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Positive Deviance

Date: November 6, 2012
Filed under: Quality Improvement, Past Project


Ideas for Change Start at the Front Line! The Positive Deviance Approach

Successful application of the Positive Deviance (PD) approach has been documented in more than 41 countries in areas such as nutrition, education, healthcare, public health, vulnerable groups and other sectors.

PD has also been applied to reduce infection rates related to Methicillin resistant Staphylococcus (MRSA) and Clostridium difficile (CD), two types of bacteria that harm patients in our hospitals. Between 2006 and 2008, 6 US hospitals were selected as Beta Sites in the PD MRSA Prevention Partnership. The Beta Sites agreed to use Positive Deviance to engage staff in determining how to consistently incorporate four evidence-based precautions in at least one pilot unit:

  • Active surveillance MRSA cultures on all patients on admission/discharge/transfer;
  • Hand hygiene before and after every patient contact;
  • Contact isolation precautions on all patients colonized or infected with MRSA; and
  • Environmental Cleaning.

The aggregate decline in the MRSA infection rate in the pilot units was 73%. The aggregate rate/1000 patient days dropped from 4.36 in 2006 to 1.17 in 2008. Two hospitals reduced their rates of infection/1000 patient days to zero!

The BC Patient Safety & Quality Council is one of the funders of the Canadian PD Project and actively provides coaching, local training, and close mentoring on Positive Deviance to the two BC sites (Vancouver General Hospital and Kelowna General Hospital). These hospitals are working with their staff to apply their knowledge and unique experiences to deal with infection control issues within their own organization and units. The expected result is to bring about sustainable culture change and residually reduced MRSA and CD infection rates.

Positive Deviance has been shown to be an effective tool to engage organizations to incur sustainable change where other change efforts have not. The process isn’t complicated. When people discover how it works, Jerry Sternin, co-founder of the Positive Deviance Initiative (PDI), says “It’s so exquisitely simple, once you hear it, there’s this automatic recognition: ‘oh yeah, of course’. But PD is best understood and only works by doing it”.

Got your interest? Here are some sites that have great information on Positive Deviance: