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Positive deviance: a different approach to achieving patient safety
  1. Rebecca Lawton1,2,
  2. Natalie Taylor2,3,
  3. Robyn Clay-Williams3,
  4. Jeffrey Braithwaite3
  1. 1Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
  2. 2Institute of Psychological Sciences, University of Leeds, Leeds, UK
  3. 3Faculty of Medicine, Centre for Clinical Governance Research, University of New South Wales, Sydney, Australia
  1. Correspondence to Dr Natalie Taylor, Faculty of Medicine, Centre for Clinical Governance Research, University of New South Wales, Sydney, NSW 2051, Australia; natalie.taylor{at}unsw.edu.au

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Patient safety management within healthcare systems globally can feel like a relentlessly negative treadmill. 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. Sometimes these methods help us to understand why patients are harmed. However, such ‘find and fix’ approaches tell us little about the presence of patient safety, alerting us instead to its absence. These efforts aim to prevent harm by striving to reduce the number of things that go wrong,1 as opposed to identifying instances when—often despite challenging circumstances and limited resources—things go right. The focus on error detection and its management has not produced the expected gains in patient safety,2 primarily because these methods are not well suited to a complex adaptive system such as healthcare.3 Behaviours that produce errors are variations on the same processes that produce success, so focusing on successful practices may be a more effective tactic.4

Focusing on the upside

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.6 ,7 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, …

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