How is innovation achieved in patient safety and quality by individuals in the NHS? 

Lead:                       Dr Laura Sheard

Collaborators:  Dr Cath Jackson (University of York; Valid Research)

Patient safety is a key government and NHS concern [8] but little is known about how individuals working within healthcare organisations are able to achieve innovations specific to patient safety and quality. Attempts to improve patient safety within healthcare organisations often rely on identifying when patient safety is compromised via methods such as mortality reviews, audits and incident reporting.  Approaches which focus on strengths and resources - looking at why things go right in order to learn from success – are beginning to gain credence. One such approach is that of ‘positive deviance’. Positive deviance has its roots in international public health research  but has recently begun to be applied to western healthcare settings to address patient safety topics such as reducing surgical site infections, and the promotion of hand hygiene.  Most studies which have identified and conducted work with positive deviants have been focused at the level of the organisation rather than the individual. 

In this study, our aim was to understand how individuals working within the NHS manage to implement innovations which benefit patient safety. This is one of the first studies to use the positive deviance approach to examine how innovators for quality and safety in the NHS achieve success. Our original research questions were: 

  • What do successful individuals believe helped them to achieve their innovation? 
  • What do innovators believe they do differently to others with a similar role and status?
  • Do the innovators see themselves as unusual? How and in what ways? 
  • What approach to leadership do the innovators take?
We set out to interview around 15 innovators working in the area of patient safety and quality, within the NHS. Potential participants were identified from the Health Services Journal (HSJ) supplement ‘Top 50 innovators in Healthcare’ in 2014 [19] and 2013 [20]. HSJ is a weekly journal read by healthcare staff and NHS managers. Potential participants were people who had won a national award for their work in innovation in healthcare. We selected participants to approach from the HSJ Innovators awards list whose innovation had made a substantial contribution to patient safety or quality (or had the potential to do so), as judged by all three authors. They also had to be a healthcare professional currently or recently working for the NHS.  For further details, see publication below.


Sheard, L., Jackson, C., & Lawton, R. (2017). How is success achieved by individuals innovating for patient safety and quality in the NHS?. BMC health services research17(1), 640.