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Research in Action: Using Positive Deviance to Improve Quality of Health Care

Health care organizations need help in accelerating improvement in health care quality and promoting more widespread adoption of proven practices. The authors of a Commonwealth Fund–supported article in Implementation Science propose that the principle of “positive deviance” can be used to identify effective health care improvement processes.


As adapted for use in health care, the positive deviance approach presumes that knowledge about “what works” is available in existing organizations that demonstrate consistently exceptional performance. It involves the following steps: 1) identifying such organizations; 2) studying them to develop hypotheses about the practices that allow them to achieve top performance; 3) testing the hypotheses in a larger sample; and 4) working with stakeholders to disseminate the newly characterized best practices. To demonstrate the approach in action, the authors identified positive-deviant hospitals based on their performance on a widely accepted indicator of quality care for patients with acute myocardial infarction: the time between hospital arrival and treatment with percutaneous coronary intervention.


Publication Details



E. H. Bradley, L. A. Curry, S. Ramanadhan et al., “Research in Action: Using Positive Deviance to Improve Quality of Health Care,” Implementation Science, May 2009 4(25).