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Accentuating the Positive

Posted By Administration, Wednesday, September 10, 2014
Updated: Friday, October 24, 2014

By Tejal K. Gandhi, MD, MPH, CPPS 


  Tejal K. Gandhi

A highlight of the NPSF Patient Safety Congress last May was a lively debate about accountability for patient safety. Two noted safety experts—Gregg Meyer, MD, MSc, and Bob Wachter, MD—each took a position on the question of whether punitive measures (fines, suspensions) should be applied when health care workers fail to consistently follow established safety procedures. Dr. Meyer argued we would make more progress if we did not solely focus on poor performers, but also celebrated those who were performing at the highest levels. “We need to laud them in front of their colleagues. We need to get people excited about trying to emulate them,” he said.

In an article in the July issue of BMJ Quality & Safety, Rebecca Lawton and colleagues make a similar argument, suggesting that focusing on positive deviance is a tactic well worth trying in health care. “Patient safety management…can feel like a relentlessly negative treadmill,” they write. “Behaviours that produce errors are variations on the same processes that produce success, so focusing on successful practices may be a more effective tactic.”

The authors note that, in health care, poor or unexpected outcomes are commonly investigated so that the root cause can be identified and avoided in future. It is the worst outcomes that bring the most attention—including the focus of external agencies such as regulatory bodies or the media. This relentless pursuit of the “negatively deviant” could certainly wear on the energy and enthusiasm of even the most committed clinicians and patient safety officers, which is a critical issue as we try to combat burnout in health care.

Yet, consistently good outcomes are seen at the unit or provider level in many organizations, and they receive relatively little notice. Lawton and colleagues offer suggestions for ways to identify the positive deviants in our midst and to support the adoption of their methods within the wider community.

I recently visited a hospital that was beginning to do RCAs on cases that went extremely well—to try to learn why they went well and share and learn from those lessons. I was really excited by this innovative concept—what a great way to learn and to celebrate the positives!


Do you think there is a role for positive deviance in your organization? Comment on this post below.



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Christine Mackay says...
Posted Friday, October 24, 2014
You are right on about positive deviants. Being one, I can share with you that positive deviants have to be careful in institutions with Lead Buffalo Cultures with strict lines of hierarchy. In institutions with geese models you still have to be careful but its not as career limiting. “Flight of the Buffalo” is great read on this.

Some Tell Tale Signs of “Lead Buffalo Culture” :

Do not have employee email. CEO and CNO are never seen engaging with front line staff. Do not have town hall meetings asking employees what they think and need.Do not have corporate compliance hot line. Do not have suggestion/communication systems.Do not have unit based shared governance.

In another issue could you discuss the theory of how Cognitive Dissonance thrives in way too many hospitals?
Thank you. Christine CCRN, ret Baxter Sales exec and life long cognitive dissonant
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