What is it about?

I am very happy to share our scoping review publication on the utilization of the positive deviance approach for healthcare service delivery. I thank you very much all the contributors of the article and hope this article could be of an interest for many to learn the approaches utility for healthcare service enhancement programs. Written be low are introductory sections of the article. Healthcare systems worldwide are faced with a myriad of challenges in enhancing accessibility and delivering top-notch healthcare services on a global scale. These hurdles encompass deficiencies in data collection and monitoring systems, subpar organizational team culture and limited capacity, ineffective leadership, a lack of incentivization for outstanding performance, and a scarcity of evidence-based health policies to bolster implementation and enhance the proficiency of healthcare professionals. Consequently, there is an increasing imperative to explore and adopt innovative approaches to enhance and provide safe, effective, and high-quality healthcare services within the healthcare system. The positive deviance approach emerges as an innovative strategy aimed at identifying exemplary practices existing within a given community. This community, within the healthcare context, encompasses various entities including teams, groups, departments, and organizations. For example, regional/provincial, zonal, and district-based administrative health offices, local health facilities, and their respective units can be considered as departments and organizations within this community. Notably, social service agencies, healthcare organization representatives, and local government bodies have been regarded as integral components of communities in studies employing the positive deviance approach to understand collaboration among social service and healthcare providers in communities achieving relatively low levels of healthcare utilization and expenses among senior citizens. This approach acknowledges the intrinsic value of existing expertise and operates under the premise that solutions to problems already exist within the community. By identifying and disseminating these solutions, others can effectively address existing complex and intractable challenges. It further underscores that despite facing similar resource constraints, there are individuals who excel in their performance within organizations, and when given the opportunity, these positive deviants are eager to share their experiences, particularly when leaders facilitate the process.

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Why is it important?

This scoping review synthesized the evidence regarding the use of the positive deviance approach in healthcare system service delivery and quality improvement programs. The findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true positive deviants. Hence, the scoping review has highlighted the criticality of using objective and validated measures of performance to identify positive deviants as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.


Positive deviance has been extensively utilized for healthcare service and quality enhancement programs around the world, particularly in developed countries as most of the articles are from three countries (USA, Canada, and the United Kingdom) with the USA contributing to more than half of all the included articles. In addition, several types of study designs including qualitative, mixed-methods, interventional, and randomized controlled trials have been employed by researchers and program implementers depending on the context and specific objectives of their project works. By identifying and learning from those who exhibit exceptional practices, healthcare systems have been able to implement successful strategies, enhance quality, reduce errors, and improve patient outcomes. However, all the outcomes of positive deviance-based research depend on the first step of identifying true positive deviants. This is because unless studies use objective and validated measures of performance, identification of true positive deviants is less likely, and this can in turn result in failure to identify best practices for learning. Therefore, researchers need to take different contexts in the initial stages of positive deviance into consideration to avoid the problems reported in the identification processes of positive deviants including the usage of standardized performance measures. In addition, the use of comparators and exploring the practice of low performers can help to uncover the traits that distinguish good performers from low performers, as well as to shed light on unproductive practices.

Mr. Ayelign Mengesha Kassie
University of Queensland

Read the Original

This page is a summary of: The use of positive deviance approach to improve health service delivery and quality of care: a scoping review, BMC Health Services Research, April 2024, Springer Science + Business Media,
DOI: 10.1186/s12913-024-10850-2.
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