Positive Deviance in Healthcare

Outlier - Rober S DonovanBlog post by Colin Hung

Over the past several weeks I’ve had the privilege of attending several healthcare events including Stanford’s Medicine X (#MedX) and Mayo Innovation’s Transform (#txfm). Both these conferences featured a unique blend of panel discussions and keynote speakers. It was incredibly inspirational and educational to be in the audience.

Privacy Panel at MedX 2015 - Photo by Bryan Vartabedian

Privacy Panel at MedX 2015 – Photo by Bryan Vartabedian

The speakers and panels covered a variety of topics from insurance reform to the maker movement and from patient entrepreneurship to the nature of privacy. The one on privacy was a panel discussion that the #hcldr helped to contribute to on our August 25th chat. The panel featured Pam Ressler, Colleen Young, Wendy Sue Swanson, Jodi Sperber and Susannah Fox. It was excellent.



As I was reflecting on all the sessions, my mind kept coming back to the concept of Positive Deviance (PD), a term that Wikipedia defines as:

An approach to behavioral and social change based on the observation that in any community, there are people whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers, despite facing similar challenges and having no extra resources or knowledge than their peers. These individuals are referred to as positive deviants.

Perhaps the most famous example of PD comes from the Sternins who lead an initiative to reduce malnutrition in war-torn Vietnam. David Dorsey of Fast Company wrote an excellent article back in 2000 highlighting this inspirational story.

In my mind, everyone I had heard at #MedX and #txfm was a positive deviant. They were succeeding despite all the economic, political and resource headwinds they faced. These people and organizations were making a measurable difference while their peers were treading water.

I’ve always been a big fan of positive deviance. I believe that by studying success in the “small corners” we can unlock the key to success on a grander scale. But does the concept of positive deviance work in healthcare? I think it does.

In 2010 a controlled trial was done to see whether PD could impact hand hygiene compliance. After the 9-month trial, the hospital unit that had deployed PD tactics showed a 2-fold increase in compliance (as measured by alcohol gel aliquots dispensed). TWO TIMES!

In 2014, BMJ published an article that outlined a framework for using positive deviance to improve patient safety. The simple 4 step process they suggested was as follows:

  1. Identify positive deviants or teams of positive deviants
  2. Study their behavior to generate hypotheses about practices that allow organizations to achieve top performance
  3. Test hypotheses statistically in larger, representative samples of organizations
  4. Work in partnership with key stakeholders to disseminate the evidence about newly characterized best practices

While touring the exhibits at Mayo’s Transform, I overheard a conversation between a data scientist and a behavioral health practitioner. They were talking about the potential of combining Big Data analytics with a PD approach to social change. I happened to hear the name of the article they were referencing and looked it up later: “Big Data with a Personal Touch: The Convergence of Predictive Analytics and Positive Deviance” in Huffington Post.

I found this article extremely fascinating and exciting. It talks about the potential of using an analytical approach to discovering why positive deviants are so successful.

The synergy between predictive analytics and positive deviance creates a new approach to healthcare delivery that is currently untapped. This approach could help open the door to explore how positive deviants traverse through the social determinants of health in order to sustain their well being.

This week on #hcldr I want to explore the concept of Positive Deviance  in healthcare – how we can do more of it, the challenges of scaling PD activities and what we can do as leaders to identify/foster PD behavior. Join us Tuesday October 6th at 8:30pm ET (for your local time click here) when we will discuss the following topics:

  • T1 What examples have you seen of Positive Deviance in healthcare?
  • T2 What challenges do you see in trying to scale what works on one team to the entire organization or from one region to the entire community?
  • T3 Which do you believe is better – studying errors & why they happen or successes & how we can replicate it?
  • T4 As healthcare leaders, what can we do to encourage/highlight positive deviant behavior?


“Positive Deviance and Unlikely Innovators”, Harvard Business Review, 2010, https://hbr.org/2010/06/positive-deviance-and-unlikely/, accessed October 3 2015

“Positive deviance: a different approach to achieving patient safety”, Lawton, Taylor, Clay-Williams and Braithwaite, BMJ Quality & Safety, July 21 2014, http://qualitysafety.bmj.com/content/early/2014/07/21/bmjqs-2014-003115.full, accessed October 3 2015

“The power of positive deviance”, Marsh, Schroeder, Dearden, Sternin and Sternin, British Medical Journal, Nov 13 2004, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC527707/, accessed October 3 2015

“Positive Deviant”, David Dorsey, Fast Company, November 30 2000, http://www.fastcompany.com/42075/positive-deviant, accessed October 3 2015

“Big Data with a Personal Touch: The Convergence of Predictive Analytics and Positive Deviance”, Jay Bhatt and Cole Zanetti, Huffington Post, April 28 2014, http://www.huffingtonpost.com/jay-bhatt/big-data-with-a-personal-_1_b_5209857.html, access October 3 2015

“Innovative Approaches to Prevention of Falls – Positive Deviance and Frontline Ownership”, Canadian Patient Safety Institute, November 2013, http://www.patientsafetyinstitute.ca/en/toolsResources/Presentations/2013/Documents/2013-11-14%20-%20Falls/National%20Call%20-%20Falls%20-%202013-11-14.pdf, accessed October 3 2015

“Preventing MRSA Through Positive Deviance”, Erin Richards, Science 2.0, March 25 2009, http://www.science20.com/erin039s_spin/preventing_mrsa_through_positive_deviance, accessed October 3 2015

“Positive deviance: a program for sustained improvement in hand hygiene compliance”, Marra et al, American Journal of Infection Control, February 2011, http://www.ncbi.nlm.nih.gov/pubmed/21281882, accessed October 3 2015

Image Credit

Outlier – Robert S Donovan https://flic.kr/p/dVzKGh


  1. […] the #HCLDR chat conversation on ‘Positive Deviance” that was held on October 6th, 2015,  (blog post by Colin Hung and transcript) an astute comment was made by Dr. Justin Smith (@TheDocSmitty) in […]

  2. […] community twitter chat conversation on ‘Positive Deviance” that was held on October 6th, 2015, (blog post by Colin Hung and transcript) an astute comment was made by Dr. Justin Smith (@TheDocSmitty) in […]

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