Learning from the best: A positive deviance approach to Veterans Health Administration leadership practices

Health care organization leaders are charged with patient safety, evidence-based practice, financial sustainability, capacity, and staff supervision in systems that are challenged by bureaucracy, fragmentation, mistrust, and limited interdisciplinary engagement. It is not known how leaders effectively address specific challenges of staff supervision, policies/mandates, difficult conversations, and staff burnout. This study collected strategies from high-performing leaders in the Veterans Health Administration to understand how they approach these challenges. Applying a positive deviance approach to examine organizational survey data across the entire administration, we first statistically identified Veterans Health Administration sites that, based on employee feedback, showed the greatest organizational health improvements from 2022. These sites' chiefs of staff (N = 24) were then interviewed about how they approached four specific challenges. Findings indicate commonalities across these leaders' best practices, including creating opportunities for dialogue, building a culture of learning and psychological safety, proactively addressing process improvements, supporting work-life balance, leading with grace and courage, and maximizing and protecting resources. Public sector health care leaders may benefit from this approach to learning from these highest performers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).