Table 3

Key themes within healthcare definitions of positive deviance

Positively deviant groups or individuals are high performersPositive deviants succeed, find better solutions and achieve better outcomes than others‘This approach emphasizes in-depth qualitative study of organizations with exceptionally high performance to understand the factors that contribute to their excellence’ (ref. 25, p.1542)
‘The positive deviance approach is a framework for identifying and learning from top performers in a system’ (ref. 51, p.64)
Positively deviant groups or individuals do things differentlyPositive deviants follow uncommon or special practises and behaviours. Only a few studies explicitly define positively deviant behaviours as being ‘deviant’ or going against cultural norms.30–32‘Positive deviance inquiries focus on individuals who behave differently from the rest of the community and, in so doing, succeed where others fail’ (ref. 11, p.1413)
‘The group that faces the problem determines the desired outcome; identifies the most effective behaviours, resources, and actions; and searches for the best solutions using unique strategies’ (ref. 39, p. 946)
The positive deviance approach is a ‘bottom up’ approachThe positive deviance approach is driven by the community. Success is internally generated rather than externally imposed‘The positive deviance process is grounded on several beliefs. First, much of the expertise and experience needed for change exist in the organization, and second, change efforts are best led from within the institution by people with first-hand knowledge of its work, history and norms, … . Third, expertise within an organization is widely distributed, necessitating the engagement of staff from various services, levels and roles’ (ref. 34, p.234)
‘Since solutions originated from within, positive deviance is inherently a culturally appropriate development approach.’ (ref. 43, p.145)
Positively deviant solutions are sustainable within current resourcesPositive deviants face similar challenges to others and succeed using existing resources‘Positive deviance is a behavioural change approach that assumes the existence in any community of individuals who handle situations more effectively (positive deviants) than their peers, despite the similarities of problems and available resources’ (ref. 39, p.946)
‘Positive deviance is an ‘assets-based’, four-stage approach that focuses on using the resources already available among communities to promote health’(ref. 48, p.72)