The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

The positive deviance approach has gained traction within healthcare organizations, yet there remains a scarcity of comprehensive guidance, resulting in the utilization of disparate methods of varying quality.

Published in Healthcare & Nursing

Like

Share this post

Choose a social network to share with, or copy the URL to share elsewhere

This is a representation of how your post may appear on social media. The actual post will vary between social networks

Explore the Research

SpringerLink
SpringerLink SpringerLink

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review - BMC Health Services Research

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.

Healthcare systems worldwide are faced with a myriad of challenges in enhancing accessibility and delivering top-notch healthcare services on a global scale. These hurdles encompass deficiencies in data collection and monitoring systems, subpar organizational team culture and limited capacity, ineffective leadership, a lack of incentivization for outstanding performance, and a scarcity of evidence-based health policies to bolster implementation and enhance the proficiency of healthcare professionals. Consequently, there is an increasing imperative to explore and adopt innovative approaches to enhance and provide safe, effective, and high-quality healthcare services within the healthcare system.

The positive deviance approach emerges as an innovative strategy aimed at identifying exemplary practices existing within a given community. This community, within the healthcare context, encompasses various entities including teams, groups, departments, and organizations. For example, regional/provincial, zonal, and district-based administrative health offices, local health facilities, and their respective units can be considered as departments and organizations within this community. Notably, social service agencies, healthcare organization representatives, and local government bodies have been regarded as integral components of communities in studies employing the positive deviance approach to understand collaboration among social service and healthcare providers in communities achieving relatively low levels of healthcare utilization and expenses among senior citizens.

This approach acknowledges the intrinsic value of existing expertise and operates under the premise that solutions to problems already exist within the community. By identifying and disseminating these solutions, others can effectively address existing complex and intractable challenges. It further underscores that despite facing similar resource constraints, there are individuals who excel in their performance within organizations, and when given the opportunity, these positive deviants are eager to share their experiences, particularly when leaders facilitate the process.

Please sign in or register for FREE

If you are a registered user on Research Communities by Springer Nature, please sign in

Follow the Topic

Health Care
Life Sciences > Health Sciences > Health Care

Related Collections

With Collections, you can get published faster and increase your visibility.

Disability-inclusive health systems

BMC Health Services Research is calling for submissions to our Collection on Disability-inclusive health systems.

Disability-inclusive health systems are essential for ensuring equitable access to health services for all individuals, including those with disabilities. This Collection aims to explore the current state of health systems and their ability to provide inclusive care that meets the diverse needs of people with disabilities. By examining the barriers faced and the strategies employed to create more accessible health services, this Collection will contribute to a better understanding of how to integrate disability considerations into health system planning and implementation.

The significance of this research lies in its potential to inform the development of health policies that are inclusive and equitable. Advances in this field have highlighted the importance of stakeholder engagement, training for health professionals, and the implementation of assistive technologies in promoting disability-inclusive health services. Furthermore, understanding the lived experiences of individuals with disabilities can provide valuable insights into how to design health systems that are responsive and respectful of their needs.

Topics for submission:

Strategies for disability-inclusive health service delivery

Barriers and gaps to accessing health services for individuals with disabilities

Impact of training on health professionals in disability inclusivity

Use of assistive technologies in health systems

Rehabilitation service delivery and disability inclusion

Exploration of interventions to promote disability inclusive health service delivery

This Collection supports and amplifies research related to SDG 3 (Good Health and Well Being) and SDG 4 (Quality Education).

All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.

Publishing Model: Open Access

Deadline: Apr 30, 2026

Challenges faced by older adults in accessing digital health services

BMC Health Services Research is calling for submissions to our Collection on Challenges faced by older adults in accessing digital health services.

As digital health services continue to evolve, older adults face unique challenges that can hinder their access and engagement with e-health technologies. These challenges often stem from a combination of technological, cognitive, and socio-economic factors, including limited familiarity with digital platforms, age-related physical limitations, and varying levels of technological literacy. Understanding these barriers is crucial to ensuring that digital health services are inclusive and accessible to all segments of the population, particularly older adults who may benefit significantly from these advancements.

Addressing the challenges faced by older adults in accessing digital health services is essential for promoting health equity and improving health outcomes. Advances in technology, such as telemedicine, remote monitoring, and health applications, have the potential to greatly enhance the quality of care and support for older individuals. However, without targeted research and interventions, many older adults remain at risk of being left behind in the digital transformation of healthcare. By focusing on their specific needs and experiences, we can develop solutions that facilitate their engagement with digital health resources.

Continued research in this area may lead to new technologies and service models tailored to the unique needs of older adults. By fostering collaboration between researchers, healthcare providers, and technology developers, we can create more user-friendly digital health solutions that not only enhance accessibility but also improve health literacy among older populations. This could ultimately empower older adults to take greater control of their health and well-being through digital means.

We invite submissions on a range of topics, including but not limited to:

Barriers to technology access for older adults

Enhancing e-health services for older people

The role of assistive technologies in digital healthcare

Strategies for improving digital health literacy

The impact of social isolation on access to digital health services

Evaluating user experience and satisfaction with digital health tools among older adults

Policy implications for digital health accessibility for older persons

Case studies of successful digital health interventions for older populations

Implementation of digital health technologies in residential settings

This Collection supports and amplifies research related to SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.

Publishing Model: Open Access

Deadline: Dec 19, 2025