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Kassie AM, Eakin E, Abate BB, Endalamaw A, Zewdie A, Wolka E, Assefa Y. The use of positive deviance approach to improve health service delivery and quality of care: a scoping review. BMC Health Serv Res 2024; 24:438. [PMID: 38589897 PMCID: PMC11003118 DOI: 10.1186/s12913-024-10850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Quality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs. METHODS Articles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats. RESULTS A total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections. CONCLUSION The scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.
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Affiliation(s)
- Ayelign Mengesha Kassie
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Biruk Beletew Abate
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Cohen R, Gesser-Edelsburg A. Advanced theoretical-applied model based on the PD approach in the light of healthcare-associated infections: what have we achieved so far? Front Public Health 2024; 12:1291551. [PMID: 38410666 PMCID: PMC10894930 DOI: 10.3389/fpubh.2024.1291551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Healthcare-associated infections remain a persistent concern despite decades of research and intervention efforts. Adherence to infection prevention and control guidelines by health professionals remains a challenge, necessitating innovative strategies. The Positive Deviance (PD) approach, rooted in harnessing localized solutions, holds promise but lacks comprehensive frameworks and empirical validation to bolster its theoretical underpinnings. This perspective article serves a dual purpose: first, to examine the unique challenges of applying the PD approach in the context of HAIs; and second, to introduce a robust theoretical-applied model developed in response to these challenges. This article addresses these gaps through a multi-faceted model developed in a mixed-methods study across three Israeli governmental hospitals and comprises four essential components that address the identified gaps in existing research. This article enriches the dialog on PD's applicability in HAIs by providing a robust model that not only offers solutions but reshapes the approach to healthcare hygiene and safety. It responds to critical gaps highlighted in the literature, offering tailored interventions by practical, context-specific solutions to improve adherence to IPC guidelines in the long term. Methodological clarity is also a key focus, offering a toolkit for practical implementation. This bottom-up approach empowers HPs to drive change, fostering a culture of innovation and improvement in healthcare settings.
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Affiliation(s)
- Ricky Cohen
- Cheryl Spencer Department of Nursing and the Health and Risk Communication Research Lab, University of Haifa, Haifa, Israel
| | - Anat Gesser-Edelsburg
- Head of the Health Promotion Program and Head of the Health and Risk Communication Lab, School of Public Health, University of Haifa, Haifa, Israel
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Hill S, Jimenez YA, Abu Awwad D, Lewis SJ. Infection prevention and control in computed tomography: creating a national survey. Infect Dis Health 2024; 29:15-24. [PMID: 37813714 DOI: 10.1016/j.idh.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Infection prevention and control (IPC) is essential for quality healthcare, with healthcare associated infections (HAI) a known risk to patients requiring medical imaging (MI). To date, few papers have adopted a national approach to understanding or benchmarking the knowledge of, attitudes toward, and practice (KAP) of IPC in the context of MI and no validated surveys or scales are identified in the literature. The Computed Tomography (CT) suite is a unique MI environment where radiographers deliver prescription medicines to patients via intravenous (IV) means through an injector system. This paper describes the development of a survey that informs the use of IPC processes in the CT suite. METHODS Standard Precautions via current national guidelines formed the benchmark of the survey, with a KAP survey used as the framework to explore IPC. The questions and associated responses are developed based on the National Health and Medical Research Council (NHMRC) guidelines, industry/professional protocols and adapted to the equipment and practices commonly used in the CT suite of MI departments by radiographers and nurses. RESULTS Key survey development steps are described to include the justification of the benchmarking source, the survey framework and design. Detailed information is given to show the evolution of truth statements and sources, KAP question variations, and rationales for the methodology of question responses. National guidelines are mapped to survey questions and responses and pilot testing reflections are included. CONCLUSION This paper reports on the construction of a standardised KAP survey for IPC specific to the CT suite in the Australian healthcare setting. The survey is ready for dissemination amongst MI departments. Documented use will aid validation and reliability as a survey tool to measure and map IPC specifically in relation to IV contrast administration.
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Affiliation(s)
- Suzanne Hill
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney. 1 Science Road, Camperdown, NSW, 2006, Australia
| | - Yobelli A Jimenez
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney. 1 Science Road, Camperdown, NSW, 2006, Australia
| | - Dania Abu Awwad
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney. 1 Science Road, Camperdown, NSW, 2006, Australia
| | - Sarah J Lewis
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney. 1 Science Road, Camperdown, NSW, 2006, Australia.
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Dhital R, Subedi M, Hamal PK, Shrestha C, Bhusal S, Rimal R, Gopali L, Shah R. How positive deviants helped in fighting the early phase of COVID-19 pandemic? A qualitative study exploring the roles of frontline health workers in Nepal. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000671. [PMID: 36962974 PMCID: PMC10021390 DOI: 10.1371/journal.pgph.0000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Positive deviance is an approach wherein learnings from persons who fare better than their peers under similar circumstances are used to enable behavioral and social change. Such behaviors and solutions are likely affordable, acceptable, sustainable, and fit into the socio-cultural milieu. Despite the wide use of positive deviance in many public health programs and research, it has yet to be used to study frontline workers in the context of COVID-19. Therefore, this study aimed to explore the positive deviance traits among frontline health workers during the early days of the COVID-19 pandemic in Nepal. This qualitative study followed a grounded theory approach. The data was collected through in-depth interviews among the 17 identified participants representing different cadres of the health workforce, types of health facilities, and regions across Nepal purposively. The findings are structured around four major themes: challenges, finding solutions and innovations, positive lessons, and motivations. The personal challenges included fear and anxiety about the uncertainties. The professional challenges included stigma, infection control, and changing work style with the use of personal protective equipment. Despite the challenges, they managed available resources and innovated low-cost, technological, and practice-based solutions. They were able to reflect upon the positive lessons learned, such as self-sustainability, teamwork, and policy direction and research, and self-reflection of personal growth and patient care. The intrinsic motivation included their inherent value system, and the extrinsic motivation included appreciation and acknowledgment, family and social support, psychosocial support from peers, and support from higher authorities. This study provides insights into how the positive deviance approach can help identify the solution amid the most challenging circumstances, such as the COVID-19 pandemic in low-resource settings. However, more extensive studies are warranted to explore deeper into positive deviance and its long-term effects in bringing positive outcomes during the pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | - Richa Shah
- Health Action and Research, Kathmandu, Nepal
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Cohen R, Gesser-Edelsburg A, Singhal A, Benenson S, Moses AE. Translating a theory-based positive deviance approach into an applied tool: Mitigating barriers among health professionals (HPs) regarding infection prevention and control (IPC) guidelines. PLoS One 2022; 17:e0269124. [PMID: 35657940 PMCID: PMC9165831 DOI: 10.1371/journal.pone.0269124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Although a wide range of intervention programs and methods have been implemented to increase health professionals’ (HPs) adherence with infection prevention and control (IPC) guidelines and decrease the incidence of healthcare associated infections (HAIs), a significant discrepancy remains between the guidelines and their implementation in practice.
Objectives
This study proposes an applied tool based on the integrated theoretical framework of the positive deviance (PD) approach for developing more effective interventions to mitigate this discrepancy.
Methods
A qualitative study guided by the PD approach based on data from two sources: (1) in-depth archival analysis of systematic review articles, and (2) integration and synthesis of findings based on an extensive empirical study we conducted, involving 250 HPs (nurses, physicians, support staff and cleaning staff) from three governmental hospitals in Israel, over 35 months (January 2017 to November 2020).
Results
The barriers faced by HPs were classified into four main categories: (1) individual-motivational, (2) social-cultural, (3) organizational, and (4) work environment and resource-centered. For each barrier, we constructed a set of questions based on the PD approach. For each question, we adapted and applied methodological tools (e.g., in-depth interviews, focus groups, social network maps, video clips and simulations) to help solve the problem.
Conclusion
Translating a theory-based approach into an applied tool that offers step-by-step actions can help researchers and practitioners adopt and implement the approach within intervention programs to mitigate barriers.
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Affiliation(s)
- Ricky Cohen
- School of Public Health, University of Haifa, Haifa, Israel
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
- * E-mail:
| | - Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Arvind Singhal
- Department of Communication, The University of Texas at El Paso, El Paso, Texas, United States of America
- School of Business and Social Sciences, Inland University of Applied Sciences, Hamar, Norway
| | - Shmuel Benenson
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Allon E. Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
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Gesser-Edelsburg A, Alamour Y, Cohen R, Abed Elhadi Shahbari N, Hijazi R, Orr D, Vered-Chen L, Singhal A. Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: A hybrid model comprising positive deviance, community-based participatory research, and entertainment-education. PLoS One 2021; 16:e0257696. [PMID: 34551005 PMCID: PMC8457499 DOI: 10.1371/journal.pone.0257696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite several intervention programs, the Bedouin population living in the Southern District of Israel has the highest mortality rate among children and adolescents from unintentional injuries. Our research questions asked: (1) How does increasing the involvement and participation of Bedouin community members influence the issue of unintentional injuries among children? (2) How does reframing of the technical issue of safety into security influence community involvement and cooperation? OBJECTIVES 1) To identify effective and efficacious positive deviance practices through community-based participatory research with adults, children, and professionals in the Bedouin community. 2) To create wider and deeper connections and cohesion between and among diverse Bedouin communities by seeding and sparking opportunities for social networking and cross-learning. METHODS The study used a qualitative multi-method approach to generate a hybrid intervention model for reducing unintentional childhood injuries among the Bedouins. To frame the issue of unintentional injuries from the lived perspective of the Bedouins, we employed the Positive Deviance (PD) and Community Based Participatory Research (CBPR) approach. Drawing upon theatrical traditions, entertainment-education (EE), was employed as a way to narratively engage and persuade the Bedouins. RESULTS Our research resulted in: (1) the emergence of several PD ideas and practices for preventing and avoiding children's injuries; (2) the actual creation of a safe and secure playroom for children at a neighborhood mosque; and (3) the creation of cascading and cross-learning social networks between and among members of the Bedouin community spread across various locations. CONCLUSION This study helped in reframing the technical issue of accidents and safety into the notion of sacredness and security, enhanced the association between emotions and cognition by means of experiential and EE methods, and stimulated creative thinking and the emergence of new culturally and contextually relevant ideas and practices through the PD process. It demonstrated the synergistic power of using a hybrid model that combined the rigor and vigor of different health communication approaches to address a significant disparity in the burden of child accidents faced by the Bedouins. Our study generated solutions that emerged from, and directly benefitted, Bedouin children-those, who face overwhelming risk of injury and death from preventable accidents.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Yousif Alamour
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Ricky Cohen
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Nour Abed Elhadi Shahbari
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Rana Hijazi
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Daniela Orr
- Beterem Safe Kids Israel, Petah Tikva, Israel
| | | | - Arvind Singhal
- Department of Communication, The University of Texas at El Paso, El Paso, Texas, United States of America
- School of Business and Social Sciences, Inland University of Applied Sciences, Hamar, Norway
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