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Learning from positively deviant wards to improve patient safety: an observational study protocol.
BMJ Open 2015; 5(12):e009650BO

Abstract

INTRODUCTION

Positive deviance is an asset-based approach to improvement which has recently been adopted to improve quality and safety within healthcare. The approach assumes that solutions to problems already exist within communities. Certain groups or individuals identify these solutions and succeed despite having the same resources as others. Within healthcare, positive deviance has previously been applied at individual or organisational levels to improve specific clinical outcomes or processes of care. This study explores whether the positive deviance approach can be applied to multidisciplinary ward teams to address the broad issue of patient safety among elderly patients.

METHODS AND ANALYSIS

Preliminary work analysed National Health Service (NHS) Safety Thermometer data from 34 elderly medical wards to identify 5 'positively deviant' and 5 matched 'comparison' wards. Researchers are blinded to ward status. This protocol describes a multimethod, observational study which will (1) assess the concurrent validity of identifying positively deviant elderly medical wards using NHS Safety Thermometer data and (2) generate hypotheses about how positively deviant wards succeed. Patient and staff perceptions of safety will be assessed on each ward using validated surveys. Correlation and ranking analyses will explore whether this survey data aligns with the routinely collected NHS Safety Thermometer data. Staff focus groups and researcher fieldwork diaries will be completed and qualitative thematic content analysis will be used to generate hypotheses about the strategies, behaviours, team cultures and dynamics that facilitate the delivery of safe patient care. The acceptability and sustainability of strategies identified will also be explored.

ETHICS AND DISSEMINATION

The South East Scotland Research Ethics Committee 01 approved this study (reference: 14/SS/1085) and NHS Permissions were granted from all trusts. Findings will be published in peer-reviewed, scientific journals, and presented at academic conferences.

TRIAL REGISTRATION NUMBER

This study is registered on the UK Clinical Research Network Study Portfolio (reference number-18050).

Authors+Show Affiliations

School of Psychology, University of Leeds, Leeds, UK Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.School of Psychology, University of Leeds, Leeds, UK Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.School of Psychology, University of Leeds, Leeds, UK Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26656985

Citation

Baxter, Ruth, et al. "Learning From Positively Deviant Wards to Improve Patient Safety: an Observational Study Protocol." BMJ Open, vol. 5, no. 12, 2015, pp. e009650.
Baxter R, Taylor N, Kellar I, et al. Learning from positively deviant wards to improve patient safety: an observational study protocol. BMJ Open. 2015;5(12):e009650.
Baxter, R., Taylor, N., Kellar, I., & Lawton, R. (2015). Learning from positively deviant wards to improve patient safety: an observational study protocol. BMJ Open, 5(12), pp. e009650. doi:10.1136/bmjopen-2015-009650.
Baxter R, et al. Learning From Positively Deviant Wards to Improve Patient Safety: an Observational Study Protocol. BMJ Open. 2015 Dec 11;5(12):e009650. PubMed PMID: 26656985.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Learning from positively deviant wards to improve patient safety: an observational study protocol. AU - Baxter,Ruth, AU - Taylor,Natalie, AU - Kellar,Ian, AU - Lawton,Rebecca, Y1 - 2015/12/11/ PY - 2015/12/15/entrez PY - 2015/12/15/pubmed PY - 2016/9/20/medline KW - Change management < HEALTH SERVICES ADMINISTRATION & MANAGEMENT KW - GERIATRIC MEDICINE KW - Improvement Science KW - Positive deviance KW - QUALITATIVE RESEARCH SP - e009650 EP - e009650 JF - BMJ open JO - BMJ Open VL - 5 IS - 12 N2 - INTRODUCTION: Positive deviance is an asset-based approach to improvement which has recently been adopted to improve quality and safety within healthcare. The approach assumes that solutions to problems already exist within communities. Certain groups or individuals identify these solutions and succeed despite having the same resources as others. Within healthcare, positive deviance has previously been applied at individual or organisational levels to improve specific clinical outcomes or processes of care. This study explores whether the positive deviance approach can be applied to multidisciplinary ward teams to address the broad issue of patient safety among elderly patients. METHODS AND ANALYSIS: Preliminary work analysed National Health Service (NHS) Safety Thermometer data from 34 elderly medical wards to identify 5 'positively deviant' and 5 matched 'comparison' wards. Researchers are blinded to ward status. This protocol describes a multimethod, observational study which will (1) assess the concurrent validity of identifying positively deviant elderly medical wards using NHS Safety Thermometer data and (2) generate hypotheses about how positively deviant wards succeed. Patient and staff perceptions of safety will be assessed on each ward using validated surveys. Correlation and ranking analyses will explore whether this survey data aligns with the routinely collected NHS Safety Thermometer data. Staff focus groups and researcher fieldwork diaries will be completed and qualitative thematic content analysis will be used to generate hypotheses about the strategies, behaviours, team cultures and dynamics that facilitate the delivery of safe patient care. The acceptability and sustainability of strategies identified will also be explored. ETHICS AND DISSEMINATION: The South East Scotland Research Ethics Committee 01 approved this study (reference: 14/SS/1085) and NHS Permissions were granted from all trusts. Findings will be published in peer-reviewed, scientific journals, and presented at academic conferences. TRIAL REGISTRATION NUMBER: This study is registered on the UK Clinical Research Network Study Portfolio (reference number-18050). SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/26656985/Learning_from_positively_deviant_wards_to_improve_patient_safety:_an_observational_study_protocol_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=26656985 DB - PRIME DP - Unbound Medicine ER -