Identifying positive deviants in healthcare quality and safety: a mixed methods study

Area of Science:

• Healthcare Quality Improvement
• Health Services Research
• Patient Safety

Background:

• Healthcare organizations possess solutions to quality and safety issues.
• Identifying 'positive deviants' is crucial for maximizing learning from successful practices.
• Routinely collected public data offers potential for identifying high-performing services.

Purpose of the Study:

• To explore the use of routinely collected, public data to identify positively deviant healthcare services in England.
• To develop and apply criteria for robust quality and safety indicators.
• To assess the feasibility of identifying exemplary services within a specific region.

Main Methods:

• A mixed-methods study using expert discussion, consensus, and statistical modeling.
• Analysis of 49 quality and safety indicators from eight administrative data sources in England.
• Selection of robust indicators suitable for sub-hospital level comparisons.

Main Results:

• Twelve of 23 usable quality and safety indicators met the established criteria.
• Four indicators related to hip and knee surgery (readmission rates, patient-reported outcomes) were selected for further analysis.
• Statistical modeling identified one service in Yorkshire and Humber exhibiting a 50% positive deviation from the national average.

Conclusions:

• Few quality and safety indicators provide meaningful service-level comparisons for local improvement.
• Robust measurement of quality and safety for specific services, such as hip and knee surgery, is achievable.
• Identifying positive deviants is possible, though challenges remain in indicator selection and data availability.