Background The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people.
Methods A qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data. In total, 70 multidisciplinary staff participated in eight focus groups to explore staff perceptions about how their teams deliver safe patient care. A thematic analysis was conducted in two stages: first to identify the tools, processes, strategies, and cultural and social contexts that facilitated safety across all wards; and second to generate hypotheses about the characteristics that facilitated ‘positively deviant’ patient care.
Results Based on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented.
Conclusion This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.
- health services research
- implementation science
- patient safety
- qualitative research
- quality improvement methodologies
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Twitter @RuthMBaxter @LawtonRebecca
Contributors RB, RL, NT and IK were involved in the design of the overall study. RB collected and analysed the data with input and guidance from RL, NT and IK. RB wrote the first draft of the manuscript, and all authors have contributed to the drafting and reviewing of it. All authors have approved the final version of this manuscript for submission.
Funding This article was funded by the Health Foundation, PhDs in Improvement Science.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Research ethics approval was granted by South East Scotland Research Ethics Comittee (ref 14/SS/1085) and permissions were gained from all NHS Trusts involved.
Provenance and peer review Not commissioned; externally peer reviewed.
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