Perspectives in Perioperative Quality Improvement: Case Studies in Positive Deviance Using Real-World Data

Area of Science:

• Healthcare Quality Improvement
• Pediatric Health Systems
• Process Optimization

Background:

• Traditional quality and safety efforts often focus on identifying and fixing errors, highlighting the absence of quality.
• Positive Deviance (PD) offers an alternative approach by concentrating on disseminating successful practices rather than solely eliminating errors.
• This study explores the application of PD in pediatric healthcare settings to improve procedural quality outcomes.

Purpose of the Study:

• To describe and evaluate the effectiveness of Positive Deviance (PD) methods in improving procedural quality outcomes in pediatric healthcare systems.
• To demonstrate how focusing on successful practices can enhance efficiency and capacity.
• To highlight the role of data accessibility in facilitating the spread of best practices.

Main Methods:

• Utilized continuous quality improvement methods with multidisciplinary teams to assess and refine clinical processes.
• Employed AdaptX software for data extraction and analysis using statistical process control and funnel charts to identify Positive Deviance (PD) providers.
• Implemented Plan-Do-Study-Act (PDSA) cycles for testing and refining new processes, guided by real-time data monitoring.

Main Results:

• Achieved a sustained 35% increase in monthly procedure volumes through reduced surgical prep time.
• Increased monthly case counts by 74% in gastroenterology through anesthesia improvements and an additional procedural room.
• Reduced Post-Anesthesia Care Unit duration, staff overtime, and enhanced operational capacity by improving on-time performance, with no adverse impact on balance measures.

Conclusions:

• Positive Deviance (PD) methods effectively enhanced procedural timeliness and capacity in pediatric healthcare without compromising other quality indicators.
• Democratized, real-time data access simplified the identification and dissemination of best practices, leading to sustained improvements.
• The PD approach aligns with clinicians' goals, fostering engagement and improving patient care delivery.