Positive and negative deviance: characteristics and learning opportunities
| Negative deviance characteristics | Positive deviance characteristics | What can positive deviance learn from negative deviance? |
|---|---|---|
| Focus on what goes wrong and preventing harm | Focus on what goes right and spreading positive behaviours | Use the same mediums of dissemination about adverse events to encourage teams to vocalise their efforts and successes |
| Reactive | Proactive | Be responsive to positively deviant practice by encouraging the spread of successful behaviours identified using the positive deviance approach |
| Easily attracts attention | Does not naturally attract attention | Market 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 problems | Solutions evolve over time | Create a sense of urgency about spreading positively deviant practice |
| Backward-looking, retrospective thinking | Forward-looking, prospective thinking | Highlight 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 pressure | Cohesive well-performing team without reason for managerial intervention | Use 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 success | A philosophy | Rather than single instances of find and fix, use a longer-term approach to build a philosophy of positive deviance across a system |
| Reduce variability | Promote effectiveness | Accept 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 harm | Good practice is a longitudinal phenomenon | Continuously measure practice to demonstrate improvement and sustained performance over time |