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  1. Home
  2. Books
  3. The Positive Deviance Approach
    • You have access
    • Open access
  • Cited by 23
  • Ruth Baxter, Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Rebecca Lawton, School of Psychology, University of Leeds
Publisher:
Cambridge University Press
Online publication date:
August 2022
Print publication year:
2022
Online ISBN:
9781009237130
DOI:
https://doi.org/10.1017/9781009237130
Creative Commons:
Creative Common License - CC Creative Common License - BY Creative Common License - NC Creative Common License - ND
This content is Open Access and distributed under the terms of the Creative Commons Attribution licence CC-BY-NC-ND 4.0 https://creativecommons.org/creativelicenses
Subjects:
Medicine: General Interest, Medicine
Series:
Elements of Improving Quality and Safety in Healthcare
Information

Book description

Positive deviance is an asset-based improvement approach. At its core is the belief that solutions to problems already exist within communities, and that identifying, understanding, and sharing these solutions enables improvements at scale. Originating in the field of international public health in the 1960s, positive deviance is now, with some adaptations, seeing growing application in healthcare. We present examples of how positive deviance has been used to support healthcare improvement. We draw on an emerging view of safety, known as Safety II, to explain why positive deviance has drawn the interest of researchers and improvers alike. In doing so, we identify a set of fundamental values associated with the positive deviance approach and consider how far they align with current use. Throughout, we consider the untapped potential of the approach, reflect on its limitations, and offer insights into the possible challenges of using it in practice. This title is also available as Open Access on Cambridge Core.

References

References

1.Wray, JD. Can we learn from successful mothers? J Trop Pediatr Environ Child Health 1972; 18: 279. https://doi.org/10.1093/tropej/18.4.279.
2.Wishik, SM, Van Der Vynckt S. The use of nutritional ‘positive deviants’ to identify approaches for modification of dietary practices. Am J Public Health 1976; 66: 38–42. https://doi.org/10.2105/ajph.66.1.38.
3.Positive Deviance Collaborative. https://positivedeviance.org (accessed 12 February 2022).
4.Sternin, M, Sternin, J, Marsh, DL. Rapid, sustained childhood malnutrition alleviation through a positive-deviance approach in rural Vietnam: preliminary findings. In: Wollinka, O, Keeley, E, Burkhalter, BR, Bashir, N, editors. Hearth Nutrition Model: Applications in Haiti, Vietnam, and Bangladesh. Arlington, VA: BASICS; 1997: 49–62. https://pdf.usaid.gov/pdf_docs/Pnaca868.pdf (accessed 12 February 2022).
5.Sternin, M, Sternin, J, Marsh, D. Scaling up a poverty alleviation and nutrition program in Vietnam. In: Marchione, T, editor. Scaling Up, Scaling Down: Overcoming Malnutrition in Developing Countries. Amsterdam: Gordon and Breach; 1999: 97–118.
6.Mackintosh, UA, Marsh, DR, Schroeder, DG. Sustained positive deviant child care practices and their effects on child growth in Viet Nam. Food Nutr Bull 2002; 23 (suppl 1): 16–25. https://doi.org/10.1177/15648265020234S104.
7.Bisits Bullen, PA. The positive deviance/hearth approach to reducing child malnutrition: systematic review. Trop Med Int Health 2011; 16: 1354–66. https://doi.org/10.1111/j.1365-3156.2011.02839.x.
8.Nutrition Working Group, Child Survival Collaborations and Resources Group (CORE). Positive Deviance/Hearth: A Resource Guide for Sustainably Rehabilitating Malnourished Children. Washington, DC: CORE; 2002. https://coregroup.org/wp-content/uploads/2017/09/Positive-Deviance-Hearth-Resource-Guide.pdf (accessed 12 February 2022).
9.Ahrari, M, Kuttab, A, Khamis, S, et al. Factors associated with successful pregnancy outcomes in upper Egypt: a positive deviance inquiry. Food Nutr Bull 2002; 23: 83–8. https://doi.org/10.1177/156482650202300111.
10.Marsh, DR, Sternin, M, Khadduri, R, et al. Identification of model newborn care practices through a positive deviance inquiry to guide behavior-change interventions in Haripur, Pakistan. Food Nutr Bull 2002; 4 (suppl 2): 107–16. https://doi.org/10.1177/15648265020234S215.
11.Stuckey, HL, Boan, J, Kraschnewski, JL, et al. Using positive deviance for determining successful weight-control practices. Qual Health Res 2011; 21: 563–79. https://doi.org/10.1177/1049732310386623.
12.Masterson, JM, Swanson, JH. Female Genital Cutting: Breaking the Silence, Enabling Change. Washington, DC: International Center for Research on Women and the Centre for Development and Population Activities; 2000. www.icrw.org/wp-content/uploads/2016/10/Female-Genital-Cutting-Breaking-the-Silence-Enabling-Change.pdf (accessed 12 February 2022).
13.Herington, MJ, van de Fliert, E. Positive deviance in theory and practice: a conceptual review. Deviant Behav 2017; 39: 664–78. https://doi.org/10.1080/01639625.2017.1286194.
14.Baxter, R, Taylor, N, Kellar, I, Lawton, R. What methods are used to apply positive deviance within healthcare organisations? A systematic review. BMJ Qual Saf 2016; 25: 190–201. https://doi.org/10.1136/bmjqs-2015-004386.
15.Initiative, Positive Deviance. Basic Field Guide to the Positive Deviance Approach. Boston, MA: Tufts University; 2010. https://static1.squarespace.com/static/5a1eeb26fe54ef288246a688/t/5a6eca16c83025f9bac2eeff/1517210135326/FINALguide10072010.pdf (accessed 12 February 2022).
16.Singhal, A, Dura, L. Positive deviance: a non-normative approach to health and risk messaging. Oxford Res Encycloped Comm 2017. https://doi.org/10.1093/acrefore/9780190228613.013.248.
17.Awofeso, N, Irwin, T, Forrest, G. Using positive deviance techniques to improve smoking cessation outcomes in New South Wales prison settings. Health Promot J Austr 2008; 19: 72–3. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.541.3589&rep=rep1&type=pdf (accessed 12 February 2022).
18.Zaidi, Z, Jaffery, T, Shahid, A, et al. Change in action: using positive deviance to improve student clinical performance. Adv Health Sci Educ 2012; 17: 95–105. https://doi.org/10.1007/s10459-011-9301-8.
19.Bradley, EH, Curry, LA, Ramanadhan, S, et al. Research in action: using positive deviance to improve quality of health care. Implement Sci 2009; 4: 25. https://doi.org/10.1186/1748-5908-4-25.
20.Bradley, EH, Herrin, J, Wang, Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006; 355: 2308–20. https://doi.org/10.1056/NEJMsa063117.
21.Bradley, EH, Roumanis, SA, Radford, MJ, et al. Achieving door-to-balloon times that meet quality guidelines: how do successful hospitals do it? J Am Coll Cardiol 2005; 46: 1236–41. https://doi.org/10.1016/j.jacc.2005.07.009.
22.Antman, EM, Anbe, DT, Armstrong, PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary. Circulation 2004; 110: 588–636. https://doi.org/10.1161/01.CIR.0000134791.68010.FA.
23.Van de Werf, F, Ardissino, D, Betriu, A, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2003; 24: 28–66. https://doi.org/10.1016/s0195-668x(02)00618-8.
24.Bradley, EH, Byam, P, Alpern, R, et al. A systems approach to improving rural care in Ethiopia. PLoS One 2012; 7: e35042. https://doi.org/10.1371/journal.pone.0035042.
25.Bradley, EH, Curry, LA, Spatz, ES, et al. Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med 2012; 56: 618–26. https://doi.org/10.1059/0003-4819-156-9-201205010-00003.
26.Gabbay, RA, Friedberg, MW, Miller-Day, M, et al. A positive deviance approach to understanding key features to improving diabetes care in the medical home. Ann Fam Med 2013; 1 (suppl 1): S99–107. https://doi.org/10.1370/afm.1473.
27.Klaiman, T, O’Connell, K, Stoto, M. Local health department public vaccination clinic success during 2009 pH1N1. J Public Health Manag Pract 2013; 19: E20–6. https://doi.org/10.1097/PHH.0b013e318269e434.
28.Klaiman, T, O’Connell, K, Stoto, MA. Learning from successful school‐based vaccination clinics during 2009 pH1N1. J Sch Health 2014; 84: 63–9. https://doi.org/10.1111/josh.12119.
29.Buscell, P. The people, the danger and the new deviants. In: Singhal, A, Buscell, P, Lindberg, C, editors. Inviting Everyone: Healing Healthcare through Positive Deviance. Bordentown, NJ: PlexusPress; 2010: 1–22. https://utminers.utep.edu/asinghal/Books/Singhal-Book-2010-Inviting-Everyone-Healing-healthcare-through-Positive-Deviance.pdf (accessed 12 February 2022).
30.Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011; 364: 1419–30. https://doi.org/10.1056/NEJMoa1007474.
31.Marra, AR, Guastelli, LR, de Araujo, CMP, et al. Positive deviance: a new strategy for improving hand hygiene compliance. Infect Control Hosp Epidemiol 2010; 31: 12–20. https://doi.org/10.1086/649224.
32.Marra, AR, Guastelli, LR, de Araujo, CMP, et al. Positive deviance: a program for sustained improvement in hand hygiene compliance. Am J Infect Control 2011; 39: 1–5. https://doi.org/10.1016/j.ajic.2010.05.024.
33.Mannion, R, Braithwaite, J. False dawns and new horizons in patient safety research and practice. Int J Health Policy Manag 2017; 6: 685–9. https://doi.org/10.15171/ijhpm.2017.115.
34.Dixon-Woods, M, Martin, GP. Does quality improvement improve quality? Future Hosp J 2016; 3: 191–4. https://doi.org/10.7861/futurehosp.3-3-191.
35.Hollnagel, E, Wears, RL, Braithwaite, J. From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net: Published simultaneously by University of Southern Denmark; University of Florida, USA; and Macquarie University, Australia; 2015. www.england.nhs.uk/signuptosafety/wp-content/uploads/sites/16/2015/10/safety-1-safety-2-whte-papr.pdf (accessed 12 February 2022).
36.Hollnagel, E, Braithwaite, J, Wears, RL. Resilient Health Care. Surrey: Ashgate; 2013.
37.Learning from Excellence. https://learningfromexcellence.com (accessed 12 February 2022).
38.People, Appreciating. How Appreciative Inquiry Can Help You. www.appreciatingpeople.co.uk/how-ai-can-help-you (accessed 12 February 2022).
39.Kelly, N, Blake, S, Plunkett, A. Learning from excellence in healthcare: a new approach to incident reporting. Arch Dis Child 2016; 101: 788–91. https://doi.org/10.1136/archdischild-2015-310021.
40.Learning from Excellence. Is Learning from Excellence ‘Safety-II’? 2017. https://learningfromexcellence.com/how-do-you-do-safety-ii (accessed 12 February 2022).
41.Richer, M, Ritchie, J, Marchionni, C. Appreciative inquiry in health care. Br J Healthc Manage 2010; 16: 164–72. https://doi.org/10.12968/bjhc.2010.16.4.47399.
42.Trajkovski, S, Schmied, V, Vickers, M, Jackson, D. Using appreciative inquiry to transform health care. Contemp Nurse 2013; 45: 95–100. https://doi.org/10.5172/conu.2013.45.1.95.
43.Lilford, R, Mohammed, MA, Spiegelhalter, D, Thomson, R. Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma. Lancet 2004; 363: 1147–54. https://doi.org/10.1016/S0140-6736(04)15901-1.
44.Dixon-Woods, M, Leslie, M, Bion, J, Tarrant, C. What counts? An ethnographic study of infection data reported to a patient safety program. Milbank Q 2012; 90: 548–91. https://doi.org/10.1111/j.1468-0009.2012.00674.x.
45.Vincent, C, Burnett, S, Carthey, J. The Measurement and Monitoring of Safety: Drawing Together Academic Evidence and Practical Experience to Produce a Framework for Safety Measurement and Monitoring. London: The Health Foundation; 2013. www.health.org.uk/publications/the-measurement-and-monitoring-of-safety (accessed 12 February 2022).
46.Woodcock, T, Liberati, EG, Dixon-Woods, M. A mixed-methods study of challenges experienced by clinical teams in measuring improvement. BMJ Qual Saf 2021; 30: 106–15. https://doi.org/10.1136/bmjqs-2018-009048.
47.Pronovost, PJ, Nolan, T, Zeger, S, Miller, M, Rubin, H. How can clinicians measure safety and quality in acute care? Lancet 2004; 363: 1061–7. https://doi.org/10.1016/S0140-6736(04)15843-1.
48.O’Hara, JK, Grasic, K, Gutacker, N, et al. Identifying positive deviants in healthcare quality and safety: a mixed methods study. J R Soc Med 2018; 111: 276–91. https://doi.org/10.1177/0141076818772230.
49.The Royal College of Surgeons of England. Surgical Outcomes. www.rcseng.ac.uk/patient-care/surgical-staff-and-regulation/surgical-outcomes (accessed 12 February 2022).
50.Healthcare Quality Improvement Partnership. The National Clinical Audit Programme. www.hqip.org.uk/a-z-of-nca/#.Xqw6gp5KjIU (accessed 12 February 2022).
51.Austin, JM, Jha, AK, Romano, PS, et al. National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Aff 2015; 34: 423–30. https://doi.org/10.1377/hlthaff.2014.0201.
52.Jacobson, B, Mindell, J, McKee, M. Hospital mortality league tables: question what they tell you – and how useful they are. BMJ 2003; 326: 777–8. https://doi.org/10.1136/bmj.326.7393.777.
53.Rothberg, MB, Morsi, E, Benjamin, EM, Pekow, PS, Lindenauer, PK. Choosing the best hospital: the limitations of public quality reporting. Health Aff (Millwood) 2008; 27: 1680–7. https://doi.org/10.1377/hlthaff.27.6.1680.
54.Baxter, R, Taylor, N, Kellar, I, et al. Identifying positively deviant elderly medical wards using routinely collected NHS safety thermometer data: an observational study. BMJ Open 2018; 8: e020219. https://doi.org/10.1136/bmjopen-2017-020219.
55.Benneyan, JC, Lloyd, RC, Plsek, PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care 2003; 12: 458–64. https://doi.org/10.1136/qhc.12.6.458.
56.Mohammed, MA, Worthington, P, Woodall, WH. Plotting basic control charts: tutorial notes for healthcare practitioners. Qual Saf Health Care 2008; 17: 137–45. https://doi.org/10.1136/qshc.2004.012047.
57.Marshall, T, Mohammed, MA, Rouse, A. A randomized controlled trial of league tables and control charts as aids to health service decision-making. Int J Qual Health Care 2004; 16: 309–15. https://doi.org/10.1093/intqhc/mzh054.
58.Mohammed MA. Statistical process control. In: Dixon-Woods, M, Brown, K, Marjanovic, S, et al., editors. Elements of Improving Quality and Safety in Healthcare. Cambridge: Cambridge University Press; forthcoming.
59.Griffith, JR, Fear, KM, Lammers, E, et al. A positive deviance perspective on hospital knowledge management: analysis of Baldrige Award recipients 2002–2008. J Healthc Manag 2013; 58: 187–203. https://doi.org/10.1097/00115514-201305000-00007.
60.Sheard, L, Jackson, C, Lawton, R. How is success achieved by individuals innovating for patient safety and quality in the NHS? BMC Health Serv Res 2017; 17: 640. https://doi.org/10.1186/s12913-017-2589-1.
61.Marra, AR, Noritomi, DT, Westheimer Cavalcante, AJ, et al. A multicenter study using positive deviance for improving hand hygiene compliance. Am J Infect Control 2013; 41: 984–8. https://doi.org/10.1016/j.ajic.2013.05.013.
62.Baxter, R, Taylor, N, Kellar, I, Lawton, R. Learning from positively deviant wards to improve patient safety: an observational study protocol. BMJ Open 2015; 5: e009650. https://doi.org/10.1136/bmjopen-2015-009650.
63.Baxter, R, Taylor, N, Kellar, I, Lawton, R. A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people. BMJ Qual Saf 2019; 28: 618–26. https://doi.org/10.1136/bmjqs-2018-008023.
64.Kraschnewski, JL, Sciamanna, CN, Pollak, KI, Stuckey, HL, Sherwood, NE. The epidemiology of weight counseling for adults in the United States: a case of positive deviance. Int J Obes (Lond) 2013; 37: 751–3. https://doi.org/10.1038/ijo.2012.113.
65.Rose, AJ, Petrakis, BA, Callahan, P, et al. Organizational characteristics of high‐ and low‐performing anticoagulation clinics in the Veterans Health Administration. Health Serv Res 2012; 47: 1541–60. https://doi.org/10.1111/j.1475-6773.2011.01377.x.
66.Davidoff, F, Dixon-Woods, M, Leviton, L, Michie, S. Demystifying theory and its use in improvement. BMJ Qual Saf 2015; 24: 228–38. https://doi.org/10.1136/bmjqs-2014-003627.
67.Rose, AJ, McCullough, MB. A practical guide to using the positive deviance method in health services research. Health Serv Res 2017; 52: 1207–22. https://doi.org/10.1111/1475-6773.12524.
68.Lawton, R, McEachan, RR, Giles, SJ, et al. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ Qual Saf 2012; 21: 369–80. https://doi.org/10.1136/bmjqs-2011-000443.
69.National Patient Safety Agency. Manchester Patient Safety Framework (MaPSaF). 2006. https://webarchive.nationalarchives.gov.uk/ukgwa/20171030124256/http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59796 (accessed 12 February 2022).
70.Michie, S, van Stralen, M, West, R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011; 6: 42. https://doi.org/10.1186/1748-5908-6-42.
71.Rycroft-Malone, J, Harvey, G, Seers, K, et al. An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs 2004; 13: 913–24. https://doi.org/10.1111/j.1365-2702.2004.01007.x.
72.Liberati, EG, Tarrant, C, Willars, J, et al. How to be a very safe maternity unit: an ethnographic study. Soc Sci Med 2019; 223: 64–72. https://doi.org/10.1016/j.socscimed.2019.01.035.
73.Curry, LA, Spatz, E, Cherlin, E, et al. What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study. Ann Intern Med 2011; 154: 384–90. https://doi.org/10.7326/0003-4819-154-6-201103150-00003.
74.Hughes, L, Sheard, L, Pinkney, L, Lawton, RL. Excellence in elective hip and knee surgery: what does it look like? A positive deviance approach. J Health Serv Res Policy 2020; 25: 5–12. https://doi.org/10.1177/1355819619867350.
75.Maryland Patient Safety Centre. Field Guide 2007. https://static1.squarespace.com/static/5a1eeb26fe54ef288246a688/t/5ac7d891aa4a996d8d80ff9d/1523046565385/Healthcare_Manual (accessed 12 February 2022).
76.Lindberg, C, Downham, G, Buscell, P, et al. Embracing collaboration: a novel strategy for reducing bloodstream infections in outpatient hemodialysis centers. Am J Infect Control 2013; 41: 513–19. https://doi.org/10.1016/j.ajic.2012.07.015.
77.Singhal, A, Buscell, P. Actions speak louder than MRSA at Billings clinic. In: Singhal, A, Buscell, P, Lindberg, C, editors. Inviting Everyone: Healing Healthcare through Positive Deviance. Bordentown, NJ: PlexusPress; 2010: 95–123. https://utminers.utep.edu/asinghal/Books/Singhal-Book-2010-Inviting-Everyone-Healing-healthcare-through-Positive-Deviance.pdf (accessed 12 February 2022).
78.Michie, S, Richardson, M, Johnston, M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013; 46: 81–95. https://doi.org/10.1007/s12160-013-9486-6.
79.Singhal, A, Greiner, K. Small solutions and big rewards: MRSA prevention at the Pittsburgh Veterans hospitals. In: Singhal, A, Buscell, P, Lindberg, C, editors. Inviting Everyone: Healing Healthcare through Positive Deviance. Bordentown, NJ: PlexusPress; 2010: 47–67. https://utminers.utep.edu/asinghal/Books/Singhal-Book-2010-Inviting-Everyone-Healing-healthcare-through-Positive-Deviance.pdf (accessed 12 February 2022).
80.Singhal, A, McCandless, K, Buscell, P, Lindberg, C. Spanning silos and spurring conversations: positive deviance for reducing infection in hospitals. Performance 2009; 2: 78–83. http://utminers.utep.edu/asinghal/Articles%20and%20Chapters/Journal%20Articles/Singhal-McCandless-Buscell-Lindberg-MRSA-Performance_2009-Article-EandY.pdf (accessed 12 February 2022).
81.Krumholz, HM, Bradley, EH, Nallamothu, BK, et al. A campaign to improve the timeliness of primary percutaneous coronary intervention: door-to-balloon: an alliance for quality. JACC Cardiovasc Interv 2008; 1: 97–104. https://doi.org/10.1016/j.jcin.2007.10.006.
82.Sreeramoju, P, Dura, L, Fernandez, ME, et al. Using a positive deviance approach to influence the culture of patient safety related to infection prevention. Open Forum Infect Dis 2018; 5: ofy231. https://doi.org/10.1093/ofid/ofy231.
83.Bate, P, Robert, G, Fulop, N, Øvretveit, J, Dixon-Woods, M. Perspectives on Context: A Selection of Essays Considering the Role of Context in Successful Quality Improvement. London: The Health Foundation; 2014. www.health.org.uk/publications/perspectives-on-context (accessed 12 February 2022).
84.Bion, J, Richardson, A, Hibbert, P, et al. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf 2013; 22: 110–23. https://doi.org/10.1136/bmjqs-2012-001325.
85.Dixon-Woods, M, Leslie, M, Tarrant, C, Bion, J. Explaining Matching Michigan: an ethnographic study of a patient safety program. Implement Sci 2013; 8: 70. https://doi.org/10.1186/1748-5908-8-70.
86.Kim, YM, Heerey, M, Kols, A. Factors that enable nurse-patient communication in a family planning context: a positive deviance study. Int J Nurs Stud 2008; 45: 1411–21. https://doi.org/10.1016/j.ijnurstu.2008.01.002.
87.Martin, G, Dixon-Woods, M. Collaboration-based approaches. In: Dixon-Woods, M, Brown, K, Marjanovic, S, et al., editors. Elements of Improving Quality and Safety in Healthcare. Cambridge: Cambridge University Press; 2022. https://doi.org/10.1017/9781009236867.
88.Mannion, R. Making culture change happen. In: Dixon-Woods, M, Brown, K, Marjanovic, S, et al., editors. Elements of Improving Quality and Safety in Healthcare. Cambridge: Cambridge University Press; 2022. https://doi.org/10.1017/9781009236935.
89.Papoutsi, C, Greenhalgh, T, Marjanovic, S. Approaches to spread, scale-up, and sustainability. In: Dixon-Woods, M, Brown, K, Marjanovic, S, et al., editors. Elements of Improving Quality and Safety in Healthcare. Cambridge: Cambridge University Press; forthcoming.
90.Lawton, R, Taylor, N, Clay-Williams, R, Braithwaite, J. Positive deviance: a different approach to achieving patient safety. BMJ Qual Saf 2014; 23: 880–3. https://doi.org/10.1136/bmjqs-2014-003115.
91.Ivers, N, Audit, Foy R., feedback, and behaviour change. In: Dixon-Woods, M, Brown, K, Marjanovic, S, et al., editors. Elements of Improving Quality and Safety in Healthcare. Cambridge: Cambridge University Press; forthcoming.
92.Cohen, R, Gesser-Edelsburg, A, Singhal, A, Benenson, S, Moses, AE. Deconstruction of central line insertion guidelines based on the positive deviance approach-reducing gaps between guidelines and implementation: a qualitative ethnographic research. PLoS One 2019; 14: e0222608. https://doi.org/10.1371/journal.pone.0222608.
93.Plsek, PE, Greenhalgh, T. The challenge of complexity in health care. BMJ 2001; 323: 625–8. https://doi.org/10.1136/bmj.323.7313.625.
94.Lindberg, C, Schneider, M. Combating infections at Maine Medical Center: insights into complexity-informed leadership from positive deviance. Leadership 2013; 9: 229–53. https://doi.org/10.1177/1742715012468784.
95.Marsh, DR, Schroeder, DG, Dearden, KA, Sternin, J, Sternin, M. The power of positive deviance. BMJ 2004; 329: 1177–9. https://doi.org/10.1136/bmj.329.7475.1177.
96.Hibbert, D, Trubacik, T. Positive Deviance in Intermediate Care Services. UK: National Audit of Intermediate Care, NHS Benchmarking Unit; 2019. https://s3.eu-west-2.amazonaws.com/nhsbn-static/NAIC%20(Providers)/2018/Positive%20deviance%20inintermediate%20care%20services%20FINAL.pdf (accessed 12 February 2022).

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