title: Learning from positively deviant wards to improve patient safety: an observational study protocol.
abstract: BACKGROUND
  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
  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.
  
  
  BACKGROUND
  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.
  
  
  BACKGROUND
  This study is registered on the UK Clinical Research Network Study Portfolio (reference number-18050).
authors.affiliation: School of Psychology, University of Leeds, Leeds, UK Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Baxter
authors.affiliation: 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.
authors.forename: Natalie
authors.initials: N
authors.lastname: Taylor
authors.affiliation: School of Psychology, University of Leeds, Leeds, UK Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Kellar
authors.affiliation: School of Psychology, University of Leeds, Leeds, UK Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lawton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017144:Focus Groups; D006282:Health Personnel; D006757:Hospital Units / Q000592:standards*; D006801:Humans; D008297:Male; D061214:Patient Safety / Q000592:standards*; D010361:Patients; D012107:Research Design; D017751:Safety Management / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Change management < HEALTH SERVICES ADMINISTRATION & MANAGEMENT; GERIATRIC MEDICINE; Improvement Science; Positive deviance; QUALITATIVE RESEARCH