Positive deviance: a different approach to achieving patient safety

Patient safety management within healthcare systems globally can feel like a relentlessly negative treadmill. Mortality reviews, incident reporting systems and audits all focus attention on what goes wrong and how often, why errors occur, and who or what is at the root of the problem. Sometimes these methods help us to understand why patients are harmed. However, such ‘find and fix’ approaches tell us little about the presence of patient safety, alerting us instead to its absence. These efforts aim to prevent harm by striving to reduce the number of things that go wrong, as opposed to identifying instances when—often despite challenging circumstances and limited resources—things go right. The focus on error detection and its management has not produced the expected gains in patient safety, primarily because these methods are not well suited to a complex adaptive system such as healthcare. Behaviours that produce errors are variations on the same processes that produce success, so focusing on successful practices may be a more effective tactic.

One approach to focusing on success is positive deviance. While positive deviance can be used to describe the behaviour of an exemplary individual, the term can also be extended to describe the behaviours of successful teams and organisations.

Along with other more optimistic approaches to patient safety, such as identifying and empowering resilient individuals or teams,3 and developing methods for capturing safety improvement work,9 positive deviance is starting to be tested in healthcare settings, albeit intermittently.