Table 1

Positive and negative deviance: characteristics and learning opportunities

Negative deviance characteristicsPositive deviance characteristicsWhat can positive deviance learn from negative deviance?
Focus on what goes wrong and preventing harmFocus on what goes right and spreading positive behavioursUse the same mediums of dissemination about adverse events to encourage teams to vocalise their efforts and successes
ReactiveProactiveBe responsive to positively deviant practice by encouraging the spread of successful behaviours identified using the positive deviance approach
Easily attracts attentionDoes not naturally attract attentionMarket positively deviant teams. Money is often spent campaigning to avoid adverse events—redirect resources to spreading positive practice
Sense of urgency to find and fix problemsSolutions evolve over timeCreate a sense of urgency about spreading positively deviant practice
Backward-looking, retrospective thinkingForward-looking, prospective thinkingHighlight the time it takes to analyse an adverse event, identify the cause, and implement the solution—and acknowledge that often the solution may not be evident from analysing the adverse event. Compare this to the time it takes for local teams to spend time looking at their own practice, and developing context-specific solutions currently available in the system
Managerial pressureCohesive well-performing team without reason for managerial interventionUse managerial support to promote positive deviance; actively recognising (and rewarding) teams that have initiated change and found improvement—highlight the need to learn how it was achieved and to spread the good practice
Targeted successA philosophyRather than single instances of find and fix, use a longer-term approach to build a philosophy of positive deviance across a system
Reduce variabilityPromote effectivenessAccept that variability is a recurring feature of all systems and can never be completely eradicated—even when evidence-based care is applied. This can be a sign of resilience
Measures change following harmGood practice is a longitudinal phenomenonContinuously measure practice to demonstrate improvement and sustained performance over time