deviance.7 Y, yes—stage addressed; N, no—stage not addressed; ?, unclear whether stage addressed.
Rows represent included articles (n=37). Rows grouped by colour (grey or white) represent unique positive deviance projects (n=22).
MRSA, methicillin-resistant Staphylococcus aureus; VA, Veterans Affairs; VAMC, Veterans Affairs Medical Centre.