This stimulating article challenges our thinking on patient safety; why errors occur, and who or what is at the root of the problem. ‘Find and fix’ approaches in complex health and care settings tell us little about patient safety, and exclusively focuses on the absence of problems.

Lawton et al. encourage a more optimistic and different approach to achieving patient safety, through positive deviants. Positive deviant approaches rely on the ability to identify role models who use uncommon, but demonstrably successful, strategies to tackle common problems.

The challenge for change activists is these approaches have not gained widespread acceptance for managing poor performance. Patient safety initiatives still tend to focus mainly on negative cases or the culprits responsible for adverse events.

Reading this article took me right back to being an operational director, I had to sign off every root cause analysis (RCA) report for a serious incident. Even though each incident had a slight variance or the context was different, I saw the same pattern of mistakes, which usually had a human factor. Our approach was invariably to apply single risk strategies to each specific problem in the process to reduce the things that went wrong, which often missed the point.

I think no matter how seemingly intractable a problem there is a more hopeful outcome when we allow staff to discover and adopt their own solutions. Find out more about the steps in the positive deviant approach; identify, study and test, in this article.

I often asked myself when I was signing off those reports; what would happen if we spent equal time doing a route cause analysis every time we had something significant go right, what would we learn?

In every health and care context there are change activists whose uncommon practices enable them to find better solutions to problems than those who have access to the same resources, so why is that?

For your reflection:

The focus on error detection and its management has not produced the expected gains in patient safety, so what can we learn from this?

How can we allow staff to discover and adopt their own solutions?

How can we identify and embrace the positive deviants?

How can you share your positive practice with others and learn from elsewhere?

What behaviours, processes and principles do we need to adopt to focus on successful practices to become more effective at dealing with patient safety?

Jackie Lynton


This contextual piece was written by Jackie Lynton, Head of Transformation, Horizons Group, NHS Improving Quality @JackieLynton