Positive deviance and the Care Quality Commission: What makes an outstanding general practice

Lead:  Dr Ruth Baxter

Collaborators: Dr Luke Budworth

Across England the Care Quality Commission (CQC) inspect and rate all NHS general practices as either outstanding, good, requires improvement, or inadequate. ‘Outstanding’ practices are considered to be positive deviants – compared to others they successfully deliver exceptionally high quality patient care. CQC inspections reports are publically available and contain information about how ‘outstanding’ CQC ratings are achieved. Furthermore, CQC inspectors have intrinsic knowledge about how teams within outstanding general practices deliver exceptionally high quality care. 

The overall aim of this project is to generate knowledge about positively deviant practices that facilitate high quality, ‘outstanding’ patient care. This will be achieved through:

  1. Thematic analysis of secondary data extracted from the CQC inspection reports of outstanding general practices (currently there are 126 outstanding practices within England). Analysis will explore common structures, processes and behaviours that facilitate the delivery of ‘outstanding’ patient care. 
  2. Thematic analysis of semi-structured interviews with CQC inspectors (n = 21) exploring their perceptions of how teams within positively deviant practices deliver outstanding patient care.

The combined findings will be used to generate robust hypotheses about how positively deviant practices succeed. Future research may be conducted to empirically assess these hypotheses.