ArticleBMJ quality & safety2019
A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people.
Article in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed.
- Sustaining nursing practice in Greenland: insights from a positive deviance study on motivation, resilience, and holistic care in arctic healthcare.International journal of circumpolar health · 2026Article
- Treatment Preferences for Relapsed/Refractory Mantle Cell Lymphoma Among Patients and Physicians in China: A Discrete Choice Experiment.The patient · 2026Article
- A qualitative approach to understanding quality symptom management in routine oncology outpatient care: phase 1 of the symptom pathways project.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Quantifying, Understanding and Enhancing Relational Continuity of Care (QUERCC): a mixed-methods protocol.BMJ open · 2025Article
- An Explanatory Mixed-Methods Study of Intensive Care Unit Net Benefit: Triage and Trajectory for Sepsis and Acute Respiratory Failure.Annals of the American Thoracic Society · 2025Article
- Incivility experiences of racially minoritised hospital staff, consequences for them and implications for patient care: An international scoping review.Sociology of health & illness · 2025Article
- Strategies that facilitate the delivery of exceptionally good patient care in general practice: a qualitative study with patients and primary care professionals.BMC primary care · 2024Article
- The use of positive deviance approach to improve health service delivery and quality of care: a scoping review.BMC health services research · 2024Article
- Characteristics and Practices of High-Performing Centers in Organ Donor Identification and Referral: A Qualitative Study.Canadian journal of kidney health and disease · 2024Article
- The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals' views.BMC health services research · 2023Article
- Identifying Factors that Support the Delivery of Exceptional Care in General Practice and Development of the IDEAL Framework: A Qualitative Study.Qualitative health research · 2023Article
- Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography.Dementia (London, England) · 2023Article
- Decision-Making about COVID-19 Vaccines among Health Care Workers and Their Adolescent Children.Western journal of nursing research · 2023Article
- Organisational drivers of performance in mental health providers.Journal of health organization and management · 2023Article
- Nurses' harm prevention practices during admission of an older person to the hospital: A multi-method qualitative study.Journal of advanced nursing · 2022Article
- Positive deviance in health and medical research on individual level outcomes - a review of methodology.Annals of epidemiology · 2022Review
- Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?BMJ quality & safety · 2021Article
- A scoping review of rebel nurse leadership: Descriptions, competences and stimulating/hindering factors.Journal of clinical nursing · 2021Article
- Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study.BMJ quality & safety · 2020Article
- Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives.BMC health services research · 2020Article
Corrections and comments
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Authors and funding
4 authors.
Funding
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Abstract
backgroundThe positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people.
methodsA qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data. In total, 70 multidisciplinary staff participated in eight focus groups to explore staff perceptions about how their teams deliver safe patient care. A thematic analysis was conducted in two stages: first to identify the tools, processes, strategies, and cultural and social contexts that facilitated safety across all wards; and second to generate hypotheses about the characteristics that facilitated 'positively deviant' patient care.
resultsBased on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented.
conclusionThis study exemplifies that there are no 'silver bullets' to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.
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